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Shanmuganathan M, Nikolaidou C, Burrage MK, Borlotti A, Kotronias R, Scarsini R, Banerjee A, Terentes-Printzios D, Pitcher A, Gara E, Langrish J, Lucking A, Choudhury R, De Maria GL, Banning A, Piechnik SK, Channon KM, Ferreira VM. Cardiovascular Magnetic Resonance Before Invasive Coronary Angiography in Suspected Non-ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging 2024:S1936-878X(24)00196-7. [PMID: 38970595 DOI: 10.1016/j.jcmg.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND In suspected non-ST-segment elevation myocardial infarction (NSTEMI), this presumed diagnosis may not hold true in all cases, particularly in patients with nonobstructive coronary arteries (NOCA). Additionally, in multivessel coronary artery disease, the presumed infarct-related artery may be incorrect. OBJECTIVES This study sought to assess the diagnostic utility of cardiac magnetic resonance (CMR) before invasive coronary angiogram (ICA) in suspected NSTEMI. METHODS A total of 100 consecutive stable patients with suspected acute NSTEMI (70% male, age 62 ± 11 years) prospectively underwent CMR pre-ICA to assess cardiac function (cine), edema (T2-weighted imaging, T1 mapping), and necrosis/scar (late gadolinium enhancement). CMR images were interpreted blinded to ICA findings. The clinical care and ICA teams were blinded to CMR findings until post-ICA. RESULTS Early CMR (median 33 hours postadmission and 4 hours pre-ICA) confirmed only 52% (52 of 100) of patients had subendocardial infarction, 15% transmural infarction, 18% nonischemic pathologies (myocarditis, Takotsubo and other forms of cardiomyopathies), and 11% normal CMR; 4% were nondiagnostic. Subanalyses according to ICA findings showed that, in patients with obstructive coronary artery disease (73 of 100), CMR confirmed only 84% (61 of 73) had MI, 10% (7 of 73) nonischemic pathologies, and 5% (4 of 73) normal. In patients with NOCA (27 of 100), CMR found MI in only 22% (6 of 27 true MI with NOCA), and reclassified the presumed diagnosis of NSTEMI in 67% (18 of 27: 11 nonischemic pathologies, 7 normal). In patients with CMR-MI and obstructive coronary artery disease (61 of 100), CMR identified a different infarct-related artery in 11% (7 of 61). CONCLUSIONS In patients presenting with suspected NSTEMI, a CMR-first strategy identified MI in 67%, nonischemic pathologies in 18%, and normal findings in 11%. Accordingly, CMR has the potential to affect at least 50% of all patients by reclassifying their diagnosis or altering their potential management.
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Affiliation(s)
- Mayooran Shanmuganathan
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Matthew K Burrage
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rafail Kotronias
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Roberto Scarsini
- Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Abhirup Banerjee
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Dimitrios Terentes-Printzios
- Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alex Pitcher
- Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Edit Gara
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Jeremy Langrish
- Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Andrew Lucking
- Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Robin Choudhury
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adrian Banning
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Keith M Channon
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
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2
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Wang YRJ, Yang K, Wen Y, Wang P, Hu Y, Lai Y, Wang Y, Zhao K, Tang S, Zhang A, Zhan H, Lu M, Chen X, Yang S, Dong Z, Wang Y, Liu H, Zhao L, Huang L, Li Y, Wu L, Chen Z, Luo Y, Liu D, Zhao P, Lin K, Wu JC, Zhao S. Screening and diagnosis of cardiovascular disease using artificial intelligence-enabled cardiac magnetic resonance imaging. Nat Med 2024; 30:1471-1480. [PMID: 38740996 PMCID: PMC11108784 DOI: 10.1038/s41591-024-02971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Cardiac magnetic resonance imaging (CMR) is the gold standard for cardiac function assessment and plays a crucial role in diagnosing cardiovascular disease (CVD). However, its widespread application has been limited by the heavy resource burden of CMR interpretation. Here, to address this challenge, we developed and validated computerized CMR interpretation for screening and diagnosis of 11 types of CVD in 9,719 patients. We propose a two-stage paradigm consisting of noninvasive cine-based CVD screening followed by cine and late gadolinium enhancement-based diagnosis. The screening and diagnostic models achieved high performance (area under the curve of 0.988 ± 0.3% and 0.991 ± 0.0%, respectively) in both internal and external datasets. Furthermore, the diagnostic model outperformed cardiologists in diagnosing pulmonary arterial hypertension, demonstrating the ability of artificial intelligence-enabled CMR to detect previously unidentified CMR features. This proof-of-concept study holds the potential to substantially advance the efficiency and scalability of CMR interpretation, thereby improving CVD screening and diagnosis.
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Affiliation(s)
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wen
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengcheng Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Yuepeng Hu
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Yongfan Lai
- School of Engineering, University of Science and Technology of China, Hefei, China
| | - Yufeng Wang
- Department of Computer Science, Stony Brook University, New York, NY, USA
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Siyi Tang
- School of Medicine, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Angela Zhang
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Huayi Zhan
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Hui Liu
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Lei Zhao
- Beijing Anzhen Hospital, Beijing, China
| | | | - Yunling Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Zixian Chen
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yi Luo
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dongbo Liu
- Changhong AI Research (CHAIR), Sichuan Changhong Electronics Holding Group, Mianyang, China
| | - Pengbo Zhao
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - Keldon Lin
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | - Joseph C Wu
- School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, School of Medicine (Division of Cardiology), Stanford University, Stanford, CA, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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3
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Folco G, Monti CB, Zanardo M, Silletta F, Capra D, Secchi F, Sardanelli F. MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis. Eur Radiol 2024; 34:2699-2710. [PMID: 37823922 PMCID: PMC10957707 DOI: 10.1007/s00330-023-10260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI-derived ECV as an early cardiotoxicity biomarker to guide timely intervention. MATERIALS AND METHODS In April 2022, we performed a systematic search on EMBASE and PubMed for articles on MRI-derived ECV as a biomarker of cancer therapy cardiotoxicity. Two blinded researchers screened the retrieved articles, including those reporting ECV values at least 3 months from cardiotoxic treatment. Data extraction was performed for each article, including clinical and technical data, and ECV values. Pooled ECV was calculated using the random effects model and compared among different treatment regimens and among those who did or did not experience overt cardiac dysfunction. Meta-regression analyses were conducted to appraise which clinical or technical variables yielded a significant impact on ECV. RESULTS Overall, 19 studies were included. Study populations ranged from 9 to 236 patients, for a total of 1123 individuals, with an average age ranging from 12.5 to 74 years. Most studies included patients with breast or esophageal cancer, treated with anthracyclines and chest radiotherapy. Pooled ECV was 28.44% (95% confidence interval, CI, 26.85-30.03%) among subjects who had undergone cardiotoxic cancer therapy, versus 25.23% (95%CI 23.31-27.14%) among those who had not (p = .003). CONCLUSION A higher ECV in patients who underwent cardiotoxic treatment could imply subclinical changes in the myocardium, present even before overt cardiac pathology is detectable. CLINICAL RELEVANCE STATEMENT The ability to detect subclinical changes in the myocardium displayed by ECV suggests its use as an early biomarker of cancer therapy-related cardiotoxicity. KEY POINTS • Cardiotoxicity is a common adverse effect of cancer therapy; therefore, its prompt detection could improve patient outcomes. • Pooled MRI-derived myocardial extracellular volume was higher in patients who underwent cardiotoxic cancer therapy than in those who did not (28.44% versus 25.23%, p = .003). • MRI-derived myocardial extracellular volume represents a potential early biomarker of cancer therapy cardiotoxicity.
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Affiliation(s)
- Gianluca Folco
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Caterina B Monti
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Silletta
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Davide Capra
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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4
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Quennelle S, Bonnet D. Pediatric heart failure with preserved ejection fraction, a review. Front Pediatr 2023; 11:1137853. [PMID: 37601131 PMCID: PMC10433757 DOI: 10.3389/fped.2023.1137853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Diastolic dysfunction refers to a structural or functional abnormality of the left ventricle, resulting in impaired filling of the heart. Severe diastolic dysfunction can lead to congestive heart failure even when the left ventricle systolic function is normal. Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of the hospitalizations for acute heart failure in the adult population but the clinical recognition and understanding of HFpEF in children is poor. The condition is certainly much less frequent than in the adult population but the confirmatory diagnosis of diastolic dysfunction in children is also challenging. The underlying causes of HFpEF in children are diverse and differ from the main cause in adults. This review addresses the underlying causes and prognostic factors of HFpEF in children. We describe the pulmonary hypertension profiles associated with this cardiac condition. We discuss diagnosis difficulties in clinical practice, and we provide a simplified diagnostic algorithm for HFpEF in children.
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Affiliation(s)
- Sophie Quennelle
- Pediatric Cardiology Department, Necker-Enfants Malades Hospital, Paris, France
- Equipe Projet HeKA, Paris, France
- Université Paris Cité, Paris, France
| | - Damien Bonnet
- Pediatric Cardiology Department, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
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5
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Laymouna R, El-Sharkawy E, El-Taha S, Elfiky M. Prognostic value of myocardial scar in ischaemic and non-ischaemic cardiomyopathy using cardiac magnetic resonance imaging. Cardiovasc J Afr 2023; 34:132-139. [PMID: 36162438 PMCID: PMC10658723 DOI: 10.5830/cvja-2022-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/02/2022] [Indexed: 06/16/2023] Open
Abstract
AIM The aim of this research was to evaluate the prognostic value of myocardial scar using cardiac magnetic resonance (CMR) imaging in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM). METHODS One hundred and fifty-four patients with either ICM or NICM underwent CMR with late gadolinium enhancement sequences for assessment of left ventricular ejection fraction (LVEF), and detection and quantification of any myocardial scar using three methods: manual, number of segments involved, and percentage of scarred myocardium. Patients were followed up for at least six months for clinical cardiac events. RESULTS Patients were divided into two groups: group I, patients with ICM (58%) and group II, those with NICM (42%). Clinical presentation ranged from eventless lpar;10%) to chest pain (18%), heart failure (15%), hospitalisation (35%), syncope (1%), ventricular tachycardia (< 1%) and cardiac arrest (< 1%). The scar mass was larger in size in group I (17 ± 15%) than in group II (8 ± 13%). A direct relationship was observed between scar size and event severity (p < 0.001). An inverse relationship between LVEF and event severity was found in group I (p < 0.001) but not in group II (p = 0.128). CONCLUSIONS Myocardial scar size was a strong predictor of clinical outcome in both the ICM and NICM patients. LVEF was less reliable in predicting morbidity in cardiomyopathy patients.
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Affiliation(s)
- Reem Laymouna
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt.
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Eman El-Sharkawy
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Salah El-Taha
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Mohamed Elfiky
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
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6
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Beroukhim RS, Merlocco A, Gerardin JF, Tham E, Patel JK, Siddiqui S, Goot B, Farooqi K, Soslow J, Grotenhuis H, Hor K, Muthurangu V, Raimondi F. Multicenter research priorities in pediatric CMR: results of a collaborative wiki survey. Sci Rep 2023; 13:9022. [PMID: 37270629 DOI: 10.1038/s41598-023-34720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/06/2023] [Indexed: 06/05/2023] Open
Abstract
Multicenter studies in pediatric cardiovascular magnetic resonance (CMR) improve statistical power and generalizability. However, a structured process for identifying important research topics has not been developed. We aimed to (1) develop a list of high priority knowledge gaps, and (2) pilot the use of a wiki survey to collect a large group of responses. Knowledge gaps were defined as areas that have been either unexplored or under-explored in the research literature. High priority goals were: (1) feasible and answerable from a multicenter research study, and (2) had potential for high impact on the field of pediatric CMR. Seed ideas were contributed by a working group and imported into a pairwise wiki survey format which allows for new ideas to be uploaded and voted upon ( https://allourideas.org ). Knowledge gaps were classified into 2 categories: 'Clinical CMR Practice' (16 ideas) and 'Disease Specific Research' (22 ideas). Over a 2-month period, 3,658 votes were cast by 96 users, and 2 new ideas were introduced. The 3 highest scoring sub-topics were myocardial disorders (9 ideas), translating new technology & techniques into clinical practice (7 ideas), and normal reference values (5 ideas). The highest priority gaps reflected strengths of CMR (e.g., myocardial tissue characterization; implementation of technologic advances into clinical practice), and deficiencies in pediatrics (e.g., data on normal reference values). The wiki survey format was effective and easy to implement, and could be used for future surveys.
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Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Anthony Merlocco
- Department of Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Jennifer F Gerardin
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Edythe Tham
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jyoti K Patel
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Saira Siddiqui
- Division of Pediatric Cardiology, Atlantic Health System, Morristown, NJ, USA
| | - Benjamin Goot
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Kanwal Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Heynric Grotenhuis
- Department of Pediatric Cardiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Kan Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Vivek Muthurangu
- Department of Cardiology, UCL Center for Translational Cardiovascular Imaging, University College London, London, UK
| | - Francesca Raimondi
- Department of Cardiology, Meyer Children's Hospital, University of Florence, Florence, Italy
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7
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Guglielmo M, Pontone G. Clinical implications of cardiac magnetic resonance imaging fibrosis. Eur Heart J Suppl 2022; 24:I123-I126. [PMID: 36380812 PMCID: PMC9653130 DOI: 10.1093/eurheartjsupp/suac085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Cardiac magnetic resonance (CMR) is a non-invasive imaging method that allows to characterize myocardial tissue. In particular, using the late gadolinium enhancement technique, it is possible to identify areas of focal fibrosis. Specific distribution patterns of this fibrosis allow us to distinguish ischaemic cardiomyopathy (iCMP) from non-ischaemic cardiomyopathy (nCMP) and sometimes to identify the aetiology of the latter. Diffuse fibrosis can also be identified using the parametric T1 mapping sequences. For this purpose, the native T1 of the tissue is measured before the administration of the contrast agent (c.a.) or the extracellular volume is calculated after c.a. Both focal and diffuse fibrosis evaluated with CMR appear to be strong prognostic predictors for the identification of threatening ventricular arrhythmias and sudden cardiac death. These evidence open the doors to a possible role of CMR in the selection of the patient to be sent to a defibrillator implant in primary prevention. In this review, we will briefly review the techniques used in CMR for the evaluation of fibrosis. We will then focus on the clinical role of myocardial tissue fibrosis detection in iCMP and nCMP.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, The Netherlands
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8
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Polacin M, Karolyi M, Eberhard M, Matziris I, Alkadhi H, Kozerke S, Manka R. Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences. BMC Cardiovasc Disord 2022; 22:226. [PMID: 35585495 PMCID: PMC9118592 DOI: 10.1186/s12872-022-02664-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams. Methods 57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. Results Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01). Conclusion Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available.
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Affiliation(s)
- Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
| | - Mihaly Karolyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ioannis Matziris
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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9
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Polacin M, Karolyi M, Blüthgen C, Pilz N, Eberhard M, Alkadhi H, Kozerke S, Manka R. Simplified image acquisition and detection of ischemic and non-ischemic myocardial fibrosis with fixed short inversion time magnetic resonance late gadolinium enhancement. Br J Radiol 2022; 95:20210966. [PMID: 35195448 PMCID: PMC10993981 DOI: 10.1259/bjr.20210966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Late gadolinium enhancement with fixed short inversion time (LGEshort) provides excellent tissue contrast with dark scar and bright blood pool and does not need prior myocardial nulling. We hypothesize better visibility of ischemic scars and equal visibility of non-ischemic LGE in LGEshort compared to clinically established LGE (LGEstandard). METHODS LGEshort and LGEstandard were retrospectively evaluated in 179 patients (3043 segments) with suspected or known coronary artery disease by four blinded readers (reader A: most experienced - D: least experienced). The amount of ischemic and non-ischemic LGE as well as visibility (4: very good - 1: poor) of ischemic LGE was visually assessed. RESULTS All readers detected more infarcted segments in LGEshort compared to LGEstandard (378 segments reported as infarcted; A:p = 0.5, B:p = 0.8, C,D:p = 0.03). Scar visibility was scored higher in LGEshort by all readers (A,B:p = 0.03; C,D:p = 0.02), especially for subendocardial infarcts (A,B:p = 0.04, C,D:p = 0.02). Less experienced readers detected significantly more infarcted papillary muscles (C:p = 0.02, D:p = 0.03) in a shorter reading time in LGEshort (C:p = 0.04, D:p = 0.02). Non-ischemic LGE was equally visible in both sequences (A:p = 0.9, B:p = 0.8, C,D:p = 0.6). CONCLUSIONS LGEshort detects more ischemic LGE with improved scar visibility compared to LGEstandard, independent of experience level. The visibility of non-ischemic LGE is equivalent to LGEstandard. Less experienced readers can diagnose ischemic and non-ischemic LGE faster in LGEshort. ADVANCES IN KNOWLEDGE LGEshort with its maximal operational simplicity can be used for visualization of all types of fibrosis - ischemic and non-ischemic - instead of LGEstandard, independent of experience level.
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Affiliation(s)
- Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH
Zurich, Zurich,
Switzerland
| | - Mihaly Karolyi
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Christian Blüthgen
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Nik Pilz
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH
Zurich, Zurich,
Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich,
Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH
Zurich, Zurich,
Switzerland
- Department of Cardiology, University Heart Center, University
Hospital Zurich, University of Zurich,
Zurich, Switzerland
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10
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Myocardial tissue imaging with cardiovascular magnetic resonance. J Cardiol 2022; 80:377-385. [PMID: 35246367 DOI: 10.1016/j.jjcc.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 12/29/2022]
Abstract
Alteration in myocardial tissue, such as myocardial fibrosis, edema, inflammation, or accumulation with amyloid, lipids, or iron, has an important role in the cardiac remodeling that leads to diastolic and/or systolic dysfunction and the development of chronic heart failure, increasing the risk of adverse cardiovascular events. Thus, the early detection of changes at myocardial tissue level has great diagnostic and prognostic potential. The gold standard technique to assess these myocardial alterations is endomyocardial biopsy. However, this has been limited to a few patients due to the invasive nature, sampling errors, and its inability to assess the entire myocardium. Cardiovascular magnetic resonance (CMR) has emerged as the gold standard imaging not only for assessing cardiac volume, function quantification, and viability but also for noninvasive myocardial tissue characterization over the past decade. Its ability to characterize myocardial tissue composition is unique among noninvasive imaging modalities in cardiovascular disease. Currently, multi-parametric myocardial characterization with T1, T2, and extracellular volume has the potential to identify and track diffuse pathology in various diseases. In this review article, we present the role of established and emerging CMR techniques in myocardial tissue characterization, with an emphasis on T1 and T2 mapping, in clinical practice.
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11
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Mingalimova AR, Drapkina OM, Sagirov MA, Mazanov MK, Bikbova MM, Argir IA. Inflammatory continuum in the pathogenesis of atrial fibrillation after coronary bypass surgery. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Atrial fibrillation (AF) after coronary bypass surgery is recorded in 20- 60% of patients and increase the early and long-term postoperative mortality. The aim of the review is to analyze the studies on causal relationships between damaging factors and the development of myocardial inflammation at each stage of surgical treatment in patients with multivessel coronary artery disease. In the review, myocardial inflammation is considered from the point of view of a continuum — a chronic process that originates from the coronary endothelium damage and continuously proceeds within the AF pathogenesis after coronary bypass surgery. For the first time, the concept of inflammatory continuum for postoperative AF is introduced. The review discusses the main and latest laboratory and instrumental markers of local and systemic inflammatory response, which are informative in terms of severity and promising for improving approaches to the diagnosis and prevention of postoperative AF. The review was prepared using available materials from Russian and foreign library databases (PubMed, Medline, Web of Science and Cochrane Library). The search depth was >25 years since 1996. Based on the analysis of available studies, we concluded that inflammation is not just evidence of AF, but plays a causal role in its pathogenesis at each stage of surgical myocardial revascularization.
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Affiliation(s)
- A. R. Mingalimova
- National Medical Research Center for Therapy and Preventive Medicine;
Sklifosovsky Research Institute of Emergency Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. A. Sagirov
- Sklifosovsky Research Institute of Emergency Medicine
| | | | - M. M. Bikbova
- Sklifosovsky Research Institute of Emergency Medicine
| | - I. A. Argir
- Sklifosovsky Research Institute of Emergency Medicine
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12
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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13
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Cui X, Peng Y, Liu J, Dong Y, Wu Z, Chen Y. Case Report: Area of Focus of Myocardial Infarction With Non-obstructive Coronary Arteries in Eosinophilic Granulomatosis With Polyangiitis. Front Cardiovasc Med 2021; 8:731897. [PMID: 34869632 PMCID: PMC8633440 DOI: 10.3389/fcvm.2021.731897] [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: 07/16/2021] [Accepted: 10/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Eosinophilic granulomatosis with polyangitis manifested as myocardial infarction with non-obstructed coronary arteries (MINOCA) is rarely reported. Case: We report a 43-year-old male patient without any cardiovascular risk factors presenting with acute chest pain. Electrocardiogram was suggestive of acute anterior and inferior myocardial infarction. MINOCA was confirmed based on significant elevated cardiac troponin and normal coronary arteries. Cardiac magnetic resonance (CMR) imaging revealed extended late gadolinium enhancement (LGE). Further diagnosis of eosinophilic granulomatosis with polyangitis (EGPA) was based on clinical manifestations and auxiliary examination. Subsequent immunosuppressive therapy led to regression of symptoms and significant resolution of LGE on CMR. Conclusion: Our case highlights that EGPA can be a rare cause of MINOCA. CMR is useful for differentiation diagnosis and evaluation of cardiac involvement.
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Affiliation(s)
- Xiaoxian Cui
- Respiratory Department, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yang Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zexuan Wu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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14
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Zorzi A, Mattesi G, Baldi E, Toniolo M, Guerra F, Cauti FM, Cipriani A, De Lazzari M, Muser D, Stronati G, Marcantoni L, Manfrin M, Calò L, Lanzillo C, Perazzolo Marra M, Savastano S, Corrado D. Prognostic Role of Myocardial Edema as Evidenced by Early Cardiac Magnetic Resonance in Survivors of Out-of-Hospital Cardiac Arrest: A Multicenter Study. J Am Heart Assoc 2021; 10:e021861. [PMID: 34779249 PMCID: PMC8751964 DOI: 10.1161/jaha.121.021861] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sudden cardiac arrest (SCA) may be caused by an acute and reversible myocardial injury, a chronic and irreversible myocardial damage, or a primary ventricular arrhythmia. Cardiac magnetic resonance imaging may identify myocardial edema (ME), which denotes acute and reversible myocardial damage. We evaluated the arrhythmic outcome of SCA survivors during follow-up and tested the prognostic role of ME. Methods and Results We included a consecutive series of 101 (71% men, median age 47 years) SCA survivors from 9 collaborative centers who underwent early (<1 month) cardiac magnetic resonance imaging and received an implantable cardioverter-defibrillator (ICD). On T2-weighted sequences, ME was found in 18 of 101 (18%) patients. According to cardiac magnetic resonance imaging findings, the arrhythmic SCA was ascribed to acute myocardial injury (either ischemic [n=10] or inflammatory [n=8]), to chronic structural heart diseases (ischemic heart disease [n=11], cardiomyopathy [n=20], or other [n=23]), or to primarily arrhythmic syndrome (n=29). During a follow-up of 47 months (28 to 67 months), 24 of 101 (24%) patients received an appropriate ICD intervention. ME was associated with a significantly higher survival free from both any ICD interventions (log-rank=0.04) and ICD shocks (log-rank=0.03) and remained an independent predictor of better arrhythmic outcome after adjustment for left ventricular ejection fraction and late gadolinium enhancement. The risk of appropriate ICD intervention was unrelated to the type of underlying heart disease. Conclusions ME on early cardiac magnetic resonance imaging, which denotes an acute and transient arrhythmogenic substrate, predicted a favorable long-term arrhythmic outcome of SCA survivors. These findings may have a substantial impact on future guidelines on the management of SCA survivors.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy
| | - Giulia Mattesi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy
| | - Enrico Baldi
- Section of Cardiology Department of Molecular Medicine University of Pavia Italy.,Cardiac Intensive Care Unit Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Mauro Toniolo
- Cardiothoracic Department University Hospital of Udine Udine Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic Marche Polytechnic UniversityUniversity Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi" Ancona Italy
| | - Filippo Maria Cauti
- Arrhythmology Unit Cardiology Division S. Giovanni Calibita Hospital Isola Tiberina, Rome Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy
| | - Daniele Muser
- Cardiothoracic Department University Hospital of Udine Udine Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic Marche Polytechnic UniversityUniversity Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi" Ancona Italy
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit Cardiology Department Santa Maria Della Misericordia Hospital Rovigo Italy
| | - Massimiliano Manfrin
- Electrophysiology and Cardiac Pacing Unit San Maurizio Regional Hospital Bolzano Italy
| | - Leonardo Calò
- Cardiology Department Policlinico Casilino Rome Italy
| | | | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy
| | - Simone Savastano
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Italy
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15
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Li X, Li L, Lei W, Chua HZ, Li Z, Huang X, Wang Q, Li N, Zhang H. Traditional Chinese medicine as a therapeutic option for cardiac fibrosis: Pharmacology and mechanisms. Biomed Pharmacother 2021; 142:111979. [PMID: 34358754 DOI: 10.1016/j.biopha.2021.111979] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are one of the leading causes of death worldwide and cardiac fibrosis is a common pathological process for cardiac remodeling in cardiovascular diseases. Cardiac fibrosis not only accelerates the deterioration progress of diseases but also becomes a pivotal contributor for futile treatment in clinical cardiovascular trials. Although cardiac fibrosis is common and prevalent, effective medicines to provide sufficient clinical intervention for cardiac fibrosis are still unavailable. Traditional Chinese medicine (TCM) is the natural essence experienced boiling, fry, and other processing methods, including active ingredients, extracts, and herbal formulas, which have been applied to treat human diseases for a long history. Recently, research has increasingly focused on the great potential of TCM for the prevention and treatment of cardiac fibrosis. Here, we aim to clarify the identified pro-fibrotic mechanisms and intensively summarize the application of TCM in improving cardiac fibrosis by working on these mechanisms. Through comprehensively analyzing, TCM mainly regulates the following pathways during ameliorating cardiac fibrosis: attenuation of inflammation and oxidative stress, inhibition of cardiac fibroblasts activation, reduction of extracellular matrix accumulation, modulation of the renin-angiotensin-aldosterone system, modulation of autophagy, regulation of metabolic-dependent mechanisms, and targeting microRNAs. We also discussed the deficiencies and the development direction of anti-fibrotic therapies on cardiac fibrosis. The data reviewed here demonstrates that TCM shows a robust effect on alleviating cardiac fibrosis, which provides us a rich source of new drugs or drug candidates. Besides, we also hope this review may give some enlightenment for treating cardiac fibrosis in clinical practice.
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Affiliation(s)
- Xiao Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Lin Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Wei Lei
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Hui Zi Chua
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Zining Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Xianglong Huang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China.
| | - Qilong Wang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Nan Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
| | - Han Zhang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Innovation Team of Research on Compound Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China; Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
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16
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Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets. Int J Mol Sci 2021; 22:ijms22147650. [PMID: 34299270 PMCID: PMC8304780 DOI: 10.3390/ijms22147650] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome responsible for high mortality and morbidity rates. It has an ever growing social and economic impact and a deeper knowledge of molecular and pathophysiological basis is essential for the ideal management of HFpEF patients. The association between HFpEF and traditional cardiovascular risk factors is known. However, myocardial alterations, as well as pathophysiological mechanisms involved are not completely defined. Under the definition of HFpEF there is a wide spectrum of different myocardial structural alterations. Myocardial hypertrophy and fibrosis, coronary microvascular dysfunction, oxidative stress and inflammation are only some of the main pathological detectable processes. Furthermore, there is a lack of effective pharmacological targets to improve HFpEF patients' outcomes and risk factors control is the primary and unique approach to treat those patients. Myocardial tissue characterization, through invasive and non-invasive techniques, such as endomyocardial biopsy and cardiac magnetic resonance respectively, may represent the starting point to understand the genetic, molecular and pathophysiological mechanisms underlying this complex syndrome. The correlation between histopathological findings and imaging aspects may be the future challenge for the earlier and large-scale HFpEF diagnosis, in order to plan a specific and effective treatment able to modify the disease's natural course.
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17
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Polacin M, Karolyi M, Eberhard M, Gotschy A, Baessler B, Alkadhi H, Kozerke S, Manka R. Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images. Sci Rep 2021; 11:12376. [PMID: 34117271 PMCID: PMC8195981 DOI: 10.1038/s41598-021-90283-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/26/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate whether segmental strain is noticeably affected in chronic infarcts and thus can be potentially used for infarct detection based on routinely acquired non-contrast cine images in patients with known coronary artery disease (CAD). Forty-six patients with known CAD and chronic scars in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age-matched controls with normal cardiac MRI (2 female, mean age 47 ± 13 years) were retrospectively enrolled. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual wall motion assessment of short axis cine images as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient and control were presented in random order to two independent blinded readers, which should localize potentially infarcted segments in those datasets blinded to LGE images and patient information. Global strain values were impaired in patients compared to controls (GPCS p = 0.02; GPLS p = 0.04; GPRS p = 0.01). Patients with preserved ejection fraction showed also impeded GPCS compared to healthy individuals (p = 0.04). In patients, mean SPCS was significantly impaired in subendocardially (- 5.4% ± 2) and in transmurally infarcted segments (- 1.2% ± 3) compared to remote myocardium (- 12.9% ± 3, p = 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut-off value for SPCS for discriminating infarcted from remote myocardium of - 7.2% with a sensitivity of 89.4% and specificity of 85.7%. Mean SPRS was impeded in transmurally infarcted segments (15.9% ± 6) compared to SPRS of remote myocardium (31.4% ± 5; p = 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16.6% with a sensitivity of 83.3% and specificity of 76.5%. 80.3% of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Global strain parameters are impaired in patients with chronic infarcts compared to controls. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected due to wall motion abnormalities in visual wall motion assessment. Analysis of segmental circumferential strain shows a promising method for detection of chronic scars in routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.
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Affiliation(s)
- M Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - M Karolyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - A Gotschy
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - B Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
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Osokina A, Karetnikova V, Polikutina O, Ivanova A, Gruzdeva O, Dyleva Y, Kokov A, Brel N, Pecherina T, Barbarash O. Prognostic potential of cardiac structural and functional parameters and N-terminal propeptide of type III procollagen in predicting cardiac fibrosis one year after myocardial infarction with preserved left ventricular ejection fraction. Aging (Albany NY) 2021; 13:194-203. [PMID: 33431713 PMCID: PMC7835023 DOI: 10.18632/aging.202495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
The aim of the study were to evaluate the prognostic potential of serum level of N-terminal propeptide procollagen type III (PIIINP) and heart parameters for predicting heart cardiac fibrosis 1 year after ST-segment elevation myocardial infarction (STEMI) with preserved left ventricular ejection fraction (LVEF). 68 patients with STEMI and preserved LVEF with acute heart failure of the I-III degree according to the Killip classification were examined. Echocardiography was performed and PIIINP levels were measured on days 1 and 12, as well as 1 year after STEMI. A year after STEMI, was performed contrast magnetic resonance imaging and patients were assigned into four groups depending on the severity of cardiac fibrosis: cardiac fibrosis 0% (n=49, 57% of 86 patients); ≤5% (n=18, 20.9%); 6-15% (n=10, 11.6%); ≥16% (n=9, 10.5%). Direct correlations between the severity of cardiac fibrosis, PIIINP level and indicators of diastolic function were established. The risk of cardiac fibrosis increases at the level of PIIINP ≥381.4 ng / ml on the 12th day after STEMI with preserved LVEF (p=0.048). Thus, measuring the level of PIIINP in the inpatient period can allow timely identification of patients with a high risk of cardiac fibrosis 1 year after STEMI with preserved LVEF.
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Affiliation(s)
- Anastasia Osokina
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Viktoria Karetnikova
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Olga Polikutina
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Anna Ivanova
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Olga Gruzdeva
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Yulia Dyleva
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Aleksandr Kokov
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Natalia Brel
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Tamara Pecherina
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
| | - Olga Barbarash
- Federal State Budgetary Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russian Federation
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19
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Nasser SB, Doeblin P, Doltra A, Schnackenburg B, Wassilew K, Berger A, Gebker R, Bigvava T, Hennig F, Pieske B, Kelle S. Cardiac Myxomas Show Elevated Native T1, T2 Relaxation Time and ECV on Parametric CMR. Front Cardiovasc Med 2020; 7:602137. [PMID: 33330663 PMCID: PMC7710854 DOI: 10.3389/fcvm.2020.602137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: While cardiac tumors are rare, their identification and differentiation has wide clinical implications. Recent cardiac magnetic resonance (CMR) parametric mapping techniques allow for quantitative tissue characterization. Our aim was to examine the range of values encountered in cardiac myxomas in correlation to histological measurements. Methods and Results: Nine patients with histologically proven cardiac myxomas were included. CMR (1.5 Tesla, Philips) including parametric mapping was performed in all patients pre-operatively. All data are reported as mean ± standard deviation. Compared to myocardium, cardiac myxomas demonstrated higher native T1 relaxation times (1,554 ± 192 ms vs. 1,017 ± 58 ms, p < 0.001), ECV (46.9 ± 13.0% vs. 27.1 ± 2.6%, p = 0.001), and T2 relaxation times (209 ± 120 ms vs. 52 ± 3 ms, p = 0.008). Areas with LGE showed higher ECV than areas without (54.3 ± 17.8% vs. 32.7 ± 18.6%, p = 0.042), with differences in native T1 relaxation times (1,644 ± 217 ms vs. 1,482 ± 351 ms, p = 0.291) and T2 relaxation times (356 ± 236 ms vs. 129 ± 68 ms, p = 0.155) not reaching statistical significance. Conclusions: Parametric CMR showed elevated native T1 and T2 relaxation times and ECV values in cardiac myxomas compared to normal myocardium, reflecting an increased interstitial space and fluid content. This might help in the differentiation of cardiac myxomas from other tumor entities.
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Affiliation(s)
- Sarah B Nasser
- Department of Cardiology, Dar Al Fouad Hospital, Cairo, Egypt
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Adelina Doltra
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Katharina Wassilew
- Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Alexander Berger
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Felix Hennig
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
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20
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Georgiopoulos G, Aimo A, Barison A, Magkas N, Emdin M, Masci PG. Imaging predictors of incident heart failure: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 22:378-387. [PMID: 33136816 DOI: 10.2459/jcm.0000000000001133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preventing the evolution of subclinical cardiac disease into overt heart failure is of paramount importance. Imaging techniques, particularly transthoracic echocardiography (TTE), are well suited to identify abnormalities in cardiac structure and function that precede the development of heart failure. METHODS This meta-analysis provides a comprehensive evaluation of 32 studies from 11 individual cohorts, which assessed cardiac indices from TTE (63%), cardiovascular magnetic resonance (CMR; 34%) or cardiac computed tomography (CCT; 16%). Eligible studies focused on measures of left ventricular geometry and function and were highly heterogeneous. RESULTS Among the variables that could be assessed through a meta-analytic approach, left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) lower than 50%, and left ventricular dilation were associated with a five-fold [hazard ratio (HR) 4.76, 95% confidence interval (95% CI) 1.85-12.26] and three-fold (HR 3.14, 95% CI 1.37 -7.19) increased risk of heart failure development, respectively. Any degree of diastolic dysfunction conveyed an independent, albeit weaker, association with heart failure (HR 1.48, 95% CI 1.11-1.96), although there was only a trend for left ventricular hypertrophy in predicting incident heart failure (hazard ratio 2.85, 95% CI 0.82-9.85). CONCLUSION LVEF less than 50%, left ventricular dilation and diastolic dysfunction are independent predictors of incident heart failure among asymptomatic individuals, while left ventricular hypertrophy seems less predictive. These findings may serve as a framework for implementing imaging-based screening strategies in patients at risk of heart failure and inform future studies testing preventive or therapeutic approaches aiming at thwarting or halting the progression from asymptomatic (preclinical) to overt heart failure.
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto Aimo
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Division, University Hospital of Pisa
| | - Andrea Barison
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Nikolaos Magkas
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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21
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Novel Magnetic Resonance Late Gadolinium Enhancement With Fixed Short Inversion Time in Ischemic Myocardial Scars. Invest Radiol 2020; 55:445-450. [DOI: 10.1097/rli.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Perez-Terol I, Rios-Navarro C, de Dios E, Morales JM, Gavara J, Perez-Sole N, Diaz A, Minana G, Segura-Sabater R, Bonanad C, Bayés-Genis A, Husser O, Monmeneu JV, Lopez-Lereu MP, Nunez J, Chorro FJ, Ruiz-Sauri A, Bodi V, Monleon D. Magnetic resonance microscopy and correlative histopathology of the infarcted heart. Sci Rep 2019; 9:20017. [PMID: 31882712 PMCID: PMC6934559 DOI: 10.1038/s41598-019-56436-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/10/2019] [Indexed: 02/08/2023] Open
Abstract
Delayed enhancement cardiovascular magnetic resonance (MR) is the gold-standard for non-invasive assessment after myocardial infarction (MI). MR microscopy (MRM) provides a level of detail comparable to the macro objective of light microscopy. We used MRM and correlative histopathology to identify infarct and remote tissue in contrast agent-free multi-sequence MRM in swine MI hearts. One control group (n = 3 swine) and two experimental MI groups were formed: 90 min of ischemia followed by 1 week (acute MI = 6 swine) or 1 month (chronic MI = 5 swine) reperfusion. Representative samples of each heart were analysed by contrast agent-free multi-sequence (T1-weighting, T2-weighting, T2*-weighting, T2-mapping, and T2*-mapping). MRM was performed in a 14-Tesla vertical axis imager (Bruker-AVANCE 600 system). Images from MRM and the corresponding histopathological stained samples revealed differences in signal intensities between infarct and remote areas in both MI groups (p-value < 0.001). The multivariable models allowed us to precisely classify regions of interest (acute MI: specificity 92% and sensitivity 80%; chronic MI: specificity 100% and sensitivity 98%). Probabilistic maps based on MRM images clearly delineated the infarcted regions. As a proof of concept, these results illustrate the potential of MRM with correlative histopathology as a platform for exploring novel contrast agent-free MR biomarkers after MI.
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Affiliation(s)
- Itziar Perez-Terol
- Laboratory of Metabolomics, Institute of Health Research-INCLIVA, Valencia, Spain
| | - Cesar Rios-Navarro
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Elena de Dios
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Jose M Morales
- Laboratory of Metabolomics, Institute of Health Research-INCLIVA, Valencia, Spain.,Unidad Central de Investigación Biomédica, University of Valencia, Valencia, Spain.,Pathology Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Jose Gavara
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Nerea Perez-Sole
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Ana Diaz
- Unidad Central de Investigación Biomédica, University of Valencia, Valencia, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | | | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Antoni Bayés-Genis
- Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oliver Husser
- Department of Cardiology, St.-Johannes-Hospital, Dortmund, Germany
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain
| | | | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain.,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain.,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Amparo Ruiz-Sauri
- Pathology Department, School of Medicine, University of Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain. .,Centro de Investigación Biomédica en Red - Cardiovascular (CIBER-CV), Madrid, Spain. .,Medicine Department, School of Medicine, University of Valencia, Valencia, Spain.
| | - Daniel Monleon
- Laboratory of Metabolomics, Institute of Health Research-INCLIVA, Valencia, Spain. .,Pathology Department, School of Medicine, University of Valencia, Valencia, Spain. .,Centro de Investigación Biomédica en Red - Fragilidad y Envejecimiento Saludable (CIBER-FES), Madrid, Spain.
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23
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Baessler B, Luecke C, Lurz J, Klingel K, Das A, von Roeder M, de Waha-Thiele S, Besler C, Rommel KP, Maintz D, Gutberlet M, Thiele H, Lurz P. Cardiac MRI and Texture Analysis of Myocardial T1 and T2 Maps in Myocarditis with Acute versus Chronic Symptoms of Heart Failure. Radiology 2019; 292:608-617. [PMID: 31361205 DOI: 10.1148/radiol.2019190101] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BackgroundThe establishment of a timely and correct diagnosis in heart failure-like myocarditis remains one of the most challenging in clinical cardiology.PurposeTo assess the diagnostic potential of texture analysis in heart failure-like myocarditis with comparison to endomyocardial biopsy (EMB) as the reference standard.Materials and MethodsSeventy-one study participants from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial (ClinicalTrials.gov registration no. NCT02177630) with clinical suspicion for myocarditis and symptoms of heart failure were prospectively included (from August 2012 to May 2015) in the study. Participants underwent biventricular EMB and cardiac MRI at 1.5 T, including native T1 and T2 mapping and standard Lake Louise criteria. Texture analysis was applied on T1 and T2 maps by using an open-source software. Stepwise dimension reduction was performed for selecting features enabling the diagnosis of myocarditis. Diagnostic performance was assessed from the area under the curve (AUC) from receiver operating characteristic analyses with 10-fold cross validation.ResultsIn participants with acute heart failure-like myocarditis (n = 31; mean age, 47 years ± 17; 10 women), the texture feature GrayLevelNonUniformity from T2 maps (T2_GLNU) showed diagnostic performance similar to that of mean myocardial T2 time (AUC, 0.69 for both). The combination of mean T2 time and T2_GLNU had the highest AUC (0.76; 95% confidence interval [CI]: 0.43, 0.95), with sensitivity of 81% (25 of 31) and specificity of 71% (22 of 31). In patients with chronic heart failure-like myocarditis (n = 40; mean age, 48 years ± 13; 12 women), the histogram feature T2_kurtosis demonstrated superior diagnostic performance compared to that of all other single parameters (AUC, 0.81; 95% CI: 0.66, 0.96). The combination of the two texture features, T2_kurtosis and the GrayLevelNonUniformity from T1, had the highest diagnostic performance (AUC, 0.85; 95% CI: 0.57, 0.90; sensitivity, 90% [36 of 40]; and specificity, 72% [29 of 40]).ConclusionIn this proof-of-concept study, texture analysis applied on cardiac MRI T1 and T2 mapping delivers quantitative imaging parameters for the diagnosis of acute or chronic heart failure-like myocarditis and might be superior to Lake Louise criteria or averaged myocardial T1 or T2 values.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by de Roos in this issue.
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Affiliation(s)
- Bettina Baessler
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Christian Luecke
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Julia Lurz
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Karin Klingel
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Arijit Das
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Maximilian von Roeder
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Suzanne de Waha-Thiele
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Christian Besler
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Karl-Philipp Rommel
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - David Maintz
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Matthias Gutberlet
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Holger Thiele
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Philipp Lurz
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
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Affiliation(s)
- A Mark Richards
- From the Cardiovascular Research Institute, National University Heart Centre, Singapore; and Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.
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Cardiac magnetic resonance T1 mapping. Part 1: Aspects of acquisition and evaluation. Eur J Radiol 2018; 109:223-234. [PMID: 30539758 DOI: 10.1016/j.ejrad.2018.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/29/2018] [Accepted: 10/05/2018] [Indexed: 12/13/2022]
Abstract
While an enormous number of studies have documented pathological alterations of the myocardial native longitudinal relaxation time (T1) and the fraction of the extracellular myocardial volume (ECV), it has also become clear that continuously evolving T1 mapping sequence, acquisition and evaluation techniques have a substantial impact on quantitative results, making the translation of reported findings into routine clinical use particularly challenging. To provide a basis for the discussion of pathological myocardial T1 and ECV alterations, the present review aims to summarize the methodological aspects of myocardial T1 mapping along with technical and physiological factors influencing results and normal ranges of myocardial native T1 and ECV reported across studies.
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Myocardial T1 and T2 mapping in severe aortic stenosis: Potential novel insights into the pathophysiology of myocardial remodelling. Eur J Radiol 2018; 107:76-83. [PMID: 30292277 DOI: 10.1016/j.ejrad.2018.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Severe aortic stenosis (AS) is known to be associated with substantial myocardial remodelling, leading to diffuse myocardial fibrosis (DMF). Native myocardial T1 is emerging as a novel imaging biomarker for the non-invasive assessment of DMF. In contrast, no studies exist elucidating changes of myocardial T2 reflecting myocardial oedema in the presence of AS. The purpose of the present study was to combine native T1 and T2 mapping in order to characterize myocardial tissue changes in the setting of severe AS. METHODS After obtaining ethical approval and informed consent, a total of 26 prospectively selected patients with severe AS (13 women, mean age 81 ± 7 years) and 17 healthy controls (12 women, mean age 63 ± 6 years) underwent cardiac magnetic resonance (CMR) imaging on a clinical 3 T scanner. The CMR protocol included a native Modified Look-Locker (MOLLI) T1 mapping and a Gradient Spin Echo (GraSE) T2-mapping sequence in three short-axis slices and one long-axis view. After segmentation, myocardial T1 and T2 values were averaged over the entire myocardium. Statistical analysis was performed using Wilcoxon sum-rank test, Welch's independent t-test and Pearson's correlation coefficient. RESULTS Global native myocardial T1 was significantly increased in AS patients when compared to controls (1305 ± 39 vs. 1272 ± 21 ms, p = .005). Similarly, mean myocardial T2 was significantly elevated in AS patients (51 ± 4 vs. 46 ± 2 ms, p < .001) and showed a strong correlation with native T1 (r = .60, p < .001). An overlap was observed between T1 of both groups, whereas T2 discriminated nearly perfectly between the two groups (area under the curve in ROC analyses: 0.76 for T1, 0.87 for T2). CONCLUSIONS Patients with severe AS exhibit significantly elevated native myocardial T1, which has previously been shown to correlate with the amount of myocardial collagen. Adding to this evidence, the present study is the first to show that native T1 and T2 are both significantly elevated and correlated in AS patients, pointing towards a potential role of oedematous/inflammatory processes in the pathophysiology of myocardial remodelling associated with AS.
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Zorzi A, Susana A, De Lazzari M, Migliore F, Vescovo G, Scarpa D, Baritussio A, Tarantini G, Cacciavillani L, Giorgi B, Basso C, Iliceto S, Bucciarelli Ducci C, Corrado D, Perazzolo Marra M. Diagnostic value and prognostic implications of early cardiac magnetic resonance in survivors of out-of-hospital cardiac arrest. Heart Rhythm 2018; 15:1031-1041. [PMID: 29550522 DOI: 10.1016/j.hrthm.2018.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In patients who survived out-of-hospital cardiac arrest (OHCA), it is crucial to establish the underlying cause and its potential reversibility. OBJECTIVE The purpose of this study was to assess the incremental diagnostic and prognostic role of early cardiac magnetic resonance (CMR) in survivors of OHCA. METHODS Among 139 consecutive OHCA patients, the study enrolled 44 patients (median age 43 years; 84% male) who underwent coronary angiography and CMR ≤7 days after admission. The CMR protocol included T2-weighted sequences for myocardial edema and late gadolinium enhancement (LGE) sequences for myocardial fibrosis. RESULTS Coronary angiography identified obstructive coronary artery disease in 18 of 44 patients in whom CMR confirmed the diagnosis of ischemic heart disease by demonstrating subendocardial or transmural LGE. The presence of myocardial edema allowed differentiation between acute myocardial ischemia (n = 12) and postinfarction myocardial scar (n = 6). Among the remaining 26 patients without obstructive coronary artery disease, CMR in 19 (73%) showed dilated cardiomyopathy in 5, myocarditis in 4, mitral valve prolapse associated with LGE in 3, ischemic scar in 2, idiopathic nonischemic scar in 2, arrhythmogenic cardiomyopathy in 1, hypertrophic cardiomyopathy in 1, and takotsubo cardiomyopathy in 1. In this subgroup of 26 patients, 6 (23%) had myocardial edema. During mean follow-up of 36 ± 17 months, all 18 patients with myocardial edema had an uneventful outcome, whereas 9 of 26 (35%) without myocardial edema experienced sudden arrhythmic death (n = 1), appropriate defibrillator interventions (n = 5), and nonarrhythmic death (n = 3; P = .006). CONCLUSION In survivors of OHCA, early CMR with a comprehensive tissue characterization protocol provided additional diagnostic and prognostic value. The identification of myocardial edema was associated with a favorable long-term outcome.
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Affiliation(s)
- Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Angela Susana
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giovanni Vescovo
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Daniele Scarpa
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Anna Baritussio
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy; Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Luisa Cacciavillani
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Benedetta Giorgi
- Division of Radiology, Department of Medicine, Az. Ospedaliera di Padova, Padova, Italy
| | - Cristina Basso
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Chiara Bucciarelli Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Arbustini E, Favalli V, Narula N. Extracellular Volume in Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2018; 11:60-63. [DOI: 10.1016/j.jcmg.2017.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 02/05/2023]
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Downstream indication to revascularization following hybrid cardiac PET/MRI: preliminary results. Nucl Med Commun 2017; 38:515-522. [PMID: 28430739 DOI: 10.1097/mnm.0000000000000680] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hybrid PET/MRI allows the acquisition of both fluorine-18-fluorodeoxyglucose (F-FDG) PET and cardiac magnetic resonance (CMR) during one session. Whether this will result in different referral to coronary revascularization (CR) is unknown. We compared this new hybrid method with all-nuclear/all-CMR methods in the assessment of viable myocardium and in downstream referral to CR. PATIENTS AND METHODS Overall, 12 patients with rest perfusion defects on a single photon emission computed tomography (SPECT) were recruited for cardiac viability assessment using a PET/MRI device. Perfusion (SPECT and CMR), metabolism, late gadolinium enhancement (LGE), and contractility were compared using a 20-segments bull's eye for agreement. The patterns of ischemia/viability were compared between all-nuclear, all-CMR, and hybrid methods. Downstream CR was proposed after correlating findings to coronary angiography. RESULTS The SPECT and CMR perfusion denoted poor agreement [agreement rate (AR): 60%; κ: 0.191, P<0.004]. The added PET metabolism concurred in reclassifying 19.2% of segments with intermediate or unassessable LGE using the hybrid method. Overall, the all-CMR method showed better agreement with the hybrid method than the all-nuclear method for findings of normal (AR: 100%, κ: 1.00 vs. 65.8% %; κ: 0.347, respectively; P<0.001), scar (AR: 85%; κ: 0.675 vs. 80.8%; κ: 0.596, respectively; P<0.001), and ischemic segments (AR: 95.8%; κ: 0.881 vs. 75.8%; κ: 0.168, respectively; P<0.001). Downstream CR was proposed in four, 11, and 12 vessels by the all-nuclear, all-CMR, or hybrid methods, respectively. CONCLUSION Compared with all-CMR, the hybrid method allowed the reclassification of 19.2% segments. Using CMR perfusion instead of SPECT perfusion had a significant impact on downstream target vessel revascularization.
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Krittayaphong R, Zhang S, Saiviroonporn P, Viprakasit V, Tanapibunpon P, Komoltri C, Wangworatrakul W. Detection of cardiac iron overload with native magnetic resonance T1 and T2 mapping in patients with thalassemia. Int J Cardiol 2017; 248:421-426. [DOI: 10.1016/j.ijcard.2017.06.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/08/2017] [Accepted: 06/26/2017] [Indexed: 12/15/2022]
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Zhang Y, Xu Y, Wang L, Chen Y, Tian R, Jiao J, Xie H, Yang L, Gao F. Quantitative assessment of salvaged myocardial zone and intramyocardial hemorrhage using non-contrast faster T2 mapping in a rat model by 7T MRI. Exp Ther Med 2017; 14:3425-3432. [PMID: 29042929 PMCID: PMC5639411 DOI: 10.3892/etm.2017.4967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 03/24/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to determine the myocardial area at risk (AAR), infarction-core size (IS) and the salvaged myocardial zone (SMZ), and to evaluate the imaging and histological characteristics of intramyocardial hemorrhage (IMH) after myocardial infarction using non-contrast T2 mapping on 7T magnetic resonance imaging (MRI). Twenty Sprague Dawley (SD) rats were randomly divided into the sham and model groups (n=10 in each). In the model group, myocardial infarction models were established by left anterior descending branch ligation. After 24 h, all animals were imaged on a 7.0 Tesla system with cine spiral imaging, T2 mapping with late gadolinium enhancement (LGE). The rats were then sacrificed for measurement of the IS and AAR using 2,3,5-triphenylterazolium chloride (TTC) and hematoxylin and eosin (H&E) staining. T2 mapping revealed that the AAR in the model group was significantly higher than that in the sham group. No remarkable T2 value was noted in the entire heart of the sham group. LGE and TTC staining demonstrated similar IS. T2 mapping and H&E staining revealed a similar AAR as well. T2 mapping characterized the IMH as a phenomenon resulting from the area of hypointensity in the hyperintensity involving the infarct-core zone and corresponding T2 value 928.6±1.52 msec with IMH vs. 35.8±2.61 msec without IMH; n=3 with 18 slices; P=0.032). In conclusion, non-contrast T2 mapping was a reliable approach to quantitatively evaluate the SMZ and IMH.
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Affiliation(s)
- Yan Zhang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China.,Department of Radiology, General Hospital of PLA, Beijing 100853, P.R. China
| | - Yini Xu
- The Key Laboratory of Optional Utilization of Natural Medicinal Resources, Guizhou Medical University, Huaxi University Town, Guiyang, Guizhou 550025, P.R. China
| | - Lei Wang
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yushu Chen
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ruiqing Tian
- Department of Oncology, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, P.R. China
| | - Jun Jiao
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Hong Xie
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Li Yang
- Department of Radiology, General Hospital of PLA, Beijing 100853, P.R. China
| | - Fabao Gao
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Karetnikova VN, Kashtalap VV, Kosareva SN, Barbarash OL. [Myocardial fibrosis: Current aspects of the problem]. TERAPEVT ARKH 2017. [PMID: 28635904 DOI: 10.17116/terarkh201789188-93] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fibrosis is one of the main components in the progression of most cardiovascular diseases, including coronary heart disease, by causing structural changes in the myocardium and vascular wall. The quantitative and qualitative characteristics of fibrosis of the myocardium are responsible for decreasing its elastic properties, developing diastolic dysfunction, impairing myocardial contractility, developing systolic dysfunction and cardiac arrhythmias, and worsening coronary blood flow in patients with heart failure of different etiologies. The important aspect of studying fibrosis is not only its interpretation as a model of the typical pathological process, but also its consideration as a systemic lesion of various organs and tissues. At the same time, the identification of myocardial fibrosis biomarkers that are available for their determination in circulating blood is of particular interest. Since there was evidence for the role of fibrosis in developing dysfunction of various organs and ensuring the systematicity of most diseases, especially at their development stages, the process of fibrosis came to be regarded as a promising therapeutic target. It is relevant to further investigate myocardial fibrosis, which is aimed at increasing the efficiency of its diagnosis and predicting its course and pathogenetically sound therapy.
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Affiliation(s)
- V N Karetnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V V Kashtalap
- Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia
| | - S N Kosareva
- Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia; Kemerovo Cardiology Dispensary, Kemerovo, Russia
| | - O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia; Kemerovo State Medical Academy, Ministry of Health of Russia, Kemerovo, Russia
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Cereda AF, Pedrotti P, De Capitani L, Giannattasio C, Roghi A. Comprehensive evaluation of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA) with cardiac magnetic resonance. Eur J Intern Med 2017; 39:51-56. [PMID: 27727077 DOI: 10.1016/j.ejim.2016.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/08/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis characterized by hypereosinophilia. EGPA typically develops in three clinical phases, beginning with asthma, followed by tissue eosinophilia and finally systemic vasculitis. Cardiac involvement is the most important predictor of mortality; it occurs in approximately 15-60% of EGPA patients, a significant proportion of whom are asymptomatic and have normal electrocardiogram (ECG) and echocardiogram. Early detection and management of cardiac disease could positevely affect prognosis. Cardiovascular magnetic resonance (CMR) has emerged as the gold standard cardiac imaging technique in the evaluation of cardiomyopathies, due to its ability to reliably assess anatomy, function, and tissue characterization. AIM Purpose of this study was to assess the role of CMR in detecting cardiac disease in patients with EGPA in clinical remission. METHODS A dedicated CMR protocol including functional analysis, and pre and post-contrast tissue characterization was performed in 11 patients with EGPA and the results were compared with 11 healthy subjects. RESULTS EGPA patients had lower left ventricular ejection fraction compared to controls (56±19 vs 68.7±5.2, p value 0.02). Late gadolinium enhancement (LGE), representing replacement fibrosis, was positive in 9/11 (82%) patients, mainly with a non-ischemic pattern. In 3/11 (27%) patients a left ventricular thrombus was detected; in 3/11 (27%) patients myocardial edema was detected. CMR parameters of interstitial fibrosis were significantly more elevated in EGPA patients compared to controls. CONCLUSIONS Patients with EGPA in clinical remission showed a high cardiovascular burden as demonstrated by lower EF, signs of active inflammation, presence of interstitial and replacement fibrosis and intraventricular thrombosis. Further studies on wider populations are warranted to better understand how these findings could impact on prognosis and eventually guide therapy.
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Affiliation(s)
- Alberto Francesco Cereda
- Bicocca University, Science of Health Department, Milano, Italy; Department of Cardiology A De Gasperis, Cardiology 4, Cardiovascular Magnetic Resonance Unit, Niguarda Cà Granda Hospital, Milano, Italy.
| | - Patrizia Pedrotti
- Department of Cardiology A De Gasperis, Cardiology 4, Cardiovascular Magnetic Resonance Unit, Niguarda Cà Granda Hospital, Milano, Italy
| | - Lucio De Capitani
- Department of Statistics and Quantitative Methods, Bicocca University, Milano, Italy
| | - Cristina Giannattasio
- Bicocca University, Science of Health Department, Milano, Italy; Department of Cardiology A De Gasperis, Cardiology 4, Niguarda Cà Granda Hospital, Milano, Italy
| | - Alberto Roghi
- Department of Cardiology A De Gasperis, Cardiology 4, Cardiovascular Magnetic Resonance Unit, Niguarda Cà Granda Hospital, Milano, Italy
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A feasible and automatic free tool for T1 and ECV mapping. Phys Med 2017; 33:47-55. [DOI: 10.1016/j.ejmp.2016.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 10/28/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022] Open
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Meloni MM, Barton S, Xu L, Kaski JC, Song W, He T. Contrast agents for cardiovascular magnetic resonance imaging: an overview. J Mater Chem B 2017; 5:5714-5725. [DOI: 10.1039/c7tb01241a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Contrast agents for Cardiovascular Magnetic Resonance (CMR) play a major role in research and clinical cardiology.
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Affiliation(s)
- Marco M. Meloni
- Molecular and Clinical Sciences Research Institute
- St George's, University of London
- London
- UK
- School of Pharmacy and Chemistry
| | - Stephen Barton
- School of Pharmacy and Chemistry
- Kingston University
- London
- UK
| | - Lei Xu
- Department of Radiology
- Beijing Anzhen Hospital
- Beijing
- China
| | - Juan C. Kaski
- Molecular and Clinical Sciences Research Institute
- St George's, University of London
- London
- UK
| | - Wenhui Song
- UCL Centre for Biomaterials
- Division of surgery & Interventional Science
- University College of London
- London
- UK
| | - Taigang He
- Molecular and Clinical Sciences Research Institute
- St George's, University of London
- London
- UK
- Royal Brompton Hospital
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Reiter U, Reiter G, Manninger M, Adelsmayr G, Schipke J, Alogna A, Rajces A, Stalder AF, Greiser A, Mühlfeld C, Scherr D, Post H, Pieske B, Fuchsjäger M. Early-stage heart failure with preserved ejection fraction in the pig: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016. [PMID: 27688028 DOI: 10.1186/s12968-016-0283-9]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hypertensive deoxy-corticosterone acetate (DOCA)-salt-treated pig (hereafter, DOCA pig) was recently introduced as large animal model for early-stage heart failure with preserved ejection fraction (HFpEF). The aim of the present study was to evaluate cardiovascular magnetic resonance (CMR) of DOCA pigs and weight-matched control pigs to characterize ventricular, atrial and myocardial structure and function of this phenotype model. METHODS Five anesthetized DOCA and seven control pigs underwent 3 T CMR at rest and during dobutamine stress. Left ventricular/atrial (LV/LA) function and myocardial mass (LVMM), strains and torsion were evaluated from (tagged) cine imaging. 4D phase-contrast measurements were used to assess blood flow and peak velocities, including transmitral early-diastolic (E) and myocardial tissue (E') velocities and coronary sinus blood flow. Myocardial perfusion reserve was estimated from stress-to-rest time-averaged coronary sinus flow. Global native myocardial T1 times were derived from prototype modified Look-Locker inversion-recovery (MOLLI) short-axis T1 maps. After in-vivo measurements, transmural biopsies were collected for stereological evaluation including the volume fractions of interstitium (VV(int/LV)) and collagen (VV(coll/LV)). Rest, stress, and stress-to-rest differences of cardiac and myocardial parameters in DOCA and control animals were compared by t-test. RESULTS In DOCA pigs LVMM (p < 0.001) and LV wall-thickness (end-systole/end-diastole, p = 0.003/p = 0.007) were elevated. During stress, increase of LV ejection-fraction and decrease of end-systolic volume accounted for normal contractility reserves in DOCA and control pigs. Rest-to-stress differences of cardiac index (p = 0.040) and end-diastolic volume (p = 0.042) were documented. Maximal (p = 0.042) and minimal (p = 0.012) LA volumes in DOCA pigs were elevated at rest; total LA ejection-fraction decreased during stress (p = 0.006). E' was lower in DOCA pigs, corresponding to higher E/E' at rest (p = 0.013) and stress (p = 0.026). Myocardial perfusion reserve was reduced in DOCA pigs (p = 0.031). T1-times and VV(int/LV) did not differ between groups, whereas VV(coll/LV) levels were higher in DOCA pigs (p = 0.044). CONCLUSIONS LA enlargement, E' and E/E' were the markers that showed the most pronounced differences between DOCA and control pigs at rest. Inadequate increase of myocardial perfusion reserve during stress might represent a metrics for early-stage HFpEF. Myocardial T1 mapping could not detect elevated levels of myocardial collagen in this model. TRIAL REGISTRATION The study was approved by the local Bioethics Committee of Vienna, Austria (BMWF-66.010/0091-II/3b/2013).
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Affiliation(s)
- Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria.
| | | | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gabriel Adelsmayr
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Julia Schipke
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | - Alessio Alogna
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany
| | - Alexandra Rajces
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | | | | | - Christian Mühlfeld
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Heiner Post
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany
| | - Burkert Pieske
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
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Reiter U, Reiter G, Manninger M, Adelsmayr G, Schipke J, Alogna A, Rajces A, Stalder AF, Greiser A, Mühlfeld C, Scherr D, Post H, Pieske B, Fuchsjäger M. Early-stage heart failure with preserved ejection fraction in the pig: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016; 18:63. [PMID: 27688028 PMCID: PMC5043627 DOI: 10.1186/s12968-016-0283-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The hypertensive deoxy-corticosterone acetate (DOCA)-salt-treated pig (hereafter, DOCA pig) was recently introduced as large animal model for early-stage heart failure with preserved ejection fraction (HFpEF). The aim of the present study was to evaluate cardiovascular magnetic resonance (CMR) of DOCA pigs and weight-matched control pigs to characterize ventricular, atrial and myocardial structure and function of this phenotype model. METHODS Five anesthetized DOCA and seven control pigs underwent 3 T CMR at rest and during dobutamine stress. Left ventricular/atrial (LV/LA) function and myocardial mass (LVMM), strains and torsion were evaluated from (tagged) cine imaging. 4D phase-contrast measurements were used to assess blood flow and peak velocities, including transmitral early-diastolic (E) and myocardial tissue (E') velocities and coronary sinus blood flow. Myocardial perfusion reserve was estimated from stress-to-rest time-averaged coronary sinus flow. Global native myocardial T1 times were derived from prototype modified Look-Locker inversion-recovery (MOLLI) short-axis T1 maps. After in-vivo measurements, transmural biopsies were collected for stereological evaluation including the volume fractions of interstitium (VV(int/LV)) and collagen (VV(coll/LV)). Rest, stress, and stress-to-rest differences of cardiac and myocardial parameters in DOCA and control animals were compared by t-test. RESULTS In DOCA pigs LVMM (p < 0.001) and LV wall-thickness (end-systole/end-diastole, p = 0.003/p = 0.007) were elevated. During stress, increase of LV ejection-fraction and decrease of end-systolic volume accounted for normal contractility reserves in DOCA and control pigs. Rest-to-stress differences of cardiac index (p = 0.040) and end-diastolic volume (p = 0.042) were documented. Maximal (p = 0.042) and minimal (p = 0.012) LA volumes in DOCA pigs were elevated at rest; total LA ejection-fraction decreased during stress (p = 0.006). E' was lower in DOCA pigs, corresponding to higher E/E' at rest (p = 0.013) and stress (p = 0.026). Myocardial perfusion reserve was reduced in DOCA pigs (p = 0.031). T1-times and VV(int/LV) did not differ between groups, whereas VV(coll/LV) levels were higher in DOCA pigs (p = 0.044). CONCLUSIONS LA enlargement, E' and E/E' were the markers that showed the most pronounced differences between DOCA and control pigs at rest. Inadequate increase of myocardial perfusion reserve during stress might represent a metrics for early-stage HFpEF. Myocardial T1 mapping could not detect elevated levels of myocardial collagen in this model. TRIAL REGISTRATION The study was approved by the local Bioethics Committee of Vienna, Austria (BMWF-66.010/0091-II/3b/2013).
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Affiliation(s)
- Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036 Graz, Austria
| | | | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gabriel Adelsmayr
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036 Graz, Austria
| | - Julia Schipke
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | - Alessio Alogna
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany
| | - Alexandra Rajces
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | | | | | - Christian Mühlfeld
- Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Heiner Post
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany
| | - Burkert Pieske
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036 Graz, Austria
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Zhang Y, Tian R, Shen X, Chen Y, Chen W, Gan L, Shen G, Ju H, Yang L, Gao F. An experimental study on use of 7T MRI for evaluation of myocardial infarction in SD rats transfected with pcDNA 3.1(+)/VEGF121 plasmid. Am J Transl Res 2016; 8:3376-3386. [PMID: 27648128 PMCID: PMC5009390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/20/2016] [Indexed: 06/06/2023]
Abstract
This study aims to build the myocardial infarction model in SD rats transfected with pcDNA 3.1(+)/VEGF121 plasmid and study the effect of the transfection using 7T MRI. Twenty-four male SD rats were randomly divided into 2 groups, pcDNA 3.1(+)/VEGF121 plasmid transfection group (with improved coronary perfusion delivery) and myocardial infarction model group. Cardiac cine magnetic resonance imaging (Cine-MRI), T2-mapping and late gadolinium enhancement (LGE) cardiac imaging were performed at 24 h, 48 h, 72 h and 7 d after myocardial infarction, respectively. The signal intensity, area at risk (AAR), myocardium infarction core (MIC) and salvageable myocardial zone (SMZ) were compared. The hearts were harvested for anatomic characterization, which was related to pathological examination (TTC staining, HE staining, Masson staining and immunohistochemical staining). The Cine-MRI results showed that pcDNA 3.1(+)/VEGF121 plasmid transfection group had higher end-diastolic volume (EDV) with a reduction in MIC and SMZ, as compared with the myocardial infarction model group. MIC, SMZ and AAR of the plasmid transfection declined over time. At 7 d, the two groups did not differ significantly in AAR and T2 value. According to Western Blotting, VEGF was up-regulated, while CaSR and caspase-3 were downregulated in the plasmid transfection group, as compared with the model group. In conclusion, a good treatment effect was achieved by coronary perfusion of pcDNA 3.1(+)/VEGF121 plasmid. 7T CMR sequences provide a non-invasive quantification of the treatment efficacy. However, the assessment of myocardial injury using T2 value and AAR in the presence of edema is less accurate. The myocardial protection of the plasmid transfection group may be related to the inhibition of myocardial apoptosis, vascular endothelial cell (VEC) proliferation and collagen proliferation. The CaSR signaling pathway may contribute to reversing the apoptosis.
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Affiliation(s)
- Yan Zhang
- Department of Radiology General Hospital of PLABeijing 100853, PR China
- Department of Radiology, Affiliated Hospital of Guizhou Medical UniversityGuiyang, PR China
| | - Ruiqing Tian
- Department of Oncology, The First People’s Hospital of GuiyangPR China
| | - Xiangchun Shen
- The Key Laboratory of Optional Utilization of Natural Medical Resource, Guizhou Medical UniversityUniversity Town, Guian New District, Guiyang, PR China
| | - Yushu Chen
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan UniversityPR China
| | - Wei Chen
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan UniversityPR China
| | - Lu Gan
- Department of Radiology General Hospital of PLABeijing 100853, PR China
| | - Guiquan Shen
- Department of Radiology, Affiliated Hospital of Guizhou Medical UniversityGuiyang, PR China
| | - Haiyue Ju
- Department of Radiology General Hospital of PLABeijing 100853, PR China
| | - Li Yang
- Department of Radiology General Hospital of PLABeijing 100853, PR China
| | - Fabao Gao
- Molecular Imaging Laboratory, Department of Radiology, West China Hospital, Sichuan UniversityPR China
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McDiarmid AK, Swoboda PP, Erhayiem B, Lancaster RE, Lyall GK, Broadbent DA, Dobson LE, Musa TA, Ripley DP, Garg P, Greenwood JP, Ferguson C, Plein S. Athletic Cardiac Adaptation in Males Is a Consequence of Elevated Myocyte Mass. Circ Cardiovasc Imaging 2016; 9:e003579. [PMID: 27033835 PMCID: PMC4841180 DOI: 10.1161/circimaging.115.003579] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 02/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac remodeling occurs in response to regular athletic training, and the degree of remodeling is associated with fitness. Understanding the myocardial structural changes in athlete's heart is important to develop tools that differentiate athletic from cardiomyopathic change. We hypothesized that athletic left ventricular hypertrophy is a consequence of increased myocardial cellular rather than extracellular mass as measured by cardiovascular magnetic resonance. METHODS AND RESULTS Forty-five males (30 athletes and 15 sedentary age-matched healthy controls) underwent comprehensive cardiovascular magnetic resonance studies, including native and postcontrast T1 mapping for extracellular volume calculation. In addition, the 30 athletes performed a maximal exercise test to assess aerobic capacity and anaerobic threshold. Participants were grouped by athleticism: untrained, low performance, and high performance (O2max <60 or>60 mL/kg per min, respectively). In athletes, indexed cellular mass was greater in high- than low-performance athletes 60.7±7.5 versus 48.6±6.3 g/m(2); P<0.001), whereas extracellular mass was constant (16.3±2.2 versus 15.3±2.2 g/m(2); P=0.20). Indexed left ventricular end-diastolic volume and mass correlated with O2max (r=0.45, P=0.01; r=0.55, P=0.002) and differed significantly by group (P=0.01; P<0.001, respectively). Extracellular volume had an inverse correlation with O2max (r=-0.53, P=0.003 and left ventricular mass index (r=-0.44, P=0.02). CONCLUSIONS Increasing left ventricular mass in athlete's heart occurs because of an expansion of the cellular compartment while the extracellular volume becomes relatively smaller: a difference which becomes more marked as left ventricular mass increases. Athletic remodeling, both on a macroscopic and cellular level, is associated with the degree of an individual's fitness. Cardiovascular magnetic resonance ECV quantification may have a future role in differentiating athlete's heart from change secondary to cardiomyopathy.
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Affiliation(s)
- Adam K McDiarmid
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Peter P Swoboda
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Bara Erhayiem
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Rosalind E Lancaster
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Gemma K Lyall
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - David A Broadbent
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Laura E Dobson
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Tarique A Musa
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - David P Ripley
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Pankaj Garg
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - John P Greenwood
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Carrie Ferguson
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Sven Plein
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
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Morgan RB, Kwong R. Role of Cardiac MRI in the Assessment of Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:53. [PMID: 26446716 DOI: 10.1007/s11936-015-0410-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OPINION STATEMENT Combining the diagnostic utilities of cardiac structures, myocardial perfusion, and various tissue characterizing pulse sequence methods in matching scan planes within a single imaging session, cardiac magnetic resonance imaging (CMR) provides a novel interrogation of myocardial physiology and abnormal anatomy from various forms of cardiomyopathy. Establishment of technical imaging standards and clinical adaptation in the past years has helped recognize the distinguishing features of different cardiomyopathies, with CMR currently assuming a pivotal role in the diagnosis of cases of new-onset cardiomyopathy in experienced centers. Quantitative measurements such as ventricular volumes, myocardial iron content, and extent of late gadolinium enhancement can effectively monitor disease status, guide medical therapy, and impact patient outcomes in specific clinical settings. This chapter will aim to summarize these current CMR applications with case examples.
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Affiliation(s)
- Róisín B Morgan
- Department of Cardiovascular Magnetic Resonance Imaging, Brigham and Womens Hospital, 75 Francis St, Boston, MA, USA.
| | - Raymond Kwong
- Department of Cardiovascular Magnetic Resonance Imaging, Brigham and Womens Hospital, 75 Francis St, Boston, MA, USA
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Imaging in Deciphering Histological Substrates in Hypertrophic Cardiomyopathy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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López B, González A, Ravassa S, Beaumont J, Moreno MU, San José G, Querejeta R, Díez J. Circulating Biomarkers of Myocardial Fibrosis: The Need for a Reappraisal. J Am Coll Cardiol 2015; 65:2449-56. [PMID: 26046739 DOI: 10.1016/j.jacc.2015.04.026] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/17/2015] [Accepted: 04/18/2015] [Indexed: 01/16/2023]
Abstract
Myocardial fibrosis impairs cardiac function, in addition to facilitating arrhythmias and ischemia, and thus influences the evolution and outcome of cardiac diseases. Its assessment is therefore clinically relevant. Although tissue biopsy is the gold standard for the diagnosis of myocardial fibrosis, a number of circulating biomarkers have been proposed for the noninvasive assessment of this lesion. A review of the published clinical data available on these biomarkers shows that most of them lack proof that they actually reflect the myocardial accumulation of fibrous tissue. In this "call to action" article, we propose that this absence of proof may lead to misinterpretations when considering the incremental value provided by the biomarkers with respect to traditional diagnostic tools in the clinical handling of patients. We thus argue that strategies are needed to more strictly validate whether a given circulating biomarker actually reflects histologically proven myocardial fibrosis before it is applied clinically.
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Affiliation(s)
- Begoña López
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Arantxa González
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Susana Ravassa
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Javier Beaumont
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - María U Moreno
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gorka San José
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ramon Querejeta
- Division of Cardiology, Donostia University Hospital, University of the Basque Country, San Sebastian, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain.
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