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Kazimierczyk R, Szumowski P, Nekolla SG, Malek LA, Blaszczak P, Hladunski M, Sobkowicz B, Mysliwiec J, Kaminski KA. The impact of specific pulmonary arterial hypertension therapy on cardiac fluorodeoxyglucose distribution in PET/MRI hybrid imaging-follow-up study. EJNMMI Res 2023; 13:20. [PMID: 36892707 PMCID: PMC9998792 DOI: 10.1186/s13550-023-00971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND PET/MRI hybrid imaging in pulmonary arterial hypertension (PAH) provides important prognostic information identifying patients who might benefit from early therapy escalation, as right ventricle (RV) metabolic alterations are linked with hemodynamics and might precede clinical deterioration. Now, we hypothesize that adequate PAH therapy escalation may result in reversal of unfavourable increased glucose uptake of RV, which is associated with improved prognosis. METHODS Out of twenty-six initially clinically stable PAH patients who had baseline PET/MRI scans, twenty (49.9 ± 14.9 years) had second PET/MRI after 24 months. SUVRV/SUVLV ratio was used to estimate and compare cardiac glucose uptake. Occurrences of clinical endpoints (CEP), defined as death or clinical deterioration, were assessed during 48-month follow-up from baseline. RESULTS In first 24 months of observation, sixteen patients had CEP and needed PAH therapy escalation. At follow-up visits, we observed significant improvement of RV ejection fraction (45.1 ± 9.6% to 52.4 ± 12.9%, p = 0.01), mean pulmonary artery pressure (50.5 ± 18.3 to 42.8 ± 18.6 mmHg, p = 0.03), and SUVRV/SUVLV, which tended to decrease (mean change -0.20 ± 0.74). Patients with baseline SUVRV/SUVLV value higher than 0.54 had worse prognosis in 48 months observation (log-rank test, p = 0.0007); follow up SUVRV/SUVLV > 1 predicted CEP in the following 24 months, regardless of previously escalated treatment. CONCLUSIONS PAH therapy escalation may influence RV glucose metabolism, what seems to be related with patients' prognosis. PET/MRI assessment may predict clinical deterioration regardless of previous clinical course, however its clinical significance in PAH requires further studies. Importantly, even mild alterations of RV glucose metabolism predict clinical deterioration in long follow-up. Clinical Trial Registration ClinicalTrials.gov, NCT03688698, 05/01/2016, https://clinicaltrials.gov/ct2/show/study/NCT03688698?term=NCT03688698&draw=2&rank=1.
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Affiliation(s)
- Remigiusz Kazimierczyk
- Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Technical University Munich, Ismaninger Str., 81675, Munich, Germany
| | - Lukasz A Malek
- Faculty of Rehabilitation, University of Physical Education, Marymoncka 34, 00-968, Warsaw, Poland
| | - Piotr Blaszczak
- Department of Cardiology, Cardinal Wyszynski' Hospital, Krasnicka Ave 100, 20-718, Lublin, Poland
| | - Marcin Hladunski
- Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Janusz Mysliwiec
- Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Karol A Kaminski
- Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland. .,Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland.
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Claver E, Di Marco A, Brown PF, Bradley J, Nucifora G, Ruiz-Majoral A, Dallaglio PD, Rodriguez M, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Prognostic impact of late gadolinium enhancement at the right ventricular insertion points in non-ischaemic dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:346-353. [PMID: 35699462 DOI: 10.1093/ehjci/jeac109] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the baseline characteristics and the prognostic implications associated with late gadolinium enhancement limited to the right ventricular insertion points (IP-LGE) or present at both the right ventricular insertion points and the left ventricle (IP&LV-LGE) in non-ischaemic dilated cardiomyopathy (DCM). METHODS AND RESULTS This is a retrospective observational multicentre cohort study including 1165 consecutive patients with DCM evaluated by cardiac magnetic resonance. The primary endpoint included appropriate defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, or sudden death. The secondary outcome encompassed heart failure hospitalizations, heart transplant, left ventricular assist device implantation, and end-stage heart failure death. IP-LGE was found in 72 patients (6%), who had clinical characteristics closer to LGE- than to LGE+ patients. During follow-up (median 36 months), none of the IP-LGE patients experienced the primary endpoint. The cumulative incidence of the primary endpoint was similar between IP-LGE and LGE- patients (P = 1), while IP-LGE had significantly lower cumulative incidence when compared with LGE+ patients (P < 0.001). When compared with IP-LGE patients, the cumulative incidence of the secondary endpoint was similar in LGE- cases (P = 0.86) but tended to be higher in LGE+ patients (P = 0.06). Both clinical characteristics and outcomes were similar between IP&LV-LGE patients and the rest of LGE+ cases. CONCLUSIONS In a large cohort of DCM patients, IP-LGE was associated with similar outcome when compared with LGE- patients and with significant lower risk of ventricular arrhythmias and sudden death when compared with LGE+ cases. Patients with IP&LV-LGE had clinical characteristics and outcomes similar to the rest of LGE+ cases.
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Affiliation(s)
- Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Alejandro Ruiz-Majoral
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodriguez
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
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Ota H, Kamada H, Higuchi S, Takase K. Clinical Application of 4D Flow MR Imaging to Pulmonary Hypertension. Magn Reson Med Sci 2022; 21:309-318. [PMID: 35185084 PMCID: PMC9680544 DOI: 10.2463/mrms.rev.2021-0111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/19/2021] [Indexed: 10/14/2023] Open
Abstract
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure (PAP). Although right-heart catheterization is the gold standard method for the diagnosis of PH by definition, various less-invasive imaging tests have been used for screening, detection of underlying diseases-causing PH, and monitoring of diseases. Among them, 4D flow MRI is an emerging and unique imaging test that allows for comprehensive visualization of blood flow in the right heart and proximal pulmonary arteries. The characteristic blood flow pattern observed in patients with PH is vortical flow formation in the main pulmonary artery. Recent studies have proposed the use of these findings to determine not only the presence of PH but also estimate the mean PAP. Other applications of 4D flow MRI for PH include measurement of wall shear stress, helicity, and 3D flow balance in the pulmonary arteries. It is worth noting that 4D flow has also the potential for longitudinal follow-ups. In this review, the clinical definition of PH, summary of conventional imaging tests, characteristics of pulmonary arterial flow as shown by 4D flow MRI, and clinical application of 4D flow MRI in the management of patients with PH will be discussed.
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Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Echocardiographic Assessment of Right Ventricular-Arterial Coupling in Predicting Prognosis of Pulmonary Arterial Hypertension Patients. J Clin Med 2021; 10:jcm10132995. [PMID: 34279478 PMCID: PMC8268071 DOI: 10.3390/jcm10132995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
In response to an increased afterload in pulmonary arterial hypertension (PAH), the right ventricle (RV) adapts by remodeling and increasing contractility. The idea of coupling refers to maintaining a relatively constant relationship between ventricular contractility and afterload. Twenty-eight stable PAH patients (mean age 49.5 ± 15.5 years) were enrolled into the study. The follow-up time of this study was 58 months, and the combined endpoint (CEP) was defined as death or clinical deterioration. We used echo TAPSE as a surrogate of RV contractility and estimated systolic pulmonary artery pressure (sPAP) reflecting RV afterload. Ventricular–arterial coupling was evaluated by the ratio between these two parameters (TAPSE/sPAP). In the PAH group, the mean pulmonary artery pressure (mPAP) was 47.29 ± 15.3 mmHg. The mean echo-estimated TAPSE/sPAP was 0.34 ± 0.19 mm/mmHg and was comparable in value and prognostic usefulness to the parameter derived from magnetic resonance and catheterization (ROC analysis). Patients who had CEP (n = 21) had a significantly higher mPAP (53.11 ± 17.11 mmHg vs. 34.86 ± 8.49 mmHg, p = 0.03) and lower TAPSE/sPAP (0.30 ± 0.21 vs. 0.43 ± 0.23, p = 0.04). Patients with a TAPSE/sPAP lower than 0.25 mm/mmHg had worse prognosis, with log-rank test p = 0.001. the echocardiographic estimation of TAPSE/sPAP offers an easy, reliable, non-invasive prognostic parameter for the comprehensive assessment of hemodynamic adaptation in PAH patients.
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Kazimierczyk R, Malek LA, Szumowski P, Nekolla SG, Blaszczak P, Jurgilewicz D, Hladunski M, Sobkowicz B, Mysliwiec J, Grzywna R, Musial WJ, Kaminski KA. Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension. J Cardiovasc Magn Reson 2021; 23:49. [PMID: 33966635 PMCID: PMC8108462 DOI: 10.1186/s12968-021-00743-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients. METHODS Twenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload-pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUVRV/LV. Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration. RESULTS Coupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUVRV/LV). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (-)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R2 = 0.68; p < 0.001). CONCLUSIONS Coupling parameters are linked with RV hemodynamics and glucose metabolism in PAH. Combining CMR and hemodynamic measurements offers more comprehensive assessment of RV function required for prognostication of PAH patients. TRIAL REGISTRATION NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689.
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Affiliation(s)
| | - Lukasz A Malek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Szumowski
- Laboratory of Molecular Imaging, Medical University of Bialystok, Białystok, Poland
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Piotr Blaszczak
- Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland
| | - Dorota Jurgilewicz
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Marcin Hladunski
- Laboratory of Molecular Imaging, Medical University of Bialystok, Białystok, Poland
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Janusz Mysliwiec
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Ryszard Grzywna
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | | | - Karol A Kaminski
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland.
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Waszyngtona 13a, Białystok, 15-269, Poland.
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