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Garg J, Kewcharoen J, Shah K, Turagam M, Bhardwaj R, Contractor T, Mandapati R, Lakkireddy D. Clinical outcomes of radiofrequency catheter ablation of ventricular tachycardia in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:219-224. [PMID: 36335616 PMCID: PMC10100142 DOI: 10.1111/jce.15739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population. OBJECTIVES We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients. METHODS A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow-up, (3) mortality. RESULTS This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug-refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%-95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1-3). During the follow-up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%-86.2%), while after the last ablation was 82.8% (95% CI: 57%-99.2%). There were two deaths during follow-up, one from heart failure and one from SCD 0.8% (95% CI: 0%-5.8%). CONCLUSION The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence-findings comparable to previously published reports in other disease substrates.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
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Naeemah QJ, Komatsu Y, Nogami A, Sekiguchi Y, Igarashi M, Yamasaki H, Shinoda Y, Aonuma K, Ieda M. Catheter Ablation of Ventricular Tachycardia in Dilated‐Phase Hypertrophic Cardiomyopathy: Substrate Characterization and Ablation Outcome. Pacing Clin Electrophysiol 2022; 45:773-785. [DOI: 10.1111/pace.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Qasim J. Naeemah
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Miyako Igarashi
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Yasutoshi Shinoda
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine University of Tsukuba Tennodai Japan
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3
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Sakakibara T, Suwa K, Ushio T, Wakayama T, Alley M, Saotome M, Satoh H, Maekawa Y. Intra-Left Ventricular Hemodynamics Assessed with 4D Flow Magnetic Resonance Imaging in Patients with Left Ventricular Thrombus. Int Heart J 2021; 62:1287-1296. [PMID: 34853222 DOI: 10.1536/ihj.20-792] [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] [Indexed: 11/18/2022]
Abstract
Left ventricular thrombus (LVT) has been identified to be crucial in patients with reduced ejection fraction (EF). Three-dimensional cine phase-contrast magnetic resonance imaging (4D flow MRI) can visualize the intra-LV vortex during diastole and quantify the maximum flow velocity (Vmax) at the apex. In this study, we investigated whether the change in the intra-LV vortex was associated with the presence of LVT in patients with cardiac disease.In total, 36 patients (63.5 ± 11.9 years, 28 men, 12/24 with/without LVT) with diffuse LV dysfunction underwent 4D flow MRI. The relative vortex area using streamline images and Vmax of blood flow toward the apex at the apical left ventricle were evaluated. The correlation between the relative vortex area and Vmax was assessed using Pearson's correlation coefficient. The ability to detect LVT was evaluated using the area under the curve (AUC) of the receiver operating characteristic.The relative vortex area was found to be smaller (27 ± 10% versus 45 ± 11%, P = 0.000026), whereas Vmax at the apical left ventricle was lower (19.1 ± 4.4 cm/second versus 27.4 ± 8.9 cm/second, P = 0.0006) in patients with LVT. Vmax at the apical left ventricle demonstrated significant correlations with the relative vortex area (r = 0.43, P = 0.01) and relative transverse length of the vortex (r = 0.45, P = 0.007). The AUC was 0.91 for the relative vortex area, whereas it was 0.80 for Vmax in the apical left ventricle.A smaller LV vortex and lower flow velocity at the LV apex were associated with LVT in patients with reduced EF.
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Affiliation(s)
- Tomoaki Sakakibara
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Takasuke Ushio
- Department of Radiology, Hamamatsu University School of Medicine
| | | | - Marcus Alley
- Division of Radiology, Stanford University School of Medicine, Stanford
| | - Masao Saotome
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Hiroshi Satoh
- Department of Cardiology, Fujinomiya City General Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
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4
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Kitaoka H, Tsutsui H, Kubo T, Ide T, Chikamori T, Fukuda K, Fujino N, Higo T, Isobe M, Kamiya C, Kato S, Kihara Y, Kinugawa K, Kinugawa S, Kogaki S, Komuro I, Hagiwara N, Ono M, Maekawa Y, Makita S, Matsui Y, Matsushima S, Sakata Y, Sawa Y, Shimizu W, Teraoka K, Tsuchihashi-Makaya M, Ishibashi-Ueda H, Watanabe M, Yoshimura M, Fukusima A, Hida S, Hikoso S, Imamura T, Ishida H, Kawai M, Kitagawa T, Kohno T, Kurisu S, Nagata Y, Nakamura M, Morita H, Takano H, Shiga T, Takei Y, Yuasa S, Yamamoto T, Watanabe T, Akasaka T, Doi Y, Kimura T, Kitakaze M, Kosuge M, Takayama M, Tomoike H. JCS/JHFS 2018 Guideline on the Diagnosis and Treatment of Cardiomyopathies. Circ J 2021; 85:1590-1689. [PMID: 34305070 DOI: 10.1253/circj.cj-20-0910] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Noboru Fujino
- Department of Cardiovascular and Internal Medicine, Kanazawa University, Graduate School of Medical Science
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Chizuko Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | | | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama International Medical Center, Saitama Medical University
| | - Yoshiro Matsui
- Department of Cardiac Surgery, Hanaoka Seishu Memorial Hospital
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Satoshi Hida
- Department of Cardiovascular Medicine, Tokyo Medical University
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoji Nagata
- Division of Cardiology, Fukui CardioVascular Center
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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The Clinical Prognosis of Presence and Location of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Imaging in Patients with Hypertrophic Cardiomyopathy: a Single-Center Cohort Study. J Cardiovasc Transl Res 2021; 14:1001-1016. [PMID: 33629154 DOI: 10.1007/s12265-021-10107-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/15/2021] [Indexed: 01/07/2023]
Abstract
Increasing data have indicated that late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) images is associated with the clinical prognosis of hypertrophic cardiomyopathy (HCM). Recently, pioneer studies indicated that the location of LGE in CMR images also had potential predictive value for HCM prognosis. The aim of the present study was to investigate the prognostic value of the location of LGE for HCM. This present cohort study included 557 HCM patients who underwent LGE-CMR imaging, and the LGE location was classified as LGE in interventricular septum only (IVS-LGE) and LGE outside the IVS with or without IVS involvement (other than IVS-LGE). All-cause mortality, cardiovascular mortality/cardiac transplantation, and sudden cardiac death (SCD) were evaluated. During a mean follow-up time of 83.0±37.8 months, there was a significantly higher all-cause mortality, cardiovascular mortality/cardiac transplantation, and SCD in patients with other than IVS-LGE than in those with IVS-LGE. Multivariate Cox regression suggested that other than IVS-LGE were one of independent prognostic predictors. Risk reclassification for prognosis showed that there were no differences between the prediction values of the presence of LGE and the location of LGE. The presence and location of LGE in CMR images are equally independent prognostic predictors of HCM, and other than IVS-LGE location is associated with an adverse clinical prognosis. Prognosis Trial Registration: ChiCTR-ONRC-11001902.
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Matusik PS, Bryll A, Matusik PT, Popiela TJ. Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction. Cardiol J 2020; 28:67-76. [PMID: 32037500 DOI: 10.5603/cj.a2020.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/27/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may reveal myocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantable cardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall is related to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was to assess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction. METHODS Sixty-seven patients were included (17.9% female, aged 45 [29-60] years), who underwent LGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography. RESULTS In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE were observed in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in 23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in the posterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previous myocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78% vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2% of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for its association with older age and previous MI (p = 0.08 and p = 0.12, respectively). CONCLUSIONS Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, and previous MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures.
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Affiliation(s)
- Patrycja S Matusik
- Department of Radiology, University Hospital, Skawińska 8 Street, 33-332 Kraków, Poland
| | - Amira Bryll
- Department of Diagnostic Imaging, Jagiellonian University Medical College
| | - Paweł T Matusik
- Institute of Cardiology, Jagiellonian University Medical College, Prądnicka 80 Street, 31-202 Kraków, Poland. .,Department of Electrocardiology, The John Paul II Hospital, Prądnicka 80 Street, 31-202 Kraków, Poland.
| | - Tadeusz J Popiela
- Department of Diagnostic Imaging, Jagiellonian University Medical College
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7
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Yamashita S, Saotome M, Satoh H, Kajihara J, Mochizuki Y, Mizuno K, Nobuhara M, Miyajima K, Kumazawa A, Tominaga H, Takase H, Tawarahara K, Wakahara N, Matsunaga M, Wakabayashi Y, Matsumoto Y, Terada H, Sano M, Ohtani H, Urushida T, Hayashi H, Ishii S, Maruyama H, Maekawa Y. Plasma Globotriaosylsphingosine Level as a Primary Screening Target for Fabry Disease in Patients With Left Ventricular Hypertrophy. Circ J 2019; 83:1901-1907. [DOI: 10.1253/circj.cj-19-0110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hiroki Maruyama
- Department of Clinical Nephroscience, Niigata University Graduate School of Medicine and Dental Science
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8
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Park J, Lee HJ, Kim SK, Yi JE, Shin DG, Lee JM, Kim Y, Kim YJ, Joung B. Smoking aggravates ventricular arrhythmic events in non-ischemic dilated cardiomyopathy associated with a late gadolinium enhancement in cardiac MRI. Sci Rep 2018; 8:15609. [PMID: 30353108 PMCID: PMC6199322 DOI: 10.1038/s41598-018-34145-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/10/2018] [Indexed: 01/09/2023] Open
Abstract
Smoking is known to increase cardiovascular events, but the association and mechanisms between smoking and ventricular arrhythmic events in dilated cardiomyopathy (DCMP) are unknown. The purpose of this study is to investigate the hypothesis that smoking is associated with sudden cardiac death (SCD) and ventricular arrhythmia in DCMP patients. We enrolled 378 patients who underwent cardiovascular magnetic resonance imaging (cMRI) and were diagnosed with DCMP at two general hospitals in Korea. The clinical data and left ventricular late-gadolinium enhancement (LV-LGE) of all patients were analyzed according to being never-smokers or smokers. Smokers were more likely to be male than never-smokers, but there was no other clinical difference between them. Smokers had a greater LV-LGE ratio, and multi-segment involvement of LV-LGEs. Smoking and a low left ventricular (LV) ejection fraction were significant predictors of the presence of LV-LGEs even after adjusting for optimal medical therapy. In addition, smokers had a higher fatal ventricular arrhythmic (FVA; sustained ventricular tachycardia, and ventricular fibrillation) and FVA + SCD, and ex-smokers had a similar FVA to never-smokers during 44.3 ± 36.4 months of follow-up. Finally, smoking independently increased the FVA + SCD even after adjusting for the clinical variables and LV-LGE. Smoking is associated with a multi-segmental involvement of LV-LGE and increased FVA + SCD in DCMP patients when compared to never-smokers.
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Affiliation(s)
- Junbeom Park
- Department of Cardiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sook Kyoung Kim
- Department of Cardiology, College of Medicine, Ewha Womans University, Seoul, Korea.,Department of Biomedical Engineering, Medical College, Korea University, Seoul, Korea
| | - Jeong-Eun Yi
- Department of Cardiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Dong Geum Shin
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Jung Myung Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Young-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Department of Cardiology, Internal medicine, Yonsei University Health System, Seoul, Korea.
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Incidence, Clinical Characteristics, and Long-term Outcome of the Dilated Phase of Hypertrophic Cardiomyopathy. Keio J Med 2018; 68:87-94. [DOI: 10.2302/kjm.2018-0004-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Cheng S, Choe YH, Ota H, Cui C, Yin G, Lu M, Li L, Chen X, Prasad SK, Zhao S. CMR assessment and clinical outcomes of hypertrophic cardiomyopathy with or without ventricular remodeling in the end-stage phase. Int J Cardiovasc Imaging 2017; 34:597-605. [DOI: 10.1007/s10554-017-1263-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/19/2017] [Indexed: 12/31/2022]
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11
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Yin L, Xu HY, Zheng SS, Zhu Y, Xiao JX, Zhou W, Yu SS, Gong LG. 3.0 T magnetic resonance myocardial perfusion imaging for semi-quantitative evaluation of coronary microvascular dysfunction in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2017; 33:1949-1959. [DOI: 10.1007/s10554-017-1189-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/09/2017] [Indexed: 01/21/2023]
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12
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Hashimura H, Kimura F, Ishibashi-Ueda H, Morita Y, Higashi M, Nakano S, Iguchi A, Uotani K, Sugimura K, Naito H. Radiologic-Pathologic Correlation of Primary and Secondary Cardiomyopathies: MR Imaging and Histopathologic Findings in Hearts from Autopsy and Transplantation. Radiographics 2017; 37:719-736. [PMID: 28129067 DOI: 10.1148/rg.2017160082] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
RSNA, 2017.
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Affiliation(s)
- Hiromi Hashimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Fumiko Kimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Hatsue Ishibashi-Ueda
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Yoshiaki Morita
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Masahiro Higashi
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Shintaro Nakano
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Atsushi Iguchi
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Kensuke Uotani
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Kazuro Sugimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Hiroaki Naito
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
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Suwa K, Saitoh T, Takehara Y, Sano M, Saotome M, Urushida T, Katoh H, Satoh H, Sugiyama M, Wakayama T, Alley M, Sakahara H, Hayashi H. Intra-left ventricular flow dynamics in patients with preserved and impaired left ventricular function: Analysis with 3D cine phase contrast MRI (4D-Flow). J Magn Reson Imaging 2016; 44:1493-1503. [PMID: 27185516 DOI: 10.1002/jmri.25315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/01/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To examine how left ventricular (LV) volume and function affect flow dynamics by analyzing 3D intra-LV vortex features using 4D-Flow. MATERIALS AND METHODS Twenty-one patients with preserved (LVEF > 60%) and 14 with impaired LV function (LVEF < 40%) underwent 4D-Flow (at 3T). RESULTS In patients with preserved LV function, the intra-LV vortices developed in both the early and late diastolic phases. The shift of inflow vectors at the basal LV toward the posterior-lateral side of the LV and the mid-ventricular turn of inflow vectors toward the LV outflow could explain clearer vortex formation in the late diastolic phase. In patients with impaired LV function, the intra-LV vortices during the diastolic phase located at the more apical LV were larger and more spherically shaped. Both the distance to the vortex core and the vortex area correlated significantly with LV end-diastolic volume (r = 0.66 and 0.73), LVEF (r = -0.74 and -0.68), LV sphericity index (r = -0.60 and -0.65), and peak filling rate (r = -0.61 and -0.64), respectively (P < 0.01). The intra-LV vortices developed during the systolic phase in 10 cases. In those, some of the particles at the apical LV rotated within the LV, whereas in patients with preserved LV function, all of the particles were directed straight to the ascending aorta with accelerated flow velocity (256.8 ± 120.2 cm/s vs. 414.3 ± 88.2 cm/s, P < 0.01). CONCLUSION Vortex formation during the diastolic phase may be critical for both LV filling and ejection. 4D-Flow showed the 3D alterations of intra-LV flow dynamics by LV dilatation and dysfunction in a noninvasive and comprehensive manner. J. Magn. Reson. Imaging 2016;44:1493-1503.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeji Saitoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Katoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masataka Sugiyama
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Wakayama
- Applied Science Laboratory Asia Pacific, GE Healthcare Japan, Hino, Tokyo, Japan
| | - Marcus Alley
- Division of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Harumi Sakahara
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideharu Hayashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Xiao Y, Yang KQ, Yang YK, Liu YX, Tian T, Song L, Jiang XJ, Zhou XL. Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy. Chin Med J (Engl) 2016; 128:1483-9. [PMID: 26021505 PMCID: PMC4733774 DOI: 10.4103/0366-6999.157656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: End-stage hypertrophic cardiomyopathy (HCM) is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM. Methods: End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality. Results: End-stage HCM was identified in 99 (5.4%) patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA) III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05–3.80; P = 0.036), left bundle branch block (LBBB) (HR: 2.80; 95% CI: 1.47–5.31; P = 0.002), and an abnormal Q wave (HR: 2.21; 95% CI: 1.16–4.23; P = 0.016) as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death. Conclusions: LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.
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Affiliation(s)
| | | | | | | | | | | | | | - Xian-Liang Zhou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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15
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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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16
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Endogenous contrast T1rho cardiac magnetic resonance for myocardial fibrosis in hypertrophic cardiomyopathy patients. J Cardiol 2015; 66:520-6. [PMID: 25981868 DOI: 10.1016/j.jjcc.2015.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/16/2015] [Accepted: 03/02/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) is a standard method to evaluate myocardial fibrosis, but restricted due to contrast agent contraindications. Non-contrast T1rho can generate endogenous contrast, and detect fibrosis in chronic myocardial infarction. However, T1rho for hypertrophic cardiomyopathy (HCM) patients is still unreported. The present study aimed to investigate T1rho for fibrotic assessment and the clinical implication in HCM patients. METHODS 18 HCM patients and 8 controls underwent T1rho, cine, and LGE cardiac magnetic resonance (CMR). T1rho relaxation time maps were created. Left ventricular (LV) parameters assessed included wall thickness, wall thickening, chamber volumes, ejection function, and fibrotic size. New York Heart Association (NYHA) functional classification was conducted. RESULTS Hyper-T1rho value was identified in 12 HCM patients, consistent with LGE. The mean T1rho values of controls, LGE-negative patients, and remote myocardium of LGE-positive patients were 42.2±1.6ms, 43.9±2.5ms, and 42.5±1.2ms respectively, and these values showed no significant difference (all p>0.05). T1rho-3-SD and T1rho-4-SD fibrotic sizes (32.5±14.0% and 25.1±11.5%) did not differ from LGE fibrotic size (28.1±11.2%) (both p>0.05). For the fibrotic size, T1rho-3-SD method obtained the strongest correlation with LGE (r=0.88, p<0.001), and T1rho-4-SD obtained the minimal mean difference with LGE (-3.1%; -15.2 to 9.1%), compared with other SDs. All the fibrotic sizes assessed by both methods correlated directly with LV maximal end-diastolic thickness (all p<0.05). Negative correlation was found between T1rho-4-SD fibrotic size and LV ejection fraction (r=-0.49, p=0.11). T1rho-4-SD fibrotic size showed positive correlation with NYHA class (r=0.46, p=0.13). CONCLUSIONS T1rho CMR has potential to detect fibrosis in HCM patients. 4-SD may be the appropriate threshold for assessment.
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18
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Chiribiri A, Leuzzi S, Conte MR, Bongioanni S, Bratis K, Olivotti L, De Rosa C, Lardone E, Di Donna P, Villa ADM, Cesarani F, Nagel E, Gaita F, Bonamini R. Rest perfusion abnormalities in hypertrophic cardiomyopathy: correlation with myocardial fibrosis and risk factors for sudden cardiac death. Clin Radiol 2015; 70:495-501. [PMID: 25659937 PMCID: PMC4398331 DOI: 10.1016/j.crad.2014.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/16/2014] [Accepted: 12/29/2014] [Indexed: 01/27/2023]
Abstract
Aim To measure the prevalence of abnormal rest perfusion in a population of consecutive patients with known hypertrophic cardiomyopathy (HCM) referred for cardiovascular MRI (CMR), and to assess any associations between abnormal rest perfusion and the presence, pattern, and severity of myocardial scar and the presence of risk factors for sudden death. Materials and methods Eighty consecutive patients with known HCM referred for CMR underwent functional imaging, rest first-pass perfusion, and late gadolinium enhancement (LGE). Results Thirty percent of the patients had abnormal rest perfusion, all of them corresponding to areas of mid-myocardial LGE and to a higher degree of segmental hypertrophy. Rest perfusion abnormalities correlated with more extensive and confluent LGE. The subgroup of patients with myocardial fibrosis and rest perfusion abnormalities (fibrosis+/perfusion+) had more than twice the incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring in comparison to patients with myocardial fibrosis and normal rest perfusion (fibrosis+/perfusion–) and patients with no fibrosis and normal rest perfusion (fibrosis–/perfusion–). Conclusions First-pass perfusion CMR identifies abnormal rest perfusion in a significant proportion of patients with HCM. These abnormalities are associated with the presence and distribution of myocardial scar and the degree of hypertrophy. Rest perfusion abnormalities identify patients with increased incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring, independently from the presence of myocardial fibrosis. 30% of patients with HCM have perfusion abnormalities related to scar. No rest perfusion abnormalities were observed in areas of viable myocardium. Scar-related perfusion abnormalities were associated with the incidence of NSVT.
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Affiliation(s)
- A Chiribiri
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Internal Medicine, University of Torino, Italy.
| | - S Leuzzi
- Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - M R Conte
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - S Bongioanni
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - K Bratis
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - L Olivotti
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - C De Rosa
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - E Lardone
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - P Di Donna
- Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - A D M Villa
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - F Cesarani
- Department of Radiology, Cardinal Massaia Hospital, Asti, Italy
| | - E Nagel
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - F Gaita
- Department of Internal Medicine, University of Torino, Italy; Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - R Bonamini
- Department of Internal Medicine, University of Torino, Italy
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Zhu Y, Park EA, Lee W, Kim HK, Chu A, Chung JW, Park JH. Extent of late gadolinium enhancement at right ventricular insertion points in patients with hypertrophic cardiomyopathy: relation with diastolic dysfunction. Eur Radiol 2015; 25:1190-200. [DOI: 10.1007/s00330-014-3390-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/29/2014] [Accepted: 08/07/2014] [Indexed: 01/20/2023]
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20
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Suwa K, Saitoh T, Takehara Y, Sano M, Nobuhara M, Saotome M, Urushida T, Katoh H, Satoh H, Sugiyama M, Wakayama T, Alley M, Sakahara H, Hayashi H. Characteristics of intra-left atrial flow dynamics and factors affecting formation of the vortex flow – analysis with phase-resolved 3-dimensional cine phase contrast magnetic resonance imaging. Circ J 2014; 79:144-52. [PMID: 25391258 DOI: 10.1253/circj.cj-14-0562] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The intra-left atrial (LA) blood flow from pulmonary veins (PVs) to the left ventricle (LV) changes under various conditions and might affect global cardiac function. By using phase-resolved 3-dimensional cine phase contrast magnetic resonance imaging (4D-Flow), the intra-LA vortex formation was visualized and the factors affecting the intra-LA flow dynamics were examined. METHODS AND RESULTS Thirty-two patients with or without organic heart diseases underwent 4D-Flow and transthoracic echocardiography. The intra-LA velocity vectors from each PV were post-processed to delineate streamline and pathline images. The vector images revealed intra-LA vortex formation in 20 of 32 patients. All the vortices developed during the late systolic and early diastolic phases and were directed counter-clockwise when viewed from the subjects' cranial side. The flow vectors from the right PVs lengthened predominantly toward the mitral valves and partly toward the LA appendage, whereas those from the left PVs directed rightward along the posterior wall and joined the vortex. Patients with vortex had less organic heart diseases, smaller LV and LA volume, and greater peak flow velocity and volume mainly in the left PVs, although the flow directions from each PV or PV areas did not differ. CONCLUSIONS 4D-Flow can clearly visualize the intra-LA vortex formation and analyze its characteristic features. The vortex formation might depend on LV and LA volume and on flow velocity and volume from PVs.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University Hospital
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21
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Suwa K, Satoh H, Sano M, Nobuhara M, Saitoh T, Saotome M, Urushida T, Katoh H, Tawarahara K, Ohtani H, Wakabayashi Y, Takase H, Terada H, Takehara Y, Sakahara H, Hayashi H. Functional, morphological and electrocardiographical abnormalities in patients with apical hypertrophic cardiomyopathy and apical aneurysm: correlation with cardiac MR. Open Heart 2014; 1:e000124. [PMID: 25332823 PMCID: PMC4189224 DOI: 10.1136/openhrt-2014-000124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 12/11/2022] Open
Abstract
Objective The prognosis of apical hypertrophic cardiomyopathy (APH) has been benign, but apical myocardial injury has prognostic importance. We studied functional, morphological and electrocardiographical abnormalities in patients with APH and with apical aneurysm and sought to find parameters that relate to apical myocardial injury. Methods Study design: a multicentre trans-sectional study. Patients: 45 patients with APH and 5 with apical aneurysm diagnosed with transthoracic echocardiography (TTE) in the database of Hamamatsu Circulation Forum. Measure: the apical contraction with cine-cardiac MR (CMR), the myocardial fibrotic scar with late gadolinium enhancement (LGE)-CMR, and QRS fragmentation (fQRS) defined when two ECG-leads exhibited RSR’s patterns. Results Cine-CMR revealed 27 patients with normal, 12 with hypokinetic and 11 with dyskinetic apical contraction. TTE misdiagnosed 11 (48%) patients with hypokinetic and dyskinetic contraction as those with normal contraction. Apical LGE was apparent in 10 (83%) and 11 (100%) patients with hypokinetic and dyskinetic contraction, whereas only in 11 patients (41%) with normal contraction (p<0.01). Patients with dyskinetic apical contraction had the lowest left ventricular ejection fraction, the highest prevalence of ventricular tachycardia, and the smallest ST depression and depth of negative T waves. The presence of fQRS was associated with impaired apical contraction and apical LGE (OR=8.32 and 8.61, p<0.05). Conclusions CMR is superior to TTE for analysing abnormalities of the apex in patients with APH and with apical aneurysm. The presence of fQRS can be a promising parameter for the early detection of apical myocardial injury.
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Affiliation(s)
- Kenichiro Suwa
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Hiroshi Satoh
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.) ; Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Sano
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Mamoru Nobuhara
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Takeji Saitoh
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Masao Saotome
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Tsuyoshi Urushida
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Hideki Katoh
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Kei Tawarahara
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Hayato Ohtani
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Yasushi Wakabayashi
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Hiroyuki Takase
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Hajime Terada
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
| | - Yasuo Takehara
- Department of Radiology , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Harumi Sakahara
- Department of Radiology , Hamamatsu University School of Medicine , Hamamatsu , Japan
| | - Hideharu Hayashi
- The Investigator Group , Hamamatsu Circulation Forum ; (Hamamatsu Circulation Forum consists of Enshu Hospital, Hamamatsu University Hospital, Hamamatsu Red Cross Hospital, Kosai General Hospital and Seirei Mikatahara Hospital.)
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Satoh H, Sano M, Suwa K, Saitoh T, Nobuhara M, Saotome M, Urushida T, Katoh H, Hayashi H. Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in differential diagnosis, clinical features and prognosis. World J Cardiol 2014; 6:585-601. [PMID: 25068019 PMCID: PMC4110607 DOI: 10.4330/wjc.v6.i7.585] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/21/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
The recent development of cardiac magnetic resonance (CMR) techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution. We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies (ICM and NICM), especially in terms of the location and distribution of late gadolinium enhancement (LGE). CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory, and the subendocardial or transmural LGE. LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer. The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function, including dilated cardiomyopathy, end-stage hypertrophic cardiomyopathy (HCM), cardiac sarcoidosis, and myocarditis, and those with diffuse left ventricular (LV) hypertrophy including HCM, cardiac amyloidosis and Anderson-Fabry disease. A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy. In arrhythmogenic right ventricular cardiomyopathy/dysplasia, an enhancement of right ventricular (RV) wall with functional and morphological changes of RV becomes apparent. Finally, the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.
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Sano M, Satoh H, Suwa K, Nobuhara M, Saitoh T, Saotome M, Urushida T, Katoh H, Shimoyama K, Suzuki D, Ogawa N, Takehara Y, Sakahara H, Hayashi H. Characteristics and clinical relevance of late gadolinium enhancement in cardiac magnetic resonance in patients with systemic sclerosis. Heart Vessels 2014; 30:779-88. [PMID: 24996373 PMCID: PMC4648959 DOI: 10.1007/s00380-014-0539-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/13/2014] [Indexed: 01/14/2023]
Abstract
Cardiac involvement in systemic sclerosis (SSc) is considerably frequent in autopsy, but the early identification is clinically difficult. Recent advantages in cardiac magnetic resonance (CMR) enabled to detect myocardial fibrotic scar as late gadolinium enhancement (LGE). We aimed to examine the prevalence and distribution of LGE in patients with SSc, and associate them with clinical features, electrocardiographic abnormalities and cardiac function. Forty patients with SSc (58 ± 14 years-old, 35 females, limited/diffuse 25/15, disease duration 106 ± 113 months) underwent serological tests, 12-lead electrocardiogram (ECG) and CMR. Seven patients (17.5 %) showed LGE in 26 segments of left ventricle (LV). LGE distributed mainly in the basal to mid inter-ventricular septum and the right ventricular (RV) insertion points, but involved all the myocardial regions. More patients with LGE showed NYHA functional class II and more (71 vs. 21 %, p < 0.05), bundle branch blocks (57 vs. 6 %, p < 0.05), LV ejection fraction (LVEF) < 50 % (72 vs. 6 %, p < 0.01), LV asynergy (43 vs. 0 %, p < 0.01) and RVEF < 40 % (100 vs. 39 %, p < 0.01). There was no difference in disease duration, disease types, or prevalence of positive autoimmune antibodies or high serum NT-proBNP level (>125 pg/ml). When cardiac involvement of SSc was defined as low LVEF, ECG abnormalities or high NT-proBNP, the sensitivity, specificity positive and negative predictive values of LGE were 36, 92, 71 and 72 %, respectively. We could clarify the prevalence and distribution of LGE in Japanese patients with SSc. The presence of LGE was associated with cardiac symptom, conduction disturbance and impaired LV/RV contraction.
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Affiliation(s)
- Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan.
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Mamoru Nobuhara
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Takeji Saitoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Hideki Katoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
| | - Kumiko Shimoyama
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Suzuki
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyoshi Ogawa
- Division of Immunology and Rheumatology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Harumi Sakahara
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideharu Hayashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ward, Hamamatsu, 431-3192, Japan
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Machii M, Satoh H, Shiraki K, Saotome M, Urushida T, Katoh H, Takehara Y, Sakahara H, Ohtani H, Wakabayashi Y, Ukigai H, Tawarahara K, Hayashi H. Distribution of late gadolinium enhancement in end-stage hypertrophic cardiomyopathy and dilated cardiomyopathy: Differential diagnosis and prediction of cardiac outcome. Magn Reson Imaging 2014; 32:118-24. [DOI: 10.1016/j.mri.2013.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/11/2013] [Accepted: 10/11/2013] [Indexed: 01/01/2023]
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Magrì D, De Cecco CN, Piccirillo G, Mastromarino V, Serdoz A, Muscogiuri G, Ricotta A, Gregori M, Marino L, Cauti FM, Pagannone E, Musumeci MB, Maruotti A, Autore C. Myocardial Repolarization Dispersion and Late Gadolinium Enhancement in Patients With Hypertrophic Cardiomyopathy. Circ J 2014; 78:1216-23. [DOI: 10.1253/circj.cj-13-1423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Sapienza University
| | - Carlo Nicola De Cecco
- Department of Radiological Sciences, Sapienza University
- Department of Radiology and Radiological Sciences, Medical University of South Carolina
| | - Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Anesthesiological, Nephrologic and Geriatrics Sciences, Sapienza University
| | | | - Andrea Serdoz
- Department of Clinical and Molecular Medicine, Sapienza University
| | | | - Agnese Ricotta
- Department of Clinical and Molecular Medicine, Sapienza University
| | - Mario Gregori
- Department of Clinical and Molecular Medicine, Sapienza University
| | - Laura Marino
- Department of Clinical and Molecular Medicine, Sapienza University
| | | | - Erika Pagannone
- Department of Clinical and Molecular Medicine, Sapienza University
| | | | - Antonello Maruotti
- Department of Political Sciences, University Roma Tre
- Southampton Statistical Sciences Research Institute and School of Mathematics, University of Southampton
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University
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Delcrè SDL, Di Donna P, Leuzzi S, Miceli S, Bisi M, Scaglione M, Caponi D, Conte MR, Cecchi F, Olivotto I, Gaita F. Relationship of ECG findings to phenotypic expression in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study. Int J Cardiol 2013; 167:1038-45. [DOI: 10.1016/j.ijcard.2012.03.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/01/2012] [Accepted: 03/03/2012] [Indexed: 01/21/2023]
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Tachi M, Amano Y, Kobayashi Y, Mizuno K, Kumita S. Evaluation of nonscarred myocardial T1 value using contrast-enhanced look-locker cardiac MRI and its relationship to cardiac function in dilated cardiomyopathy: Comparison of 1.5 and 3.0 Tesla MRI. J Magn Reson Imaging 2013; 38:1395-401. [PMID: 23852918 DOI: 10.1002/jmri.24131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess relationship between nonscarred myocardial T1 value measured using contrast-enhanced Look-Locker MRI and cardiac function in dilated cardiomyopathy (DCM) at 1.5 Tesla (T) and 3.0T MRI. MATERIALS AND METHODS Contrast-enhanced Look-Locker MRI was performed in 35 DCM patients. Nonscarred myocardial and blood T1 values were calculated from the signal intensity values and the delay time obtained on Look-Locker MRI. We assessed the correlation between the myocardial T1 value or myocardial T1 minus blood T1 value and cardiac function estimated using cine MRI (e.g., end-diastolic volume: EDV, left ventricular ejection fraction: LVEF) or brain natriuretic peptide (BNP). RESULTS With 1.5T MRI (n = 16), the myocardial T1 value correlated negatively with the EDV(r = -0.66) and end-systolic volume (ESV; r = -0.68), and positively with the LVEF (r = 0.51); the myocardial T1 minus blood T1 value correlated inversely with EDV (r = -0.70), ESV (r = -0.62), and brain natriuretic peptide (BNP; r = -0.56). With 3.0T MRI (n = 17), the myocardial T1 value correlated negatively with ESV (r = -0.44), septal thickness (r = -0.60), and BNP (r = -0.51), and positively with LVEF (r = 0.61); the myocardial T1 minus blood T1 value negatively correlated with BNP (r = -0.50) and positively with LVEF (r = 0.54). CONCLUSION The nonscarred myocardial T1 value measured with either 1.5T or 3.0T contrast-enhanced Look-Locker MRI is significantly related to cardiac dysfunction in DCM.
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Affiliation(s)
- Masaki Tachi
- Departments of Radiology, Nippon Medical School, Tokyo, Japan
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28
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Al-Mallah MH, Shareef MN. The role of cardiac magnetic resonance imaging in the assessment of non-ischemic cardiomyopathy. Heart Fail Rev 2011; 16:369-80. [PMID: 21170585 DOI: 10.1007/s10741-010-9221-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cardiovascular magnetic resonance imaging (CMR) plays an increasing role in the assessment of patients with various cardiovascular disorders. Given its enhanced spatial resolution, improved tissue characterization, and lack of ionizing radiation, it has become the test of choice in the evaluation of patients with new-onset cardiomyopathy of unknown etiology. In this paper, we will review the role of CMR in the evaluation of patients with various types of non-ischemic cardiomyopathy.
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Affiliation(s)
- Mouaz H Al-Mallah
- King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City, Department Mail Code 1413, P.O. Box 22490, Riyadh 11426, Kingdom of Saudi Arabia.
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Nojiri A, Hongo K, Kawai M, Komukai K, Sakuma T, Taniguchi I, Yoshimura M. Scoring of late gadolinium enhancement in cardiac magnetic resonance imaging can predict cardiac events in patients with hypertrophic cardiomyopathy. J Cardiol 2011; 58:253-60. [DOI: 10.1016/j.jjcc.2011.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 07/23/2011] [Indexed: 01/16/2023]
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Shiraki K, Satoh H, Saitoh T, Saotome M, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. Comparison of global and regional abnormalities in 99mTc-sestamibi and cardiac magnetic resonance imaging in dilated cardiomyopathy. J Card Fail 2010; 16:641-8. [PMID: 20670843 DOI: 10.1016/j.cardfail.2010.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 02/09/2010] [Accepted: 03/04/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The clinical relevance of perfusion defects and increased washout rate (WOR) in (99m)Tc-sestamibi (Tc MIBI) imaging has not been well characterized in dilated cardiomyopathy (DCM). We analyzed abnormalities in Tc MIBI imaging in relation to those in cardiac magnetic resonance (CMR) imaging. METHODS AND RESULTS Nineteen DCM patients underwent both Tc MIBI and CMR imaging. The perfusion defects and global and regional MIBI WORs were evaluated with planar and single photon emission computed tomography (SPECT) images. The left ventricular function and the delayed enhancement (DE) were estimated with the cine- and DE-mode CMR. In the DCM patients, the Tc MIBI SPECT showed perfusion defects in 65 segments of 14 patients. The global and regional Tc MIBI WORs were higher than those in 10 normal volunteers (19.4 +/- 9.1% vs. 11.7 +/- 6.8% in global and 13.8 +/- 8.6% vs. 9.6 +/- 8.2% in regional WORs; mean +/- SD, P < .01). The DE-mode CMR demonstrated DE in 103 segments of 14 patients. The severity of perfusion defects was correlated with the extent of DE (r = 0.71, P < .01). The regional Tc MIBI WOR was highest in the segments with perfusion defects or DE, but the Tc MIBI WOR in segments without them was also higher than that in the normal volunteers. There was a weak but significant negative correlation between the regional Tc MIBI WOR and wall thickening (r = -0.23, P < .01). CONCLUSIONS In DCM, the severity of perfusion defects and the increase in Tc MIBI WOR reflect the spread of myocardial fibrosis and/or scar. The increase in Tc MIBI WOR is potentially associated with regional dysfunction of LV wall.
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Affiliation(s)
- Katsunori Shiraki
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
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Kitaoka H, Kubo T, Okawa M, Hayato K, Yamasaki N, Matsumura Y, Doi YL. Impact of Metalloproteinases on Left Ventricular Remodeling and Heart Failure Events in Patients With Hypertrophic Cardiomyopathy. Circ J 2010; 74:1191-6. [DOI: 10.1253/circj.cj-09-1013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Toru Kubo
- Department of Medicine and Geriatrics, Kochi Medical School
| | - Makoto Okawa
- Department of Medicine and Geriatrics, Kochi Medical School
| | - Kayo Hayato
- Department of Medicine and Geriatrics, Kochi Medical School
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Rubinshtein R, Glockner JF, Ommen SR, Araoz PA, Ackerman MJ, Sorajja P, Bos JM, Tajik AJ, Valeti US, Nishimura RA, Gersh BJ. Characteristics and clinical significance of late gadolinium enhancement by contrast-enhanced magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Circ Heart Fail 2009; 3:51-8. [PMID: 19850699 DOI: 10.1161/circheartfailure.109.854026] [Citation(s) in RCA: 308] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Myocardial late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (CE-MRI) of patients with hypertrophic cardiomyopathy (HCM) has been suggested to represent intramyocardial fibrosis and, as such, an adverse prognostic risk factor. We evaluated the characteristics of LGE on CE-MRI and explored whether LGE among patients with HCM was associated with genetic testing, severe symptoms, ventricular arrhythmias, or sudden cardiac death (SCD). METHODS AND RESULTS Four hundred twenty-four patients with HCM (age=55+/-16 years [range 2 to 90], 41% females), without a history of septal ablation/myectomy, underwent CE-MRI (GE 1.5 Tesla). We evaluated the relation between LGE and HCM genes status, severity of symptoms, and the degree of ventricular ectopy on Holter ECG. Subsequent SCD and appropriate implanted cardioverter defibrillator (ICD) therapies were recorded during a mean follow-up of 43+/-14 months (range 16 to 94). Two hundred thirty-nine patients (56%) had LGE on CE-MRI, ranging from 0.4% to 65% of the left ventricle. Gene-positive patients were more likely to have LGE (P<0.001). The frequencies of New York Heart Association class >or=3 dyspnea and angina class >or=3 were similar in patients with and without LGE (125 of 239 [52%] versus 94 of 185 [51%] and 24 of 239 [10%] versus 18 of 185 [10%], respectively, P=NS). LGE-positive patients were more likely to have episodes of nonsustained ventricular tachycardia (34 of 126 [27%] versus 8 of 94 [8.5%], P<0.001), had more episodes of nonsustained ventricular tachycardia per patient (4.5+/-12 versus 1.1+/-0.3, P=0.04), and had higher frequency of ventricular extrasystoles/24 hours (700+/-2080 versus 103+/-460, P=0.003). During follow-up, SCD occurred in 4 patients, and additional 4 patients received appropriate ICD discharges. All 8 patients were LGE positive (event rate of 0.94%/y, P=0.01 versus LGE negative). Two additional heart failure-related deaths were recorded among LGE-positive patients. Univariate associates of SCD or appropriate ICD discharge were positive LGE (P=0.002) and presence of nonsustained ventricular tachycardia (P=0.04). The association of LGE with events remained significant after controlling for other risk factors. CONCLUSIONS In patients with HCM, presence of LGE on CE-MRI was common and more prevalent among gene-positive patients. LGE was not associated with severe symptoms. However, LGE was strongly associated with surrogates of arrhythmia and remained a significant associate of subsequent SCD and/or ICD discharge after controlling for other variables. If replicated, LGE may be considered an important risk factor for sudden death in patients with HCM.
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Affiliation(s)
- Ronen Rubinshtein
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Senthilkumar A, Majmudar MD, Shenoy C, Kim HW, Kim RJ. Identifying the etiology: a systematic approach using delayed-enhancement cardiovascular magnetic resonance. Heart Fail Clin 2009; 5:349-67, vi. [PMID: 19564013 DOI: 10.1016/j.hfc.2009.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In patients who have heart failure, treatment and survival are directly related to the cause. Clinically, as a practical first step, patients are classified as having either ischemic or non-ischemic cardiomyopathy, a delineation usually based on the presence or absence of epicardial coronary artery disease. However, this approach does not account for patients with non-ischemic cardiomyopathy who also have coronary artery disease, which may be either incidental or partly contributing to myocardial dysfunction (mixed cardiomyopathy). By allowing direct assessment of the myocardium, delayed-enhancement cardiovascular magnetic resonance (DE-CMR) may aid in addressing these conundrums. This article explores the use of DE-CMR in identifying ischemic and non-ischemic myopathic processes and details a systematic approach to determine the cause of cardiomyopathy.
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Nanjo S, Yoshikawa K, Harada M, Inoue Y, Namiki A, Nakano H, Yamazaki J. Correlation between left ventricular diastolic function and ejection fraction in dilated cardiomyopathy using magnetic resonance imaging with late gadolinium enhancement. Circ J 2009; 73:1939-44. [PMID: 19729860 DOI: 10.1253/circj.cj-08-0965] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The distribution of left ventricular (LV) fibrosis and the percent fibrosis in patients with dilated cardiomyopathy (DCM) were evaluated using late gadolinium enhanced (LGE) MRI. Then the relation with the LV ejection fraction (EF) and deceleration time (DT), an index of diastolic function obtained using echocardiography, was investigated. METHODS AND RESULTS LGEMRI at 20 min after intravenous injection of Gd-DTPA (0.15 +/-0.03 mmol/kg) was performed in 17 patients with DCM. The distribution of the LV enhanced area and LGE rate (%) were calculated. EF, as well as E/A ratio and DT were obtained using echocardiography. LGE was observed in 15 out of 17 patients (88%) and the enhanced region appeared to represent myocardial fibrosis. The LV fibrosis was often found in the intraventricular septum (IVS), but there were no differences in its distribution. The LGE rate (%) had a correlation between cardiac magnetic resonance ejection fraction (CMREF) (Y = 51.7 - 2.1X [R(2) = 0.23, P<0.001]) and DT (Y = 162.2 +12.0X [R(2) = 0.35, P<0.001]). CONCLUSIONS The LV fibrosis is often found in the IVS with DCM. A correlation exists between LGE rate (%) to EF on CMR and DT on echocardiography in patients with DCM.
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Affiliation(s)
- Shuji Nanjo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
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Current World Literature. Curr Opin Pulm Med 2009; 15:521-7. [DOI: 10.1097/mcp.0b013e3283304c7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Satoh H, Matoh F, Shiraki K, Saitoh T, Odagiri K, Saotome M, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. Delayed enhancement on cardiac magnetic resonance and clinical, morphological, and electrocardiographical features in hypertrophic cardiomyopathy. J Card Fail 2009; 15:419-27. [PMID: 19477402 DOI: 10.1016/j.cardfail.2008.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/09/2008] [Accepted: 11/26/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND The clinical, morphological, and electrocardiographical relevance of delayed enhancement (DE) in cardiac magnetic resonance (CMR) was studied in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS A total of 56 patients underwent both gadolinium-enhanced CMR and 12-lead electrocardiogram. The CMR demonstrated DE at the left ventricular (LV) wall in 39 patients. The patients with DE included more cases with dilated phase of HCM, higher New York Heart Association (NYHA) classes and incidence of ventricular tachyarrhythmias (VT), lower LV ejection fraction (LVEF) and mean LV wall thickness (WT), and a larger ratio of maximum to minimum LVWT. The QRS duration was prolonged and the QRS axis deviated toward left with increases in the DE volume (r = 0.58 and r = 0.41, P < .01). Abnormal Q waves were present in 5 patients and the location coincided with the DE segments in 4 patients, but the concordance was not significant. The amplitude of T waves correlated with the ratio of the apex to basal LVWT (r = 0.38, P < .01) and was more negative in cases with DE at the apex. CONCLUSIONS In HCM, the DE was associated with higher NYHA classes and prevalence of VT, impaired global LV function and asymmetrical hypertrophy, and conduction disturbance, abnormal Q waves, and giant negative T waves.
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Affiliation(s)
- Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Japan.
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Shehata ML, Turkbey EB, Vogel-Claussen J, Bluemke DA. Role of cardiac magnetic resonance imaging in assessment of nonischemic cardiomyopathies. Top Magn Reson Imaging 2008; 19:43-57. [PMID: 18690160 DOI: 10.1097/rmr.0b013e31816fcb22] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnosis of nonischemic cardiomyopathy is a challenging process that influences patient morbidity and mortality. Currently, the well known World Health Organization classification has been revisited by an American Heart Association expert consensus panel. The contemporary classification is compatible with the rapid evolution in molecular genetics and evolving diagnostic tools such as cardiac magnetic resonance imaging (MRI). Magnetic resonance imaging is a robust diagnostic tool that offers various techniques to assess the function, morphology, perfusion, and scarring of myocardial tissue thus providing better understanding of the underlying causes of nonischemic cardiomyopathies. In this review, we discuss the current role of cardiac MRI in the evaluation of nonischemic cardiomyopathy, in the context of the current American Heart Association classification of these disorders.
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Affiliation(s)
- Monda L Shehata
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Payá E, Marín F, González J, Gimeno JR, Feliu E, Romero A, Ruiz-Espejo F, Roldán V, Climent V, de la Morena G, Valdés M. Variables Associated With Contrast-Enhanced Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy: Clinical Implications. J Card Fail 2008; 14:414-9. [DOI: 10.1016/j.cardfail.2008.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 02/01/2008] [Accepted: 02/06/2008] [Indexed: 12/26/2022]
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Matoh F, Satoh H, Shiraki K, Odagiri K, Saitoh T, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis. J Cardiol 2008; 51:179-88. [PMID: 18522793 DOI: 10.1016/j.jjcc.2008.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 03/18/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Cardiac involvement is an important prognostic factor in patients with sarcoidosis. We evaluated the usefulness of delayed enhancement MRI (DE-MRI) for diagnosing cardiac sarcoidosis by comparing with nuclear imaging and studying the correlation between DE area and left ventricular (LV) function. METHODS Twelve patients (male:female 3:9) diagnosed as having sarcoidosis underwent Gd-MRI, myocardial perfusion SPECT (Tl-201, Tc-99m sestamibi), Ga-67 scintigraphy, and/or F-18 FDG-PET. RESULTS DE was observed in 5 patients, and was positive in 39 (39%) of 100 LV segments. The corresponding perfusion defects in myocardial perfusion SPECT were undetectable in 14 (36%) segments. DE distributed mainly in mid- to epi-myocardium, and the lack of perfusion defects in myocardial perfusion SPECT was more prominent in less transmural DE segments. Two patients with diffuse DE and 1 case with focal DE exhibited positive cardiac uptake in Ga-67 scintigraphy, and 2 other cases with focal DE showed cardiac uptake in F-18 FDG-PET. In 7 patients without DE, there were no significant findings in nuclear imaging. Both LV end-diastolic and end-systolic volume were positively and LV ejection fraction was negatively correlated with the extent of DE area. Four patients treated with corticosteroid showed improvement in nuclear imaging and slight decreases in DE area but no recovery in LV function. CONCLUSIONS DE-MRI is useful to diagnose the cardiac involvement of sarcoidosis and to evaluate cardiac function. It is likely that the distribution of DE in mid- to epi-myocardium is the characteristic of cardiac sarcoidosis, and the larger DE area may be correlated with poor LV function.
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Affiliation(s)
- Fumitaka Matoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan.
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