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Lamy J, Gonzales RA, Xiang J, Seemann F, Huber S, Steele J, Wieben O, Heiberg E, Peters DC. Tricuspid valve flow measurement using a deep learning framework for automated valve-tracking 2D phase contrast. Magn Reson Med 2024; 92:1838-1850. [PMID: 38817154 PMCID: PMC11341256 DOI: 10.1002/mrm.30163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Tricuspid valve flow velocities are challenging to measure with cardiovascular MR, as the rapidly moving valvular plane prohibits direct flow evaluation, but they are vitally important to diastolic function evaluation. We developed an automated valve-tracking 2D method for measuring flow through the dynamic tricuspid valve. METHODS Nine healthy subjects and 2 patients were imaged. The approach uses a previously trained deep learning network, TVnet, to automatically track the tricuspid valve plane from long-axis cine images. Subsequently, the tracking information is used to acquire 2D phase contrast (PC) with a dynamic (moving) acquisition plane that tracks the valve. Direct diastolic net flows evaluated from the dynamic PC sequence were compared with flows from 2D-PC scans acquired in a static slice localized at the end-systolic valve position, and also ventricular stroke volumes (SVs) using both planimetry and 2D PC of the great vessels. RESULTS The mean tricuspid valve systolic excursion was 17.8 ± 2.5 mm. The 2D valve-tracking PC net diastolic flow showed excellent correlation with SV by right-ventricle planimetry (bias ± 1.96 SD = -0.2 ± 10.4 mL, intraclass correlation coefficient [ICC] = 0.92) and aortic PC (-1.0 ± 13.8 mL, ICC = 0.87). In comparison, static tricuspid valve 2D PC also showed a strong correlation but had greater bias (p = 0.01) versus the right-ventricle SV (10.6 ± 16.1 mL, ICC = 0.61). In most (8 of 9) healthy subjects, trace regurgitation was measured at begin-systole. In one patient, valve-tracking PC displayed a high-velocity jet (380 cm/s) with maximal velocity agreeing with echocardiography. CONCLUSION Automated valve-tracking 2D PC is a feasible route toward evaluation of tricuspid regurgitant velocities, potentially solving a major clinical challenge.
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Affiliation(s)
- Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Ricardo A Gonzales
- Oxford Center for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jie Xiang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Jeremy Steele
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Einar Heiberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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Marsac P, Wallet T, Redheuil A, Gueda Moussa M, Lamy J, Nguyen V, Charpentier E, Hammoudi N, Bollache E, Kachenoura N. New atrio-ventricular indices derived from conventional cine MRI correlate with functional capacity in patients with asymptomatic primary mitral regurgitation. Sci Rep 2024; 14:21429. [PMID: 39271732 PMCID: PMC11399337 DOI: 10.1038/s41598-024-71563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
Mitral regurgitation (MR) is associated with morphological and functional alterations of left atrium (LA) and ventricle (LV), possibly inducing LA-LV misalignment. We aimed to: (1) characterize angulation between LA and mitral annulus from conventional cine MRI data and feature-tracking (FT) contours, (2) assess their associations with functional capacity in MR patients, as assessed by oxygen consumption (peak-VO2) and minute ventilation to carbon dioxide production (VE/VCO2) slope, in comparison with MRI LA/LV strain indices. Thirty-two asymptomatic primary MR patients (56 [40; 66] years, 12 women) underwent cardiac MRI resulting in LA/LV conventional FT-derived strain indices. Then, end-diastolic angles were derived from FT LA contours: (1) α, centered on the LA centre of mass and defined by mitral valve extremities, (2) γ, centered on the mitral ring anterior/lateral side, and defined by LA centre and the other extremity of the mitral ring. Cardiopulmonary exercise testing with simultaneous echocardiography were also performed; peak-VO2 and VE/VCO2 slope were measured. While peak-VO2 and VE/VCO2 slope were not correlated to LA/LV strains, they were significantly associated with angles (α: r = 0.50, p = 0.003 and r = - 0.52, p = 0.003; γ: r = - 0.53, p = 0.002 and r = 0.52, p = 0.003; respectively), independently of age and gender (R2 ≥ 0.29, p ≤ 0.03). In primary MR, the new LA/mitral annulus angles, computed directly from standard-of-care MRI, are better correlated to exercise tolerance than conventional LA/LV strain.
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Affiliation(s)
- Perrine Marsac
- Sorbonne Université, Inserm, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15 rue de l'ecole de medecine, 75006, Paris, France
| | - Thomas Wallet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Alban Redheuil
- Hôpital Universitaire Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), Paris, France
| | - Moussa Gueda Moussa
- Sorbonne Université, Inserm, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15 rue de l'ecole de medecine, 75006, Paris, France
| | - Jérôme Lamy
- Hôpital Européen Georges-Pompidou, Cardiovascular Research Center (PARCC, Inserm U970), Paris, France
| | - Vincent Nguyen
- Sorbonne Université, Inserm, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15 rue de l'ecole de medecine, 75006, Paris, France
| | - Etienne Charpentier
- Hôpital Universitaire Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Emilie Bollache
- Sorbonne Université, Inserm, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15 rue de l'ecole de medecine, 75006, Paris, France
| | - Nadjia Kachenoura
- Sorbonne Université, Inserm, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, 15 rue de l'ecole de medecine, 75006, Paris, France.
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Gueda Moussa M, Lamy J, Nguyen V, Marsac P, Gencer U, Mousseaux E, Bollache E, Kachenoura N. Estimate of the hydraulic force in the aging heart: a cardiovascular magnetic resonance imaging study. BMC Med Imaging 2024; 24:168. [PMID: 38977955 PMCID: PMC11232129 DOI: 10.1186/s12880-024-01303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/20/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Coupling between left ventricle (LV) and left atrium (LA) plays a central role in the process of cardiac remodeling during aging and development of cardiac disease. The hydraulic force (HyF) is related to variation in size between LV and LA. The objectives of this study were to: (1) derive an estimate of left atrioventricular HyF using cine- Magnetic Resonance Imaging (MRI) in healthy subjects with a wide age range, and (2) study its relationship with age and conventional diastolic function parameters, as estimated by reference echocardiography. METHODS We studied 119 healthy volunteers (mean age 44 ± 17 years, 58 women) who underwent Doppler echocardiography and MRI on the same day. Conventional transmitral flow early (E) and late (A) LV filling peak velocities as well as mitral annulus diastolic longitudinal peak velocity (E') were derived from echocardiography. MRI cine SSFP images in longitudinal two and four chamber views were acquired, and analyzed using feature tracking (FT) software. In addition to conventional LV and LA strain measurements, FT-derived LV and LA contours were further used to calculate chamber cross-sectional areas. HyF was approximated as the difference between the LV and LA maximal cross-sectional areas in the diastasis phase corresponding to the lowest LV-LA pressure gradient. Univariate and multivariate analyses while adjusting for appropriate variables were used to study the associations between HyF and age as well as diastolic function and strain indices. RESULTS HyF decreased significantly with age (R²=0.34, p < 0.0001). In addition, HyF was significantly associated with conventional indices of diastolic function and LA strain: E/A: R²=0.24, p < 0.0001; E': R²=0.24, p < 0.0001; E/E': R²=0.12, p = 0.0004; LA conduit longitudinal strain: R²=0.27, p < 0.0001. In multivariate analysis, associations with E/A (R2 = 0.39, p = 0.03) and LA conduit strain (R2 = 0.37, p = 0.02) remained significant after adjustment for age, sex, and body mass index. CONCLUSIONS HyF, estimated using FT contours, which are primarily used to quantify LV/LA strain on standard cardiac cine MRI, varied significantly with age in association with subclinical changes in ventricular filling. Its usefulness in cohorts of patients with left heart disease to detect LV-LA uncoupling remains to be evaluated.
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Affiliation(s)
- Moussa Gueda Moussa
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, 15 Rue de École de Médecine, Paris, 75006, France
| | - Jérôme Lamy
- PARCC, Université Paris Cité, Inserm, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Nguyen
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, 15 Rue de École de Médecine, Paris, 75006, France
| | - Perrine Marsac
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, 15 Rue de École de Médecine, Paris, 75006, France
| | - Umit Gencer
- PARCC, Université Paris Cité, Inserm, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elie Mousseaux
- PARCC, Université Paris Cité, Inserm, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emilie Bollache
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, 15 Rue de École de Médecine, Paris, 75006, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, 15 Rue de École de Médecine, Paris, 75006, France.
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Ittleman BR, Tretter JT, Bader AS, Mcollum S, Shabanova V, Steele JM. Longitudinal Evaluation of Atrial Function in Patients with Tetralogy of Fallot. Pediatr Cardiol 2024:10.1007/s00246-024-03503-y. [PMID: 38849600 DOI: 10.1007/s00246-024-03503-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/17/2024] [Indexed: 06/09/2024]
Abstract
Atrial function provides insight into ventricular diastolic function. Invasive assessment of left ventricular (LV) diastolic function correlates with development of sustained ventricular tachyarrhythmias in patients with repaired tetralogy of Fallot (rTOF). Non-invasive assessment of atrial function may prove key towards assessment of diastolic function. We longitudinally evaluated the progression of biatrial function in patients with rTOF, regardless of pulmonary valve replacement (PVR). Patients with rTOF who had multiple CMR were identified. CMR examinations were retrospectively reviewed. Left (LA) and right (RA) atrial size and function were measured in the two and four-chamber views and assessed over time and after PVR. Left and right atrial reservoir, conduit, pump strain and strain rates were determined using tissue tracking. Thirty-six patients with rTOF were identified (64% male), ten (28%) had PVR during the study. Median age of PVR was 16.5 years. No improvement in RA or LA function was observed after PVR. A decline in RA reservoir strain rate (p < 0.05) and RA pump strain (p < 0.05) were observed despite improvements in right ventricular systolic function (p < 0.05). In patients who had multiple CMR without PVR, RA reservoir strain rate (p < 0.05) and pump strain rate (p < 0.05) worsened over time. LA pump strain decreased over time in all patients. There is progressive decline of several RA functional parameters over time. No significant improvement in LA or RA function after PVR was observed. Additional studies are needed to understand how these changes may relate to poor outcomes and potentially better guide timing of PVR.
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Affiliation(s)
- Benjamin R Ittleman
- Section of Pediatric Cardiology, Department of Pediatrics, University of Arkansas College of Medicine, Little Rock, AR, USA
- Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT, USA
| | - Justin T Tretter
- Cleveland Clinic Children's, and Cardiovascular Medicine Department, The Heart, Vascular, & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anna S Bader
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Mcollum
- Yale Center for Analytical Science, Yale University, New Haven, CT, USA
| | | | - Jeremy M Steele
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
- Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT, USA.
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Cai Q, Zhao Z, Gao J, Liu J, Li J, Peng X, Chen H. Normal Values for Atrial Deformation Measured by Feature-Tracking Cardiac MRI: A Meta-Analysis. J Magn Reson Imaging 2024. [PMID: 38807354 DOI: 10.1002/jmri.29465] [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: 02/25/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND A consensus on normal atrial deformation measurements by feature-tracking cardiac MRI remained absent. PURPOSE Provide reference ranges for atrial strain parameters in normal subjects, evaluating the influence of field strength and analysis software on the measurements. STUDY TYPE Meta-analysis. POPULATION 2708 subjects from 42 studies undergoing cardiac MRI. ASSESSMENT A systematic search was conducted from database (PubMed, Web of Science, ScienceDirect, and EMBASE) inception through August 2023. The random-effects model was used to pool the means of biatrial strain parameters. Heterogeneity and clinical variable effects were assessed. Strain measurements among different field strengths and analysis software were compared. STATISTICAL TESTS The inverse-variance method, Cochrane Q statistic, and I2 value, meta-regression analysis, and ANOVA were used; P < 0.05 was considered statistically significant. RESULTS The pooled means of left atrial (LA) total strain (εs), passive strain (εe), and active strain (εa) were 37.46%, 22.73%, and 16.24%, respectively, and the pooled means of LA total strain rate (SRs), passive strain rate (SRe), and active strain rate (SRa) were 1.66, -1.95, and -1.83, indicating significant heterogeneity. The pooled means of right atrial (RA) εs, εe, and εa were 44.87%, 26.05%, and 18.83%. RA SRs, SRe, and SRa were 1.66, -1.95, and -1.83, respectively. The meta-regression identified age as significantly associated with LA εs, εe and SRe, field strength was associated with LA SRa (all P < 0.05). ANOVA revealed differences in LA εa and SRa among different analysis software and in LA εs and all LA strain rates (all P < 0.05) among field strengths. No significant differences were identified in RA strain across analysis software (RA strain: P = 0.145-0.749; RA strain rates: P = 0.073-0.744) and field strengths (RA strain: P = 0.641-0.794; RA strain rates: P = 0.204-0.458). DATA CONCLUSION This study demonstrated the pooled reference values of biatrial strain. Age, analysis software, and field strength were attributed to differences in LA strain, whereas RA strain showed consistency across different field strengths and analysis software. Limited study subjects may account for the absence of influence on RA strain. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY Stage 5.
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Affiliation(s)
- Qiuyi Cai
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zhengkai Zhao
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jin Gao
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jian Liu
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jianlin Li
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xin Peng
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Hang Chen
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
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Sakhi H, Soulat G, Craiem D, Gencer U, Lamy J, Stipechi V, Puscas T, Hulot JS, Hagege A, Mousseaux E. Association of Impaired Left Ventricular Mitral Filling from 4D Flow Cardiac MRI and Prognosis of Hypertrophic Cardiomyopathy. Radiol Cardiothorac Imaging 2024; 6:e230198. [PMID: 38512023 PMCID: PMC11058532 DOI: 10.1148/ryct.230198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024]
Abstract
Purpose To investigate whether the peak early filling rate normalized to the filling volume (PEFR/FV) estimated from four-dimensional (4D) flow cardiac MRI may be used to assess impaired left ventricular (LV) filling and predict clinical outcomes in individuals with hypertrophic cardiomyopathy (HCM). Materials and Methods Cardiac MRI with a 4D flow sequence and late gadolinium enhancement (LGE), as well as echocardiography, was performed in 88 individuals: 44 participants with HCM from a French prospective registry (ClinicalTrials.gov; NCT01091480) and 44 healthy volunteers matched for age and sex. In participants with HCM, a composite primary end point was assessed at follow-up, including unexplained syncope, new-onset atrial fibrillation, hospitalization for congestive heart failure, ischemic stroke, sustained ventricular arrhythmia, septal reduction therapy, and cardiac death. A Cox proportional hazard model was used to analyze associations with the primary end point. Results PEFR/FV was significantly lower in the HCM group (mean age, 51.8 years ± 18.5 [SD]; 29 male participants) compared with healthy volunteers (mean, 3.35 sec-1 ± 0.99 [0.90-5.20] vs 4.42 sec-1 ± 1.68 [2.74-11.86]; P < .001) and correlated with both B-type natriuretic peptide (BNP) level (r = -0.31; P < .001) and the ratio of pulsed Doppler early transmitral inflow to Doppler tissue imaging annulus velocities (E/E'; r = -0.54; P < .001). At a median follow-up of 2.3 years (IQR, 1.7-3.3 years), the primary end point occurred in 14 (32%) participants. A PEFR/FV of 2.61 sec-1 or less was significantly associated with occurrence of the primary end point (hazard ratio, 9.46 [95% CI: 2.61, 45.17; P < .001] to 15.21 [95% CI: 3.51, 80.22; P < .001]), independently of age, BNP level, E/E', LGE extent, and LV and left atrial strain according to successive bivariate models. Conclusion In HCM, LV filling evaluated with 4D flow cardiac MRI correlated with Doppler and biologic indexes of diastolic dysfunction and predicted clinical outcomes. Keywords: Diastolic Function, Left Ventricular Filling, Hypertrophic Cardiomyopathy, Cardiac MRI, 4D Flow Sequence Clinical trial registration no. NCT01091480 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Hichem Sakhi
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Gilles Soulat
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Damian Craiem
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Umit Gencer
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Jérôme Lamy
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Valentina Stipechi
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Tania Puscas
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Jean-Sébastien Hulot
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Albert Hagege
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Elie Mousseaux
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
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7
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Ibrahim ESH, Rubenstein J, Sosa A, Stojanovska J, Pan A, North P, Rui H, Benjamin I. Myocardial Strain for the Differentiation of Myocardial Involvement in the Post-Acute Sequelae of COVID-19-A Multiparametric Cardiac MRI Study. Tomography 2024; 10:331-348. [PMID: 38535768 PMCID: PMC10974260 DOI: 10.3390/tomography10030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/01/2024] Open
Abstract
Myocardial involvement was shown to be associated with an unfavorable prognosis in patients with COVID-19, which could lead to fatal outcomes as in myocardial injury-induced arrhythmias and sudden cardiac death. We hypothesized that magnetic resonance imaging (MRI) myocardial strain parameters are sensitive markers for identifying subclinical cardiac dysfunction associated with myocardial involvement in the post-acute sequelae of COVID-19 (PASC). This study evaluated 115 subjects, including 65 consecutive COVID-19 patients, using MRI for the assessment of either post-COVID-19 myocarditis or other cardiomyopathies. Subjects were categorized, based on the results of the MRI exams, as having either 'suspected' or 'excluded' myocarditis. A control group of 50 matched individuals was studied. Along with parameters of global cardiac function, the MRI images were analyzed for measurements of the myocardial T1, T2, extracellular volume (ECV), strain, and strain rate. Based on the MRI late gadolinium enhancement and T1/T2/ECV mappings, myocarditis was suspected in 7 out of 22 patients referred due to concern of myocarditis and in 9 out of 43 patients referred due to concern of cardiomyopathies. The myocardial global longitudinal, circumferential, and radial strains and strain rates in the suspected myocarditis group were significantly smaller than those in the excluded myocarditis group, which in turn were significantly smaller than those in the control group. The results showed significant correlations between the strain, strain rate, and global cardiac function parameters. In conclusion, this study emphasizes the value of multiparametric MRI for differentiating patients with myocardial involvement in the PASC based on changes in the myocardial contractility pattern and tissue structure.
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Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jason Rubenstein
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.R.); (I.B.)
| | - Antonio Sosa
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Jadranka Stojanovska
- Department of Radiology, New York University, 221 Lexington Ave, New York, NY 10016, USA;
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA;
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (P.N.); (H.R.)
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (P.N.); (H.R.)
| | - Ivor Benjamin
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA; (J.R.); (I.B.)
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8
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Dong Z, Ma X, Wang J, Yang S, Yu S, Song Y, Tang Y, Xiang X, Yang K, Zhao K, Lu M, Chen X, Zhao S. Incremental Diagnostic Value of Right Ventricular Strain Analysis in Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Heart Assoc 2024; 13:e031403. [PMID: 38156506 PMCID: PMC10863820 DOI: 10.1161/jaha.123.031403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Strain analysis is a sensitive method for the assessment of ventricular structural or functional alterations. The authors aimed to determine whether right ventricular (RV) strain parameters can discriminate patients with revised Task Force Criteria-diagnosed arrhythmogenic RV cardiomyopathy (ARVC) incremental to the existing cardiovascular magnetic resonance (CMR) criteria, thus improving the diagnostic yield of CMR in ARVC. METHODS AND RESULTS A total of 74 patients with revised Task Force Criteria-diagnosed ARVC (37 borderline and 37 definite) and 37 controls were retrospectively enrolled for analysis. Using CMR feature tracking, RV global longitudinal (GLS), circumferential, and radial strain of all participants were evaluated. Compared with controls, the study patients demonstrated significantly impaired global biventricular strain in all 3 directions (all P<0.001). Receiver operating characteristic curve analysis indicated that RV GLS was the strongest discriminator among all RV strain parameters for the identification of patients with ARVC (area under the curve, 0.92). Using the Youden index, the authors determined RV GLS ≥-19.95% as the diagnostic criterion of ARVC. In patients diagnosed with borderline ARVC according to revised Task Force Criteria but with no or only minor CMR criteria, there were >50% presenting with impaired RV GLS. When both conventional criteria and RV GLS were considered together, this new diagnostic method demonstrated an overall diagnostic accuracy of 90%. The likelihood ratio test showed a significant incremental diagnostic value of RV GLS (P=0.02) over the existing CMR major criteria. CONCLUSIONS The current study showed an improved diagnostic accuracy when both RV GLS and the existing CMR criteria were considered together, especially for patients with borderline diagnosis, suggesting the incremental value of strain analysis to the initial assessment of ARVC.
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Affiliation(s)
- Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiaxin Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shiqin Yu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yanyan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yun Tang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaorui Xiang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesSZ University TownShenzhenChina
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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9
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:107-117. [PMID: 37857929 PMCID: PMC11378145 DOI: 10.1007/s10554-023-02968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean LA pressure/LA reservoir strain). Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N = 41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active, i.e. active atrial contraction, phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index overall (R = 0.59, p < 0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R = 0.32) and the time to peak reservoir strain rate (R = 0.32) (both p < 0.01), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R = 0.95, p < 0.001) and LA minimum volume (r = 0.82, p < 0.001). In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA pressure/ LA reservoir strain, a metric of stiffness, correlates with LA fibrosis (LA LGE), reflecting Hook's Law.
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Affiliation(s)
- Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Roy Taoutel
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Romy Chamoun
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Joseph Akar
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | | | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Lauren A Baldassarre
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Judith Meadows
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA.
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10
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Yoganathan T, Perez-Liva M, Balvay D, Le Gall M, Lallemand A, Certain A, Autret G, Mokrani Y, Guillonneau F, Bruce J, Nguyen V, Gencer U, Schmitt A, Lager F, Guilbert T, Bruneval P, Vilar J, Maissa N, Mousseaux E, Viel T, Renault G, Kachenoura N, Tavitian B. Acute stress induces long-term metabolic, functional, and structural remodeling of the heart. Nat Commun 2023; 14:3835. [PMID: 37380648 DOI: 10.1038/s41467-023-39590-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/21/2023] [Indexed: 06/30/2023] Open
Abstract
Takotsubo cardiomyopathy is a stress-induced cardiovascular disease with symptoms comparable to those of an acute coronary syndrome but without coronary obstruction. Takotsubo was initially considered spontaneously reversible, but epidemiological studies revealed significant long-term morbidity and mortality, the reason for which is unknown. Here, we show in a female rodent model that a single pharmacological challenge creates a stress-induced cardiomyopathy similar to Takotsubo. The acute response involves changes in blood and tissue biomarkers and in cardiac in vivo imaging acquired with ultrasound, magnetic resonance and positron emission tomography. Longitudinal follow up using in vivo imaging, histochemistry, protein and proteomics analyses evidences a continued metabolic reprogramming of the heart towards metabolic malfunction, eventually leading to irreversible damage in cardiac function and structure. The results combat the supposed reversibility of Takotsubo, point to dysregulation of glucose metabolic pathways as a main cause of long-term cardiac disease and support early therapeutic management of Takotsubo.
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Affiliation(s)
| | | | - Daniel Balvay
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France
| | - Morgane Le Gall
- Université Paris Cité, P53 proteom'IC facility, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Alice Lallemand
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Anais Certain
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Gwennhael Autret
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France
| | - Yasmine Mokrani
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - François Guillonneau
- Institut de Cancérologie de l'Ouest, CNRS UMR6075 INSERM U1307, 15 rue André Boquel, F-49055, Angers, France
| | - Johanna Bruce
- Université Paris Cité, P53 proteom'IC facility, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Vincent Nguyen
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Inserm, CNRS, F-75006, Paris, France
| | - Umit Gencer
- Service de Radiologie, AP-HP, hôpital européen Georges Pompidou, F-75015, Paris, France
| | - Alain Schmitt
- Université Paris Cité, Cochin Imaging, Electron microscopy, Institut Cochin, INSERM, CNRS, F-75014, Paris, France
| | - Franck Lager
- Université Paris Cité, Plateforme d'Imageries du Vivant, Institut Cochin, Inserm-CNRS, F-75014, Paris, France
| | - Thomas Guilbert
- Université Paris Cité, Cochin Imaging Photonic, IMAG'IC, Institut Cochin, Inserm, CNRS, F-75014, Paris, France
| | | | - Jose Vilar
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Nawal Maissa
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
| | - Elie Mousseaux
- Service de Radiologie, AP-HP, hôpital européen Georges Pompidou, F-75015, Paris, France
| | - Thomas Viel
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France
| | - Gilles Renault
- Université Paris Cité, Plateforme d'Imageries du Vivant, Institut Cochin, Inserm-CNRS, F-75014, Paris, France
| | - Nadjia Kachenoura
- Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Inserm, CNRS, F-75006, Paris, France
| | - Bertrand Tavitian
- Université Paris Cité, Inserm, PARCC, F-75015, Paris, France.
- Université Paris Cité, Plateforme d'Imageries du Vivant, PARCC, F-75015, Paris, France.
- Service de Radiologie, AP-HP, hôpital européen Georges Pompidou, F-75015, Paris, France.
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11
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Soghomonian A, Dutour A, Kachenoura N, Thuny F, Lasbleiz A, Ancel P, Cristofari R, Jouve E, Simeoni U, Kober F, Bernard M, Gaborit B. Is increased myocardial triglyceride content associated with early changes in left ventricular function? A 1H-MRS and MRI strain study. Front Endocrinol (Lausanne) 2023; 14:1181452. [PMID: 37424866 PMCID: PMC10323751 DOI: 10.3389/fendo.2023.1181452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Type 2 diabetes (T2D) and obesity induce left ventricular (LV) dysfunction. The underlying pathophysiological mechanisms remain unclear, but myocardial triglyceride content (MTGC) could be involved. Objectives This study aimed to determine which clinical and biological factors are associated with increased MTGC and to establish whether MTGC is associated with early changes in LV function. Methods A retrospective study was conducted using five previous prospective cohorts, leading to 338 subjects studied, including 208 well-phenotyped healthy volunteers and 130 subjects living with T2D and/or obesity. All the subjects underwent proton magnetic resonance spectroscopy and feature tracking cardiac magnetic resonance imaging to measure myocardial strain. Results MTGC content increased with age, body mass index (BMI), waist circumference, T2D, obesity, hypertension, and dyslipidemia, but the only independent correlate found in multivariate analysis was BMI (p=0.01; R²=0.20). MTGC was correlated to LV diastolic dysfunction, notably with the global peak early diastolic circumferential strain rate (r=-0.17, p=0.003), the global peak late diastolic circumferential strain rate (r=0.40, p<0.0001) and global peak late diastolic longitudinal strain rate (r=0.24, p<0.0001). MTGC was also correlated to systolic dysfunction via end-systolic volume index (r=-0.34, p<0.0001) and stroke volume index (r=-0.31, p<0.0001), but not with longitudinal strain (r=0.009, p=0.88). Interestingly, the associations between MTGC and strain measures did not persist in multivariate analysis. Furthermore, MTGC was independently associated with LV end-systolic volume index (p=0.01, R²=0.29), LV end-diastolic volume index (p=0.04, R²=0.46), and LV mass (p=0.002, R²=0.58). Conclusions Predicting MTGC remains a challenge in routine clinical practice, as only BMI independently correlates with increased MTGC. MTGC may play a role in LV dysfunction but does not appear to be involved in the development of subclinical strain abnormalities.
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Affiliation(s)
- Astrid Soghomonian
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Anne Dutour
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Nadjia Kachenoura
- Sorbonne Université, INSERM, CNRS, Laboratoire d’Imagerie Biomédicale, Paris, France
| | - Franck Thuny
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Adele Lasbleiz
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
| | - Patricia Ancel
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
| | | | - Elisabeth Jouve
- UPCET, Clinical Pharmacology, Assistance-Publique Hôpitaux de Marseille, Marseille, France
| | - Umberto Simeoni
- Division of Pediatrics & DOHaD Laboratory, CHUV University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frank Kober
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
| | | | - Bénédicte Gaborit
- Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, Marseille, France
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12
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial Fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. RESEARCH SQUARE 2023:rs.3.rs-2818190. [PMID: 37131741 PMCID: PMC10153380 DOI: 10.21203/rs.3.rs-2818190/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Aims A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean pressure/LA reservoir strain). Methods and Results Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N=41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index (LA mean pressure/LA reservoir strain) overall (R=0.59, p<0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R=0.32) and the time to peak reservoir strain rate (R=0.32), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R=0.95, p<0.001) and LA minimum volume (r=0.82, p<0.001). Conclusion In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA LGE is a strong marker of stiffness.
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13
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Laredo M, Lamy J, Bouazizi-Verdier K, Gueda M, Giron A, Gallo A, Cluzel P, Gandjbakhch E, Redheuil A, Kachenoura N. Feasibility of a New Regional Myocardial Strain Parameter for the Detection of Wall Motion Abnormalities in Arrhythmogenic Right Ventricular Cardiomyopathy. Radiol Cardiothorac Imaging 2023; 5:e220160. [PMID: 36860830 PMCID: PMC9969209 DOI: 10.1148/ryct.220160] [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: 07/27/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 02/18/2023]
Abstract
Purpose To evaluate a cardiac MRI feature tracking (FT)-derived parameter that combines right ventricular (RV) longitudinal and radial motions in detecting arrhythmogenic right ventricular cardiomyopathy (ARVC). Materials and Methods Patients with ARVC (n = 47; median age, 46 [IQR, 30-52] years; 31 men) were compared with controls (n = 39; median age, 46 [IQR, 33-53] years; 23 men) and separated into two groups based on fulfillment of major structural 2020 International criteria. Cine data from 1.5-T cardiac MRI examinations were analyzed using FT, resulting in conventional strain parameters and a novel composite index named the longitudinal-to-radial strain loop (LRSL). Receiver operating characteristic (ROC) analysis was used to assess diagnostic performance of RV parameters. Results Volumetric parameters differed significantly between patients in the major structural criteria group and controls but not between patients in the no major structural criteria group and controls. Patients in the major structural criteria group had significantly lower magnitudes of all FT parameters than controls, including RV basal longitudinal strain, radial motion fraction, circumferential strain, and LRSL (-15.6% ± 6.4 vs -26.7% ± 13.9; -9.6% ± 4.89 vs -13.8% ± 4.7; -6.9% ± 4.6 vs -10.1% ± 3.8; and 217.0 ± 128.9 versus 618.6 ± 356.3, respectively). Only LRSL differed between patients in the no major structural criteria group and controls (359.5 ± 195.8 vs 618.6 ± 356.3; P < .0001). Parameters with the highest area under the ROC curve values for discriminating patients in the no major structural criteria group from controls were LRSL, RV ejection fraction, and RV basal longitudinal strain (0.75, 0.70, and 0.61, respectively). Conclusion A new parameter combining RV longitudinal and radial motions showed good diagnostic performance in ARVC, even in patients without major structural abnormalities.Keywords: Arrhythmogenic Right Ventricular Dysplasia, Strain, Wall Motion Abnormalities, Right Ventricle, MRI, Inherited Cardiomyopathy Supplemental material is available for this article. © RSNA, 2023.
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14
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Yang S, Chen X, Zhao K, Yu S, Dong W, Wang J, Yang K, Yang Q, Ma X, Dong Z, Liu L, Song Y, Lu M, Wang S, Zhao S. Reverse remodeling of left atrium assessed by cardiovascular magnetic resonance feature tracking in hypertrophic obstructive cardiomyopathy after septal myectomy. J Cardiovasc Magn Reson 2023; 25:13. [PMID: 36775820 PMCID: PMC9923913 DOI: 10.1186/s12968-023-00915-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Assessing the structure and function of left atrium (LA) is crucial in hypertrophic obstructive cardiomyopathy (HOCM) because LA remodeling correlates with atrial fibrillation. However, few studies have investigated the potential effect of myomectomy on LA phasic remodeling in HOCM after myectomy using cardiovascular magnetic resonance (CMR) feature tracking (FT). This study aims to evaluate the LA structural and functional remodeling with HOCM after myectomy by CMR-FT and to further investigate the determinants of LA reverse remodeling. METHODS In this single-center study, we retrospectively studied 88 patients with HOCM who received CMR before and after myectomy between January 2011 and June 2021. Preoperative and postoperative LA parameters derived from CMR-FT were compared, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster function (booster EF, active strain [εa], late peak negative strain rate [SRa]). Eighty-six healthy participants were collected for comparison. Univariate and multivariate linear regression identified variables associated with the rate of change of εa. RESULTS Compared with preoperative parameters, LA reservoir function (total EF, εs, SRs), booster function (booster EF, εa, SRa), and SRe were significantly improved after myectomy (all P < 0.05), while no significant differences were observed in passive EF and εe. Postoperative patients with HOCM still had larger LA and worse LA function than healthy controls (all P < 0.05). After analyzing the rates of change in LA parameters, LA boost function, especially εa, showed the most dramatic improvement beyond the improvements in reservoir function, conduit function, and volume. In multivariable regression analysis, minimum LA volume index (adjusted β = - 0.39, P < 0.001) and Δleft ventricular outflow tract (LVOT) pressure gradient (adjusted β = - 0.29, P = 0.003) were significantly related to the rate of change of εa. CONCLUSIONS Patients with HOCM after septal myectomy showed LA reverse remodeling with a reduction in LA size and restoration in LA reservoir and booster function but unchanged LA conduit function. Among volumetric and functional changes, booster function had the greatest improvement postoperatively. Besides, preoperative LAVmin index and ΔLVOT might be potential factors associated with the degree of improvement in εa.
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Affiliation(s)
- Shujuan Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, 518055, China
| | - Shiqin Yu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Wenhao Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Jiaxin Wang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Kai Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Qiulan Yang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Xuan Ma
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Zhixiang Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Lele Liu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Yanyan Song
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Shuiyun Wang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China.
| | - Shihua Zhao
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China.
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15
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Left atrial strain correlates with severity of cardiac involvement in Anderson-Fabry disease. Eur Radiol 2023; 33:2039-2051. [PMID: 36322192 PMCID: PMC9935647 DOI: 10.1007/s00330-022-09183-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/08/2022] [Accepted: 09/19/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Cardiac involvement in Anderson-Fabry disease (AFD) results in myocardial lipid depositions. An early diagnosis can maximize therapeutic benefit. Thus, this study aims to investigate the potential of cardiac MRI (CMR) based parameters of left atrial (LA) function and strain to detect early stages of AFD. METHODS Patients (n = 58, age 40 (29-51) years, 31 female) with genetically proven AFD had undergone CMR including left ventricular (LV) volumetry, mass index (LVMi), T1, and late gadolinium enhancement, complemented by LA and LV strain measurements and atrial emptying fractions. Patients were stratified into three disease phases and compared to age and sex-matched healthy controls (HC, n = 58, age 41 [26-56] years, 31 female). RESULTS A total of 19 early-, 20 intermediate-, and 19 advanced-phase patients were included. LV and LA reservoir strain was significantly impaired in all AFD phases, including early disease (both p < 0.001). In contrast, LA volumetry, T1, and LVMi showed no significant differences between the early phase and HC (p > 0.05). In the intermediate phase, LVMi and T1 demonstrated significant differences. In advanced phase, all parameters except active emptying fractions differed significantly from HC. ROC curve analyses of early disease phases revealed superior diagnostic confidence for the LA reservoir strain (AUC 0.88, sensitivity 89%, specificity 75%) over the LV strain (AUC 0.82). CONCLUSIONS LA reservoir strain showed impairment in early AFD and significantly correlated with disease severity. The novel approach performed better in identifying early disease than the established approach using LVMi and T1. Further studies are needed to evaluate whether these results justify earlier initiation of therapy and help minimize cardiac complications. KEY POINTS • Parameters of left atrial function and deformation showed impairments in the early stages of Anderson-Fabry disease and correlated significantly with the severity of Anderson-Fabry disease. • Left atrial reservoir strain performed superior to ventricular strain in detecting early myocardial involvement in Anderson-Fabry disease and improved diagnostic accuracies of approaches already using ventricular strain. • Further studies are needed to evaluate whether earlier initiation of enzyme replacement therapy based on these results can help minimize cardiac complications from Anderson-Fabry disease.
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16
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Peters DC, Lamy J, Sinusas AJ, Baldassarre LA. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 2021; 23:14-30. [PMID: 34718484 DOI: 10.1093/ehjci/jeab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan-rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of 'pre-existent' atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.
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Affiliation(s)
- Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
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17
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Gallo A, Giral P, Rosenbaum D, Mattina A, Kilinc A, Giron A, Bouazizi K, Gueda Moussa M, Salem JE, Carrié A, Carreau V, Béliard S, Bittar R, Cluzel P, Bruckert E, Redheuil A, Kachenoura N. Myocardial fibrosis assessed by magnetic resonance imaging in asymptomatic heterozygous familial hypercholesterolemia: the cholcoeur study. EBioMedicine 2021; 74:103735. [PMID: 34864619 PMCID: PMC8646177 DOI: 10.1016/j.ebiom.2021.103735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Familial Hypercholesterolemia (FH) is an underdiagnosed condition with an increased cardiovascular risk. It is unknown whether lipid accumulation plays a role in structural myocardial changes. Cardiovascular Magnetic Resonance (CMR) is the reference technique for the morpho-functional evaluation of heart chambers through cine sequences and for myocardial tissue characterization through late gadolinium enhancement (LGE) and T1 mapping images. We aimed to assess the prevalence of myocardial fibrosis in FH patients. METHODS Seventy-two asymptomatic subjects with genetically confirmed FH (mean age 49·24, range 40 to 60 years) were prospectively recruited along with 31 controls without dyslipidaemia matched for age, sex, BMI, and other cardiovascular risk factors. All underwent CMR including cine, LGE, pre- and post-contrast T1 mapping. Extracellular volume (ECV) and enhancement rate of the myocardium (ERM = difference between pre- and post-contrast myocardial T1, normalized by pre-contrast myocardial T1) were calculated. FINDINGS Five FH patients and none of the controls had intramyocardial LGE (p= 0·188). While no changes in Native T1 and ECV were found, post-contrast T1 was significantly lower (430·6 ± 55ms vs. 476·1 ± 43ms, p<0·001) and ERM was higher (57·44± 5·99 % vs 53·04±4·88, p=0·005) in HeFH patients compared to controls. Moreover, low post-contrast T1 was independently associated with the presence of xanthoma (HR 5·221 [1·04-26·28], p= 0·045). A composite score combining the presence of LGE, high native T1 and high ERM (defined as ≥ mean ± 1·5 SD) was found in 20·8% of the HeFH patients vs. 0% in controls (p<0·000, after adjustment for main confounders). INTERPRETATION CMR revealed early changes in myocardial tissue characteristics in HeFH patients, that should foster further work to better understand and prevent the underlying pathophysiological processes.
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Affiliation(s)
- Antonio Gallo
- Cardiovascular Prevention Unit, Department of Endocrinology, Metabolism and cardiovascular prevention-University Hospital Pitié-Salpêtrière - Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Sorbonne University; Sorbonne University, Biomedical Imaging Laboratory, CNRS, INSERM, Paris, France; Sorbonne University, INSERM, Institute of Cardio-metabolism and Nutrition (ICAN), Imaging Core Lab, Hôpital de la Pitié-Salpêtrière, Paris, France; Université de La Réunion, INSERM, UMR 1188 Diabète athérothrombose, Réunion Océan Indien (DéTROI), Saint-Denis de La Réunion, France.
| | - Philippe Giral
- Cardiovascular Prevention Unit, Department of Endocrinology, Metabolism and cardiovascular prevention-University Hospital Pitié-Salpêtrière - Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Sorbonne University
| | - David Rosenbaum
- Cardiovascular Prevention Unit, Department of Endocrinology, Metabolism and cardiovascular prevention-University Hospital Pitié-Salpêtrière - Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Sorbonne University
| | - Alessandro Mattina
- Cardiovascular Prevention Unit, Department of Endocrinology, Metabolism and cardiovascular prevention-University Hospital Pitié-Salpêtrière - Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Sorbonne University; Diabetes and Islet Transplantation Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center - Italy, Palermo, Italy
| | - Ali Kilinc
- Sorbonne University, INSERM, Institute of Cardio-metabolism and Nutrition (ICAN), Imaging Core Lab, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alain Giron
- Sorbonne University, Biomedical Imaging Laboratory, CNRS, INSERM, Paris, France
| | - Khaoula Bouazizi
- Sorbonne University, INSERM, Institute of Cardio-metabolism and Nutrition (ICAN), Imaging Core Lab, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Moussa Gueda Moussa
- Sorbonne University, Biomedical Imaging Laboratory, CNRS, INSERM, Paris, France
| | - Joe-Elie Salem
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1901, F-75013 Paris, France; INSERM, CIC-1901 and UMR 1166, F-75013 Paris, France, Sorbonne Universités
| | - Alain Carrié
- Sorbonne University, Inserm, UMR_S1166, APHP, Department of Biochemistry, Obesity and Dyslipidemia Genetics Unit, Hôpital de la Pitié, Paris, France
| | - Valérie Carreau
- Cardiovascular Prevention Unit, Department of Endocrinology, Metabolism and cardiovascular prevention-University Hospital Pitié-Salpêtrière - Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Sorbonne University
| | - Sophie Béliard
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France; Department of Nutrition, Metabolic Diseases, Endocrinology, La Conception Hospital, Marseille, France
| | - Randa Bittar
- Sorbonne University, Inserm, UMR_S1166, Department of Metabolic Biochemistry, Assistance Publique, Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Cardiovascular and Thoracic Imaging Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, INSERM, Paris, France
| | - Eric Bruckert
- Cardiovascular Prevention Unit, Department of Endocrinology, Metabolism and cardiovascular prevention-University Hospital Pitié-Salpêtrière - Assistance Publique/Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière - Sorbonne University; Sorbonne University, INSERM, Institute of Cardio-metabolism and Nutrition (ICAN), Imaging Core Lab, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alban Redheuil
- Sorbonne University, Biomedical Imaging Laboratory, CNRS, INSERM, Paris, France; Sorbonne University, INSERM, Institute of Cardio-metabolism and Nutrition (ICAN), Imaging Core Lab, Hôpital de la Pitié-Salpêtrière, Paris, France; Cardiovascular and Thoracic Imaging Unit, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, INSERM, Paris, France
| | - Nadjia Kachenoura
- Sorbonne University, Biomedical Imaging Laboratory, CNRS, INSERM, Paris, France; Sorbonne University, INSERM, Institute of Cardio-metabolism and Nutrition (ICAN), Imaging Core Lab, Hôpital de la Pitié-Salpêtrière, Paris, France
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18
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Raman B, Smillie RW, Mahmod M, Chan K, Ariga R, Nikolaidou C, Ormondroyd E, Thomson K, Harper AR, Tan G, Lewandowski AJ, Rodriguez Bajo F, Wicks EC, Casadei B, Watkins H, Neubauer S. Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2021; 23:109. [PMID: 34635131 PMCID: PMC8504076 DOI: 10.1186/s12968-021-00793-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/08/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Left atrial (LA) size and function are known predictors of new onset atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients. Components of LA deformation including reservoir, conduit, and booster function provide additional information on atrial mechanics. Whether or not LA deformation can augment our ability to predict the risk of new onset AF in HCM patients beyond standard measurements is unknown. METHODS We assessed LA size, function, and deformation on cardiovascular magnetic resonance (CMR) in 238 genotyped HCM patients and compared this with twenty age, sex, blood pressure and body mass index matched control subjects. We further evaluated the determinants of new onset AF in HCM patients. RESULTS Compared to control subjects, HCM patients had higher LA antero-posterior diameter, lower LA ejection fraction and lower LA reservoir (19.9 [17.1, 22.2], 21.6 [19.9, 22.9], P = 0.047) and conduit strain (10.6 ± 4.4, 13.7 ± 3.3, P = 0.002). LA booster strain did not differ between healthy controls and HCM patients, but HCM patients who developed new onset AF (n = 33) had lower booster strain (7.6 ± 3.3, 9.5 ± 3.0, P = 0.001) than those that did not (n = 205). In separate multivariate models, age, LA ejection fraction, and LA booster and reservoir strain were each independent determinants of AF. Age ≥ 55 years was the strongest determinant (HR 6.62, 95% CI 2.79-15.70), followed by LA booster strain ≤ 8% (HR 3.69, 95% CI 1.81-7.52) and LA reservoir strain ≤ 18% (HR 2.56, 95% CI 1.24-5.27). Conventional markers of HCM phenotypic severity, age and sudden death risk factors were associated with LA strain components. CONCLUSIONS LA strain components are impaired in HCM and, together with age, independently predicted the risk of new onset AF. Increasing age and phenotypic severity were associated with LA strain abnormalities. Our findings suggest that the routine assessment of LA strain components and consideration of age could augment LA size in predicting risk of AF, and potentially guide prophylactic anticoagulation use in HCM.
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Affiliation(s)
- Betty Raman
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom.
| | - Robert W Smillie
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Masliza Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Kenneth Chan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Rina Ariga
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Chrysovalantou Nikolaidou
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Elizabeth Ormondroyd
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kate Thomson
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew R Harper
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Gifford Tan
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Adam J Lewandowski
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Fernando Rodriguez Bajo
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Eleanor C Wicks
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Hugh Watkins
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, OX3 9DU, United Kingdom
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19
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Bojer AS, Soerensen MH, Gaede P, Myerson S, Madsen PL. Left Ventricular Diastolic Function Studied with Magnetic Resonance Imaging: A Systematic Review of Techniques and Relation to Established Measures of Diastolic Function. Diagnostics (Basel) 2021; 11:diagnostics11071282. [PMID: 34359363 PMCID: PMC8305340 DOI: 10.3390/diagnostics11071282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: In recent years, cardiac magnetic resonance (CMR) has been used to assess LV diastolic function. In this systematic review, studies were identified where CMR parameters had been evaluated in healthy and/or patient groups with proven diastolic dysfunction or known to develop heart failure with preserved ejection fraction. We aimed at describing the parameters most often used, thresholds where possible, and correlation to echocardiographic and invasive measurements. Methods and results: A systematic literature review was performed using the databases of PubMed, Embase, and Cochrane. In total, 3808 articles were screened, and 102 studies were included. Four main CMR techniques were identified: tagging; time/volume curves; mitral inflow quantification with velocity-encoded phase-contrast sequences; and feature tracking. Techniques were described and estimates were presented in tables. From published studies, peak change of torsion shear angle versus volume changes in early diastole (−dφ′/dV′) (from tagging analysis), early peak filling rate indexed to LV end-diastolic volume <2.1 s−1 (from LV time-volume curve analysis), enlarged LA maximal volume >52 mL/m2, lowered LA total (<40%), and lowered LA passive emptying fractions (<16%) seem to be reliable measures of LV diastolic dysfunction. Feature tracking, especially of the atrium, shows promise but is still a novel technique. Conclusion: CMR techniques of LV untwisting and early filling and LA measures of poor emptying are promising for the diagnosis of LV filling impairment, but further research in long-term follow-up studies is needed to assess the ability for the parameters to predict patient related outcomes.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
- Correspondence:
| | - Martin Heyn Soerensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
| | - Saul Myerson
- Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX1 2JD, UK;
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, 2730 Herlev, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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20
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Xu E, Kachenoura N, Della Valle V, Dubern B, Karsenty A, Tounian P, Dacher JN, Layese R, Lamy J, Ducou le Pointe H, Redheuil A, Blondiaux E. Multichamber Dysfunction in Children and Adolescents With Severe Obesity: A Cardiac Magnetic Resonance Imaging Myocardial Strain Study. J Magn Reson Imaging 2021; 54:1393-1403. [PMID: 34155711 DOI: 10.1002/jmri.27796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In severe obesity, left ventricular (LV) and right ventricular (RV) remodeling and contractile dysfunction have been documented, but less is known regarding left atrial (LA) dysfunction and its association with LV/RV remodeling, especially in children. PURPOSE To assess the effects of severe childhood obesity on cardiac function by using multichamber strain analysis with MRI. STUDY TYPE Prospective. SUBJECTS Forty-five children aged 7-18 years (including 20 with severe obesity, defined as a body mass index values above the 99th percentile). FIELD STRENGTH 5 T. SEQUENCE Steady-state-free-precession (SSFP) images in short-axis views and longitudinal two- and four-chamber views. ASSESSMENT Cardiac strain measurements were derived from standard SSFP cine images by using a dedicated MR imaging feature tracking software. Inter- and intra-rater reliability were evaluated. STATISTICAL TESTS Independent sample t test, Spearman's correlation coefficient, principal component analysis, Bland-Altman analysis, and intra-class correlation coefficients (ICC). A P value <0.05 was considered statistically significant. RESULTS As compared to children without obesity, those with obesity showed significantly reduced LA reservoir function (22.2% ± 6.4% vs. 33.8% ± 9.0%) and contractile function (5.4% ± 3.2% vs. 13.3% ± 8.0%) as well as significantly decreased absolute values for LA longitudinal strain in reservoir and contraction phases and LA radial motion fraction in reservoir and contraction phases. Children with severe obesity showed significantly reduced absolute RV radial motion fraction (-10.6% ± 2.9% vs. -18.2% ± 2.9%) and circumferential strain (-10.6% ± 2.9% vs. -16% ± 2.5%) as well as higher LV mass index (28.7% ± 5.1% vs. 21.7 ± 4.6 g/m2 ) along with significantly reduced LV ejection fraction (56.4% ± 3.9% vs. 60% ± 4.1%), LV radial strain (56% ± 6% vs. 61.8% ± 11.3%), and longitudinal strain (-17.8% ± 1.8% vs. -20.3% ± 3.2%). Reliability was good to excellent, with ICC ranging from 79.1% to 97.7%. DATA CONCLUSION MR feature-tracking strain analysis revealed multichamber dysfunction in severely obese children with impaired LA reservoir and atrial contraction phases, which suggest an early loss in the compensatory ability of atrial contraction with severe obesity. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Eric Xu
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France
| | - Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France
| | - Valeria Della Valle
- Department of Radiology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Béatrice Dubern
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Alexandra Karsenty
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | - Patrick Tounian
- Department of Pediatric Nutrition and Gastroenterology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
| | | | - Richard Layese
- Unité de Recherche Clinique, Henri Mondor Hospital, AP-HP and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), Unit EA4393, UPEC, Créteil, France
| | - Jérôme Lamy
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France
| | | | - Alban Redheuil
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Institute of Cardiometabolism and Nutrition, Paris, France.,Cardiovascular and Thoracic Imaging Unit (ICT), Institute of Cardiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Eléonore Blondiaux
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France.,Department of Radiology, Trousseau Hospital, APHP, Sorbonne Université, Paris, France
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21
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Gonzales RA, Seemann F, Lamy J, Arvidsson PM, Heiberg E, Murray V, Peters DC. Automated left atrial time-resolved segmentation in MRI long-axis cine images using active contours. BMC Med Imaging 2021; 21:101. [PMID: 34147081 PMCID: PMC8214286 DOI: 10.1186/s12880-021-00630-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Segmentation of the left atrium (LA) is required to evaluate atrial size and function, which are important imaging biomarkers for a wide range of cardiovascular conditions, such as atrial fibrillation, stroke, and diastolic dysfunction. LA segmentations are currently being performed manually, which is time-consuming and observer-dependent. METHODS This study presents an automated image processing algorithm for time-resolved LA segmentation in cardiac magnetic resonance imaging (MRI) long-axis cine images of the 2-chamber (2ch) and 4-chamber (4ch) views using active contours. The proposed algorithm combines mitral valve tracking, automated threshold calculation, edge detection on a radially resampled image, edge tracking based on Dijkstra's algorithm, and post-processing involving smoothing and interpolation. The algorithm was evaluated in 37 patients diagnosed mainly with paroxysmal atrial fibrillation. Segmentation accuracy was assessed using the Dice similarity coefficient (DSC) and Hausdorff distance (HD), with manual segmentations in all time frames as the reference standard. For inter-observer variability analysis, a second observer performed manual segmentations at end-diastole and end-systole on all subjects. RESULTS The proposed automated method achieved high performance in segmenting the LA in long-axis cine sequences, with a DSC of 0.96 for 2ch and 0.95 for 4ch, and an HD of 5.5 mm for 2ch and 6.4 mm for 4ch. The manual inter-observer variability analysis had an average DSC of 0.95 and an average HD of 4.9 mm. CONCLUSION The proposed automated method achieved performance on par with human experts analyzing MRI images for evaluation of atrial size and function. Video Abstract.
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Affiliation(s)
- Ricardo A Gonzales
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Electrical Engineering, Universidad de Ingeniería y Tecnología, Lima, Peru
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Felicia Seemann
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Per M Arvidsson
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Victor Murray
- Department of Electrical Engineering, Universidad de Ingeniería y Tecnología, Lima, Peru
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.
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22
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Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity. PLoS One 2021; 16:e0246764. [PMID: 33606757 PMCID: PMC7895343 DOI: 10.1371/journal.pone.0246764] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/25/2021] [Indexed: 01/14/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer; however, cardiotoxicity can occur, including myocarditis. Cardiac magnetic resonance (CMR) imaging is useful for evaluation of myocarditis, although it has not been well studied in ICI cardiotoxicity. Methods We identified patients referred for CMR evaluation of ICI cardiotoxicity from September 2015 through September 2019. We assessed structural and functional parameters, feature tracking (FT) left ventricular and atrial strain, T2- weighted ratios and quantitative late gadolinium enhancement (LGE). We also applied the Updated Lake Louise Criteria for diagnosis of myocarditis. Results Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (≥53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of −9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at −12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = −0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = −0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment. Conclusion In patients with suspected ICI cardiotoxicity, CMR is an important diagnostic tool, even in the absence of overt left ventricular dysfunction, as abnormalities in left ventricular strain, T2 signal and LGE can identifying disease.
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23
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Multiparametric Differentiation of Idiopathic Dilated Cardiomyopathy With and Without Congestive Heart Failure by Means of Cardiac and Hepatic T1-Weighted MRI Mapping. AJR Am J Roentgenol 2020; 215:79-86. [DOI: 10.2214/ajr.19.22009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Cardiovascular Magnetic Resonance Imaging Tissue Characterization in Non-ischemic Cardiomyopathies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Nazir SA, Shetye AM, Khan JN, Singh A, Arnold JR, Squire I, McCann GP. Inter-study repeatability of circumferential strain and diastolic strain rate by CMR tagging, feature tracking and tissue tracking in ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2020; 36:1133-1146. [PMID: 32152811 PMCID: PMC7228913 DOI: 10.1007/s10554-020-01806-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Strain assessment allows accurate evaluation of myocardial function and mechanics in ST-segment elevation myocardial infarction (STEMI). Strain using cardiovascular magnetic resonance (CMR) has traditionally been assessed with tagging but limitations of this technique have led to more widespread use of alternative methods, which may be more robust. We compared the inter-study repeatability of circumferential global peak-systolic strain (Ecc) and peak-early diastolic strain rate (PEDSR) derived by tagging with values obtained using novel cine-based software: Feature Tracking (FT) (TomTec, Germany) and Tissue Tracking (TT) (Circle cvi42, Canada) in patients following STEMI. Twenty male patients (mean age 56 ± 10 years, mean infarct size 13.7 ± 7.1% of left ventricular mass) were randomised to undergo CMR 1-5 days post-STEMI at 1.5 T or 3.0 T, repeated after ten minutes at the same field strength. Ecc and PEDSR were assessed using tagging, FT and TT. Inter-study repeatability was evaluated using Bland-Altman analyses, coefficients of variation (CoV) and intra-class correlation coefficient (ICC). Ecc (%) was significantly lower with tagging than with FT or TT at 1.5 T (- 9.5 ± 3.3 vs. - 17.5 ± 3.8 vs. -15.5 ± 5.2, respectively, p < 0.001) and 3.0 T (- 13.1 ± 1.8 vs. - 19.4 ± 2.9 vs. - 17.3 ± 2.1, respectively, p = 0.001). This was similar for PEDSR (.s-1): 1.5 T (0.6 ± 0.2 vs. 1.5 ± 0.4 vs. 1.0 ± 0.4, for tagging, FT and TT respectively, p < 0.001) and 3.0 T (0.6 ± 0.2 vs. 1.5 ± 0.3 vs. 0.9 ± 0.3, respectively, p < 0.001). Inter-study repeatability for Ecc at 1.5 T was good for tagging and excellent for FT and TT: CoV 16.7%, 6.38%, and 8.65%, respectively. Repeatability for Ecc at 3.0 T was good for all three techniques: CoV 14.4%, 11.2%, and 13.0%, respectively. However, repeatability of PEDSR was generally lower than that for Ecc at 1.5 T (CoV 15.1%, 13.1%, and 34.0% for tagging, FT and TT, respectively) and 3.0 T (CoV 23.0%, 18.6%, and 26.2%, respectively). Following STEMI, Ecc and PEDSR are higher when measured with FT and TT than with tagging. Inter-study repeatability of Ecc is good for tagging, excellent for FT and TT at 1.5 T, and good for all three methods at 3.0 T. The repeatability of PEDSR is good to moderate at 1.5 T and moderate at 3.0 T. Cine-based methods to assess Ecc following STEMI may be preferable to tagging.
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Affiliation(s)
- Sheraz A. Nazir
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Abhishek M. Shetye
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Jamal N. Khan
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Jayanth R. Arnold
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
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26
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Ta HT, Alsaied T, Steele JM, Truong VT, Mazur W, Nagueh SF, Kutty S, Tretter JT. Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease. Pediatr Cardiol 2020; 41:654-668. [PMID: 32342149 DOI: 10.1007/s00246-020-02351-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
Diastolic dysfunction has correlated with adverse outcomes in various forms of unrepaired and repaired or palliated congenital heart disease (CHD). The non-invasive assessment of diastolic function in pediatric and adult patients with CHD remains challenging. Atrial size has a pivotal role in the evaluation of diastolic function; however, a growing body of evidence supports the additional role of atrial function as a more sensitive parameter of ventricular diastolic dysfunction. While the importance of atrial function is becoming clearer in adult acquired heart disease, it remains ambiguous in those with CHD. In this review we set the stage with the current understanding of diastolic function assessment in CHD, followed by insight into atrial form and function including its non-invasive assessment, and conclude with the current knowledge of atrial function in CHD. A general pattern of decrease in reservoir and conduit function with compensatory increase followed by decompensatory decrease in contractile function seems to be the common pathway of atrial dysfunction in most forms of CHD.
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Affiliation(s)
- Hieu T Ta
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeremy M Steele
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Vien T Truong
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Wojciech Mazur
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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27
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CMR in the Evaluation of Diastolic Dysfunction and Phenotyping of HFpEF. JACC Cardiovasc Imaging 2020; 13:283-296. [DOI: 10.1016/j.jcmg.2019.02.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 01/20/2023]
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28
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Clinical Diagnosis, Imaging, and Genetics of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 72:784-804. [PMID: 30092956 DOI: 10.1016/j.jacc.2018.05.065] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 01/30/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy that can lead to sudden cardiac death and heart failure. Our understanding of its pathophysiology and clinical expressivity is continuously evolving. The diagnosis of ARVC/D remains particularly challenging due to the absence of specific unique diagnostic criteria, its variable expressivity, and incomplete penetrance. Advances in genetics have enlarged the clinical spectrum of the disease, highlighting possible phenotypes that overlap with arrhythmogenic dilated cardiomyopathy and channelopathies. The principal challenges for ARVC/D diagnosis include the following: earlier detection of the disease, particularly in cases of focal right ventricular involvement; differential diagnosis from other arrhythmogenic diseases affecting the right ventricle; and the development of new objective electrocardiographic and imaging criteria for diagnosis. This review provides an update on the diagnosis of ARVC/D, focusing on the contribution of emerging imaging techniques, such as echocardiogram/magnetic resonance imaging strain measurements or computed tomography scanning, new electrocardiographic parameters, and high-throughput sequencing.
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