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Lukovic D, Gyöngyösi M, Pavo IJ, Mester-Tonczar J, Einzinger P, Zlabinger K, Kastner N, Spannbauer A, Traxler D, Pavo N, Goliasch G, Pils D, Jakab A, Szankai Z, Michel-Behnke I, Zhang L, Devaux Y, Graf S, Beitzke D, Winkler J. Increased [ 18F]FDG uptake in the infarcted myocardial area displayed by combined PET/CMR correlates with snRNA-seq-detected inflammatory cell invasion. Basic Res Cardiol 2024; 119:807-829. [PMID: 38922408 DOI: 10.1007/s00395-024-01064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
Combined [18F]FDG PET-cardiac MRI imaging (PET/CMR) is a useful tool to assess myocardial viability and cardiac function in patients with acute myocardial infarction (AMI). Here, we evaluated the prognostic value of PET/CMR in a porcine closed-chest reperfused AMI (rAMI) model. Late gadolinium enhancement by PET/CMR imaging displayed tracer uptake defect at the infarction site by 3 days after the rAMI in the majority of the animals (group Match, n = 28). Increased [18F]FDG uptake at the infarcted area (metabolism/contractility mismatch) with reduced tracer uptake in the remote viable myocardium (group Mismatch, n = 12) 3 days after rAMI was observed in the animals with larger infarct size and worse left ventricular ejection fraction (LVEF) (34 ± 8.7 vs 42.0 ± 5.2%), with lower LVEF also at the 1-month follow-up (35.8 ± 9.5 vs 43.0 ± 6.3%). Transcriptome analyses by bulk and single-nuclei RNA sequencing of the infarcted myocardium and border zones (n = 3 of each group, and 3 sham-operated controls) revealed a strong inflammatory response with infiltration of monocytes and macrophages in the infarcted and border areas in Mismatch animals. Our data indicate a high prognostic relevance of combined PET/MRI in the subacute phase of rAMI for subsequent impairment of heart function and underline the adverse effects of an excessive activation of the innate immune system in the initial phase after rAMI.
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Affiliation(s)
- Dominika Lukovic
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
| | - Imre J Pavo
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Mester-Tonczar
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Patrick Einzinger
- Institute of Information Systems Engineering, Research Unit of Information and Software Engineering, Vienna University of Technology, 1040, Vienna, Austria
| | - Katrin Zlabinger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nina Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andreas Spannbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Denise Traxler
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dietmar Pils
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Andras Jakab
- Center for MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Lu Zhang
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Yvan Devaux
- Cardiovascular Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Senta Graf
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Johannes Winkler
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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2
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Sakai T, Tsuboi K, Takarada S, Okabe M, Nakaoka H, Ibuki K, Ozawa SW, Hata Y, Ichimata S, Nishida N, Hirono K. Tachycardia-Induced Cardiomyopathy in an Infant with Atrial Flutter and Prolonged Recovery of Cardiac Function. J Clin Med 2024; 13:3313. [PMID: 38893024 PMCID: PMC11172730 DOI: 10.3390/jcm13113313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Tachycardia-induced cardiomyopathy (TIC) is caused by prolonged tachycardia, leading to left ventricular dilatation and systolic dysfunction with heart failure. Although TIC is more common in adults, it is rare in early infancy. Methods: Clinical testing was performed as part of medical evaluation and management. Next-generation sequencing (NGS) was conducted for a patient with TIC. A literature review on TIC was also conducted. Results: The case involved a 5-month-old infant referred to the hospital due to symptoms of heart failure lasting at least two months. The infant's heart rate was 200 beats per minute, the left ventricular ejection fraction fell below 14%, and electrocardiograms showed atrial flutter, suggesting TIC. After cardioversion, there was no recurrence of atrial flutter, and cardiac function improved 98 days after tachycardia arrest. The NGS did not identify any pathogenic variants. The literature review identified eight early infantile cases of TIC. However, no previous reports described a case with such a prolonged duration of TIC as ours. Conclusions: This is the first report of a case of prolonged TIC in a child with the documented time to recover normal cardiac function. The improvement of cardiac function depends on the duration of TIC. Early recognition and intervention in TIC are essential to improve outcomes for infantile patients, as timely treatment offers the potential for recovery.
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Affiliation(s)
- Tomohide Sakai
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Kaori Tsuboi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Shinya Takarada
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Mako Okabe
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Hideyuki Nakaoka
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Sayaka W. Ozawa
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
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Bergamaschi L, Foà A, Paolisso P, Renzulli M, Angeli F, Fabrizio M, Bartoli L, Armillotta M, Sansonetti A, Amicone S, Stefanizzi A, Rinaldi A, Niro F, Lovato L, Gherbesi E, Carugo S, Pasquale F, Casella G, Galiè N, Rucci P, Bucciarelli-Ducci C, Pizzi C. Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries. JACC Cardiovasc Imaging 2024; 17:149-161. [PMID: 37480903 DOI: 10.1016/j.jcmg.2023.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/10/2023] [Accepted: 05/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) plays a pivotal diagnostic role in myocardial infarction with nonobstructive coronary arteries (MINOCA). To date, a prognostic stratification of these patients is still lacking. OBJECTIVES This study aims to assess the prognostic role of CMR in MINOCA. METHODS The authors assessed 437 MINOCA from January 2017 to October 2021. They excluded acute myocarditis, takotsubo syndromes, cardiomyopathies, and other nonischemic etiologies. Patients were classified into 3 subgroups according to the CMR phenotype: 1) presence of late gadolinium enhancement (LGE) and abnormal mapping (M) values (LGE+/M+); 2) regional ischemic injury with abnormal mapping and no LGE (LGE-/M+); and 3) nonpathological CMRs (LGE-/M-). The primary outcome was the presence of major adverse cardiovascular events (MACE). The mean follow-up was 33.7 ± 12.0 months and CMR was performed on average at 4.8 ± 1.5 days from the acute presentation. RESULTS The final cohort included 198 MINOCA; 116 (58.6%) comprised the LGE+/M+ group. During follow-up, MACE occurred significantly more frequently in MINOCA LGE+/M+ than in the LGE+/M- and normal-CMR (LGE-/M-) subgroups (20.7% vs 6.7% and 2.7%; P = 0.006). The extension of myocardial damage at CMR was significantly greater in patients who developed MACE. In multivariable Cox regression, %LGE was an independent predictor of MACE (HR: 1.123 [95% CI: 1.064-1.185]; P < 0.001) together with T2 mapping values (HR: 1.190 [95% CI: 1.145-1.237]; P = 0.001). CONCLUSIONS In MINOCA with early CMR execution, the %LGE and abnormal T2 mapping values were identified as independent predictors of adverse cardiac events at ∼3.0 years of follow-up. These parameters can be considered as high-risk markers in MINOCA.
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Affiliation(s)
- Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michele Fabrizio
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lorenzo Bartoli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabio Niro
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Pediatric and Adult CardioThoracic and Vascular, Onchoematologic and Emergency Radiology Unit
| | - Luigi Lovato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Pediatric and Adult CardioThoracic and Vascular, Onchoematologic and Emergency Radiology Unit
| | - Elisa Gherbesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | - Ferdinando Pasquale
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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4
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Gaudino M, Flather M, Capodanno D, Milojevic M, Bhatt DL, Biondi Zoccai G, Boden WE, Devereaux PJ, Doenst T, Farkouh M, Freemantle N, Fremes S, Puskas J, Landoni G, Lawton J, Myers PO, Redfors B, Sandner S. European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery. Eur J Cardiothorac Surg 2024; 65:ezad415. [PMID: 38420786 DOI: 10.1093/ejcts/ezad415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 03/02/2024] Open
Abstract
Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated with an increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was found that large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs of ischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the group that establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should be included in the primary composite outcome of coronary intervention trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Davide Capodanno
- Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - William E Boden
- VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - P J Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Michael Farkouh
- Academic Affairs, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Stephen Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jennifer Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick O Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Datta P, Nath S, Pathade AG, Yelne S. Unveiling the Enigma: Exploring the Intricate Link Between Coronary Microvascular Dysfunction and Takotsubo Cardiomyopathy. Cureus 2023; 15:e44552. [PMID: 37790001 PMCID: PMC10544771 DOI: 10.7759/cureus.44552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
This review article delves into the intricate and evolving relationship between coronary microvascular dysfunction (CMD) and takotsubo cardiomyopathy (TCM), two intriguing cardiovascular conditions increasingly recognised for their potential interplay. We examine their characteristics, shared pathophysiological mechanisms, diagnostic challenges, and management strategies. Emerging evidence suggests a link between microvascular dysfunction and the development of TCM, leading to a deeper exploration of their connection. Accurate diagnosis of both conditions becomes essential, as microvascular dysfunction may modify TCM outcomes. We underscore the significance of understanding this connection for improved patient care, emphasising the need for tailored interventions when CMD and TCM coexist. Collaborative research and heightened clinical awareness are advocated to advance our comprehension of this relationship. Through interdisciplinary efforts, we aim to refine diagnostic precision, develop targeted therapies, and enhance patient outcomes in cardiovascular medicine.
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Affiliation(s)
- Pragyamita Datta
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | | | - Aniket G Pathade
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Masutani EM, Chandrupatla RS, Wang S, Zocchi C, Hahn LD, Horowitz M, Jacobs K, Kligerman S, Raimondi F, Patel A, Hsiao A. Deep Learning Synthetic Strain: Quantitative Assessment of Regional Myocardial Wall Motion at MRI. Radiol Cardiothorac Imaging 2023; 5:e220202. [PMID: 37404797 PMCID: PMC10316298 DOI: 10.1148/ryct.220202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 07/06/2023]
Abstract
Purpose To assess the feasibility of a newly developed algorithm, called deep learning synthetic strain (DLSS), to infer myocardial velocity from cine steady-state free precession (SSFP) images and detect wall motion abnormalities in patients with ischemic heart disease. Materials and Methods In this retrospective study, DLSS was developed by using a data set of 223 cardiac MRI examinations including cine SSFP images and four-dimensional flow velocity data (November 2017 to May 2021). To establish normal ranges, segmental strain was measured in 40 individuals (mean age, 41 years ± 17 [SD]; 30 men) without cardiac disease. Then, DLSS performance in the detection of wall motion abnormalities was assessed in a separate group of patients with coronary artery disease, and these findings were compared with consensus results of four independent cardiothoracic radiologists (ground truth). Algorithm performance was evaluated by using receiver operating characteristic curve analysis. Results Median peak segmental radial strain in individuals with normal cardiac MRI findings was 38% (IQR: 30%-48%). Among patients with ischemic heart disease (846 segments in 53 patients; mean age, 61 years ± 12; 41 men), the Cohen κ among four cardiothoracic readers for detecting wall motion abnormalities was 0.60-0.78. DLSS achieved an area under the receiver operating characteristic curve of 0.90. Using a fixed 30% threshold for abnormal peak radial strain, the algorithm achieved a sensitivity, specificity, and accuracy of 86%, 85%, and 86%, respectively. Conclusion The deep learning algorithm had comparable performance with subspecialty radiologists in inferring myocardial velocity from cine SSFP images and identifying myocardial wall motion abnormalities at rest in patients with ischemic heart disease.Keywords: Neural Networks, Cardiac, MR Imaging, Ischemia/Infarction Supplemental material is available for this article. © RSNA, 2023.
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7
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Lopes MAAADM, Campos CM, Rosa VEE, Sampaio RO, Morais TC, de Brito Júnior FS, Vieira MLC, Mathias W, Fernandes JRC, de Santis A, Santos LDM, Rochitte CE, Capodanno D, Tamburino C, Abizaid A, Tarasoutchi F. Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification. Front Cardiovasc Med 2023; 10:1149613. [PMID: 37180790 PMCID: PMC10174252 DOI: 10.3389/fcvm.2023.1149613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS). Background Elevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS. Methods Prospective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 (n = 17) when BNP and hsTnI levels were below median [BNP < 1.98 fold upper reference limit (URL) and hsTnI < 1.8 fold URL]; Group 2 (n = 14) when BNP or hsTnI were higher than median; and Group 3 (n = 18) when both hsTnI and BNP were higher than median. Results 49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance (P = 0.03) and lower left ventricular ejection fraction (P = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31-47] vs. 32 [29-41] vs. 26 [19-33]%; p < 0.01) and right ventricular EF (62 [53-69] vs. 51 [35-63] vs. 30 [24-46]%; p < 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8-30.7] vs. 28.2 [26.9-34.5] vs. 31.8 [28.9-35.5]%; p = 0.03) and indexed ECV (iECV) (28.7 [21.2-39.1] vs. 28.8 [25.4-39.9] vs. 44.2 [36.4-51.2] ml/m2, respectively; p < 0.01) from Group 1 to Group 3. Conclusions Higher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.
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Affiliation(s)
- Maria Antonieta Albanez A. de M. Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Real Hospital Português, Real Cardiologia, Recife, PE, Brazil
| | - Carlos M. Campos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Insituto Prevent Senior, São Paulo, SP, Brazil
| | - Vitor Emer Egypto Rosa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Correspondence: Vitor Emer Egypto Rosa
| | - Roney O. Sampaio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thamara C. Morais
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fábio Sândoli de Brito Júnior
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo L. C. Vieira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wilson Mathias
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joao Ricardo Cordeiro Fernandes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Antonio de Santis
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Luciano de Moura Santos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos E. Rochitte
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Davide Capodanno
- CardioT Division of Cardiology, Policlinico-Vittorio Emanuele Hospital University of Catania, Catania, Italy
| | - Corrado Tamburino
- CardioT Division of Cardiology, Policlinico-Vittorio Emanuele Hospital University of Catania, Catania, Italy
| | - Alexandre Abizaid
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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8
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Chong L, Gopinathannair R, Ahmad A, Mar P, Olshansky B. Arrhythmia-Induced Cardiomyopathy: Mechanisms and Risk Assessment to Guide Management and Follow-Up. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Addae-Mensah K, Revels J, Febbo J. Pitfalls and pearls in the imaging of cardiac ischemia. Semin Ultrasound CT MR 2022; 43:184-193. [PMID: 35688530 DOI: 10.1053/j.sult.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease is the most common cause of cardiac ischemia and a leading cause of death globally. There are multiple imaging modalities which can assess cardiac ischemia, in particular coronary CT calcium score, coronary CT angiography, and cardiac MRI. Each of these modalities offers insight into the overall patient picture. However, coronary CT and cardiac MRI are not free from limitations. This article will review the roles of CT and MRI in cardiac imaging, mimics, technical limitations, and potential pitfalls that may be encountered.
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Affiliation(s)
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, Albuquerque, NM..
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10
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Assessment of the relationship between regional wall motion abnormality score revealed by parametric imaging and the extent of LGE with CMR. Clin Imaging 2022; 89:68-77. [DOI: 10.1016/j.clinimag.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022]
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11
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Fully Automatic Scar Segmentation for Late Gadolinium Enhancement MRI Images in Left Ventricle with Myocardial Infarction. Curr Med Sci 2021; 41:398-404. [PMID: 33877559 DOI: 10.1007/s11596-021-2360-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
Numerous methods have been published to segment the infarct tissue in the left ventricle, most of them either need manual work, post-processing, or suffer from poor reproducibility. We proposed an automatic segmentation method for segmenting the infarct tissue in left ventricle with myocardial infarction. Cardiac images of a total of 60 diseased hearts (55 human hearts and 5 porcine hearts) were used in this study. The epicardial and endocardial boundaries of the ventricles in every 2D slice of the cardiac magnetic resonance with late gadolinium enhancement images were manually segmented. The subsequent pipeline of infarct tissue segmentation is fully automatic. The segmentation results with the automatic algorithm proposed in this paper were compared to the consensus ground truth. The median of Dice overlap between our automatic method and the consensus ground truth is 0.79. We also compared the automatic method with the consensus ground truth using different image sources from different centers with different scan parameters and different scan machines. The results showed that the Dice overlap with the public dataset was 0.83, and the overall Dice overlap was 0.79. The results show that our method is robust with respect to different MRI image sources, which were scanned by different centers with different image collection parameters. The segmentation accuracy we obtained is comparable to or better than that of the conventional semi-automatic methods. Our segmentation method may be useful for processing large amount of dataset in clinic.
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Behzadnia N, Sharif-Kashani B, Ahmadi ZH, Naghashzadeh F, Dorudinia A, Jahangirifard A, Hamarz H, Abbasi P. Evaluation of cardiomyopathy diagnosis in heart transplant recipients: comparison of echocardiographic and pathologic classification. Egypt Heart J 2021; 73:29. [PMID: 33765208 PMCID: PMC7994484 DOI: 10.1186/s43044-021-00154-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Definite diagnosis of cardiomyopathy types can be challenging in end-stage disease process. New growing data have suggested that there is inconsistency between echocardiography and pathology in defining type of cardiomyopathy before and after heart transplantation. The aim of the present study was to compare the pre-heart transplant echocardiographic diagnosis of cardiomyopathy with the results of post-transplant pathologic diagnosis. Results In this retrospective cross-sectional clinicopathological study, 100 consecutive patients have undergone heart transplantation in Masih-Daneshvari hospital, Tehran, Iran, between 2010 and 2019. The mean age of patients was 40 ± 13 years and 79% of patients were male. The frequency of different types of cardiomyopathy was significantly different between two diagnostic tools (echocardiography versus pathology, P < 0.001). On the other hand, in 24 patients, the results of echocardiography as regard to the type of cardiomyopathy were inconsistent with pathologic findings. Conclusion Based on the findings of the present study, it could be concluded that there is a significant difference between echocardiographic and pathologic diagnosis of cardiomyopathy; therefore, it is necessary to use additional tools for definite diagnosis of cardiomyopathy like advanced cardiac imaging or even endomyocardial biopsy before heart transplantation to reach an appropriate treatment strategy.
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Affiliation(s)
- Neda Behzadnia
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zargham Hossein Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atosa Dorudinia
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jahangirifard
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamoun Hamarz
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Abbasi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Nikan Education and Research Center, Tehran, Iran.
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Mirtajaddini M, Naderi N, Houshmand G, Taghavi S, Amin A. Challenge of coronavirus disease 2019-related myocarditis diagnosis in patients with negative real-time polymerase chain reaction test: A case series. Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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14
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Pennig L, Lennartz S, Wagner A, Sokolowski M, Gajzler M, Ney S, Laukamp KR, Persigehl T, Bunck AC, Maintz D, Weiss K, Naehle CP, Doerner J. Clinical application of free-breathing 3D whole heart late gadolinium enhancement cardiovascular magnetic resonance with high isotropic spatial resolution using Compressed SENSE. J Cardiovasc Magn Reson 2020; 22:89. [PMID: 33327958 PMCID: PMC7745391 DOI: 10.1186/s12968-020-00673-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm3 acquired voxel size) compared to standard breath-hold LGE imaging. METHODS This was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February-November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic-5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis. RESULTS Global LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1-50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired. CONCLUSIONS In a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matej Gajzler
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Svenja Ney
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Philips GmbH, Röntgenstraße 22, 22335, Hamburg, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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15
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Comparison of free breathing 3D mDIXON with single breath-hold 3D inversion recovery sequences for the assessment of Late Gadolinium Enhancement. Eur J Radiol 2020; 134:109427. [PMID: 33307461 DOI: 10.1016/j.ejrad.2020.109427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/30/2020] [Accepted: 11/14/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the technical and diagnostic performance of three dimensional (3D) mDIXON versus 3D inversion recovery (3D VIAB) and 3D spectral presaturation with inversion recovery (3D SPIR) late gadolinium enhancement (LGE) sequences. METHODS A total of 78 patients (50 males and 28 females, age 49 ± 18 years) with 1.5 T CMR examination including three different 3D LGE sequences (3D mDIXON, 3D VIAB, and 3D SPIR) were evaluated for technical and diagnostic performance by two readers. Qualitative scores and quantitative signal and contrast-to-noise ratios were compared among sequences. Qualitative comparisons were made using Friedman and Wilcoxon signed rank tests. Quantitative comparisons were made using one way ANOVA. Reader agreements were tested using Cohen's Kappa. Any p-value <0.05 was significant. RESULTS 19 out of 78 patients (24 %) were excluded due to poor (grade 4) image quality and 29 patients were excluded due to absence of LGE. For the remaining 30 patients, free breathing 3D mDIXON showed higher confidence in diagnosis of subepicardial LGE (p-value < 0.05). 3D mDIXON outperformed 3D SPIR in both visualization of LGE (p = 0.02) and quality of fat suppression (p = 0.001). Nevertheless, 3D mDIXON showed lower image quality compared to the other two sequences. CONCLUSION Free breathing 3D mDIXON is a diagnostic problem-solving tool, especially when making a diagnosis of subepicardial enhancement and/or fat suppression is needed, owing to its high spatial resolution and robust fat suppression. Choice of 3D LGE sequence should be based on patient's breath-hold ability, diagnostic needs, and institutional availability considering the strengths and limitations of each sequence.
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16
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Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
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Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
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17
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Schiau C, Schiau Ş, Dudea SM, Manole S. Cardiovascular magnetic resonance: contribution to the exploration of cardiomyopathies. Med Pharm Rep 2019; 92:326-336. [PMID: 31750431 PMCID: PMC6853046 DOI: 10.15386/mpr-1343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/14/2019] [Accepted: 07/31/2019] [Indexed: 01/10/2023] Open
Abstract
Background and aims Magnetic resonance imaging is a non-invasive and non-irradiating imaging method, complementary to cardiac ultrasound in the assessment of cardiovascular disease and implicitly of cardiomyopathies. Although it is not a first intention imaging method, it is superior in the assessment of cardiac volumes, left ventricular ejection fraction, in the analysis of cardiac wall dyskinesia and myocardial tissue characteristics with and without using a contrast agent. The purpose of this paper is to review the current knowledge regarding cardiovascular magnetic resonance imaging (CMR) and its applications in cardiomyopathy analysis. Methods In order to create this review, relevant articles were searched and analyzed by using MeSH terms such as: “cardiac magnetic resonance imaging”, “cardiomyopathy”, “myocardial fibrosis”. Three main international databases PubMed, Web of Science and Medscape were searched. We carried out a narrative review focused on the current indications of cardiovascular magnetic resonance imaging in cardiomyopathies, both common and raret, of ischemic and nonischemic types. Results Cardiac magnetic resonance imaging has a very important role in the diagnosis, assessment and prognosis of common cardiomyopathies (the dilated, hypertrophic and inflammatory types) or other more rare ones such as (amyloidosis, arrhythmogenic right ventricular, non-compaction or Takotsubo cardiomyopathy), as it represents the gold standard for evaluating the ejection fraction, ventricular volumes and mass. CMR techniques, such as late gadolinium enhancement, T1 and T2 mapping have proven their usefulness, helping differentiate between ischemic (subendocardial enhancement) and nonischemic cardiomyopathy (varied pattern) or also establish the etiology. Another important feature of this imaging technique is that it can establish the myocardial viability, thus the chance of contractile recovery after revascularization. This feature is based on the transmural extent of LGE, left ventricle wall thickness and the assessment of the contractile reserve after administration of low dose dobutamine. Conclusions Cardiovascular magnetic resonance imaging is an indispensable tool, with proven efficiency, capable of providing the differential diagnosis between ischemic and nonischemic cardiomyopathy or establishing the etiology in the nonischemic type. In addition, these findings have a prognostic value, they may guide the patient management plan and, if necessary, can evaluate treatment response. Therefore, this technique should be part of any routine investigation of various cardiomyopathies.
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Affiliation(s)
- Călin Schiau
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Şerban Schiau
- "Niculae Stancioiu" Heart Institute, Cluj-Napoca, Romania
| | - Sorin M Dudea
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Radiology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Simona Manole
- Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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18
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Role of multimodality imaging in the diagnosis and management of cardiomyopathies. Arch Cardiovasc Dis 2019; 112:615-629. [PMID: 31607558 DOI: 10.1016/j.acvd.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/06/2023]
Abstract
Multimodality imaging plays an important role in the initial evaluation, diagnosis and management of patients suspected of having a cardiomyopathy. Beyond functional and anatomical information, multimodality imaging provides important variables that facilitate risk stratification and prognosis evaluation. Whatever the underlying suspected cardiomyopathy, echocardiography is the most common initial imaging test used to establish the presence of cardiomyopathy, by depicting structural and functional abnormalities. However, echocardiographic findings are non-specific, and therefore have a limited role in identifying the underlying aetiology. Cardiac magnetic resonance imaging allows characterization of myocardial tissue, which can be of great help in identifying the aetiology of the cardiomyopathy. When a specific aetiology is suspected, particularly inflammation, 18F-fluorodeoxyglucose positron emission tomography is recommended. The clinician should be capable of selecting the appropriate imaging techniques for each clinical scenario. Each technique has strengths and weaknesses, which should be known. In order to improve diagnostic performance, and as proposed by the European Association for Cardiovascular Imaging, cardiovascular imaging groups must be composed of experts from all modalities. The future of multimodality imaging in the diagnosis and management of cardiomyopathies will also involve evolution of its use in care, teaching and research. Training goals for future cardiac imaging experts must be defined; academic and industry partnerships should enable the connection to be made between imaging data and clinical data on the one hand and outcomes on the other hand, using big-data analysis and artificial intelligence.
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19
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Rustamova YK. Actual Problems of Diagnostics of Viable Myocardium. KARDIOLOGIIA 2019; 59:68-78. [PMID: 30853023 DOI: 10.18087/cardio.2019.2.10243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/18/2022]
Abstract
The article presents modern analysis of the studies and reflects the key problems concerning the feasibility of performing cardiac MRI for assessment of myocardial viability in patients with history of myocardial infarction (with postinfarction cardiosclerosis), as well as the effectiveness of the method for predicting restoration of the function of hibernating myocardium after myocardial revascularization.
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20
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Spath NB, Lilburn DML, Gray GA, Le Page LM, Papanastasiou G, Lennen RJ, Janiczek RL, Dweck MR, Newby DE, Yang PC, Jansen MA, Semple SI. Manganese-Enhanced T 1 Mapping in the Myocardium of Normal and Infarcted Hearts. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:9641527. [PMID: 30498403 PMCID: PMC6222240 DOI: 10.1155/2018/9641527] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 02/01/2023]
Abstract
Background Manganese-enhanced MRI (MEMRI) has the potential to identify viable myocardium and quantify calcium influx and handling. Two distinct manganese contrast media have been developed for clinical application, mangafodipir and EVP1001-1, employing different strategies to mitigate against adverse effects resulting from calcium-channel agonism. Mangafodipir delivers manganese ions as a chelate, and EVP1001-1 coadministers calcium gluconate. Using myocardial T1 mapping, we aimed to explore chelated and nonchelated manganese contrast agents, their mechanism of myocardial uptake, and their application to infarcted hearts. Methods T1 mapping was performed in healthy adult male Sprague-Dawley rats using a 7T MRI scanner before and after nonchelated (EVP1001-1 or MnCl2 (22 μmol/kg)) or chelated (mangafodipir (22-44 μmol/kg)) manganese-based contrast media in the presence of calcium channel blockade (diltiazem (100-200 μmol/kg/min)) or sodium chloride (0.9%). A second cohort of rats underwent surgery to induce anterior myocardial infarction by permanent coronary artery ligation or sham surgery. Infarcted rats were imaged with standard gadolinium delayed enhancement MRI (DEMRI) with inversion recovery techniques (DEMRI inversion recovery) as well as DEMRI T1 mapping. A subsequent MEMRI scan was performed 48 h later using either nonchelated or chelated manganese and T1 mapping. Finally, animals were culled at 12 weeks, and infarct size was quantified histologically with Masson's trichrome (MTC). Results Both manganese agents induced concentration-dependent shortening of myocardial T1 values. This was greatest with nonchelated manganese, and could be inhibited by 30-43% with calcium-channel blockade. Manganese imaging successfully delineated the area of myocardial infarction. Indeed, irrespective of the manganese agent, there was good agreement between infarct size on MEMRI T1 mapping and histology (bias 1.4%, 95% CI -14.8 to 17.1 P>0.05). In contrast, DEMRI inversion recovery overestimated infarct size (bias 11.4%, 95% CI -9.1 to 31.8 P=0.002), as did DEMRI T1 mapping (bias 8.2%, 95% CI -10.7 to 27.2 P=0.008). Increased manganese uptake was also observed in the remote myocardium, with remote myocardial ∆T1 inversely correlating with left ventricular ejection fraction after myocardial infarction (r=-0.61, P=0.022). Conclusions MEMRI causes concentration and calcium channel-dependent myocardial T1 shortening. MEMRI with T1 mapping provides an accurate assessment of infarct size and can also identify changes in calcium handling in the remote myocardium. This technique has potential applications for the assessment of myocardial viability, remodelling, and regeneration.
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Affiliation(s)
- N. B. Spath
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - D. M. L. Lilburn
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - G. A. Gray
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - L. M. Le Page
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - G. Papanastasiou
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - R. J. Lennen
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Preclinical Imaging, University of Edinburgh, Edinburgh, UK
| | - R. L. Janiczek
- GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - M. R. Dweck
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D. E. Newby
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - P. C. Yang
- Department of Cardiology, Stanford University, Stanford, CA, USA
| | - M. A. Jansen
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Preclinical Imaging, University of Edinburgh, Edinburgh, UK
| | - S. I. Semple
- British Heart Foundation Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Left ventricular MRI wall motion assessment by monogenic signal amplitude image computation. Magn Reson Imaging 2018; 54:109-118. [PMID: 30118827 DOI: 10.1016/j.mri.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac Magnetic Resonance Imaging (MRI) is the commonly used technique for the assessment of left ventricular (LV) function. Apart manually or semi-automatically contouring LV boundaries for quantification of By visual interpretation of cine images, assessment of regional wall motion is performed by visual interpretation of cine images, thus relying on an experience-dependent and subjective modality. OBJECTIVE The aim of this work is to describe a novel algorithm based on the computation of the monogenic amplitude image to be utilized in conjunction with conventional cine-MRI visualization to assess LV motion abnormalities and to validate it against gold standard expert visual interpretation. METHODS The proposed method uses a recent image processing tool called "monogenic signal" to decompose the MR images into features, which are relevant for motion estimation. Wall motion abnormalities are quantified locally by measuring the temporal variations of the monogenic signal amplitude. The new method was validated by two non-expert radiologists using a wall motion scoring without and with the computed image, and compared against the expert interpretation. The proposed approach was tested on a population of 40 patients, including 8 subjects with normal ventricular function and 32 pathological cases (20 with myocardial infarction, 9 with myocarditis, and 3 with dilated cardiomyopathy). RESULTS The results show that, for both radiologists, sensitivity, specificity and accuracy of cine-MRI alone were similar and around 59%, 77%, and 71%, respectively. Adding the proposed amplitude image while visualizing the cine MRI images significantly increased both sensitivity, specificity and accuracy up to 75%, 89%, and 84%, respectively. CONCLUSION Accuracy of wall motion interpretation adding amplitude image to conventional visualization was proven feasible and superior to standard image interpretation on the considered population, in inexperienced observers. Adding the amplitude images as a diagnostic tool in clinical routine is likely to improve the detection of myocardial segments presenting a cardiac dysfunction.
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Khaper N, Bailey CDC, Ghugre NR, Reitz C, Awosanmi Z, Waines R, Martino TA. Implications of disturbances in circadian rhythms for cardiovascular health: A new frontier in free radical biology. Free Radic Biol Med 2018; 119:85-92. [PMID: 29146117 DOI: 10.1016/j.freeradbiomed.2017.11.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/27/2017] [Accepted: 11/08/2017] [Indexed: 01/19/2023]
Abstract
Cell autonomous circadian "clock" mechanisms are present in virtually every organ, and generate daily rhythms that are important for normal physiology. This is especially relevant to the cardiovascular system, for example the circadian mechanism orchestrates rhythms in heart rate, blood pressure, cardiac contractility, metabolism, gene and protein abundance over the 24-h day and night cycles. Conversely, disturbing circadian rhythms (e.g. via shift work, sleep disorders) increases cardiovascular disease risk, and exacerbates cardiac remodelling and worsens outcome. Notably, reactive oxygen species (ROS) are important contributors to heart disease, especially the pathophysiologic damage that occurs after myocardial infarction (MI, heart attack). However, little is known about how the circadian mechanism, or rhythm desynchrony, is involved in these key pathologic stress responses. This review summarizes the current knowledge on circadian rhythms in the cardiovascular system, and the implications of rhythm disturbances for cardiovascular health. Furthermore, we highlight how free radical biology coincides with the pathogenesis of myocardial repair and remodelling after MI, and indicate a role for the circadian system in the oxidative stress pathways in the heart and brain after MI. This fusion of circadian biology with cardiac oxidative stress pathways is novel, and offers enormous potential for improving our understanding and treatment of heart disease.
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Affiliation(s)
- Neelam Khaper
- Medical Sciences Division, Northern Ontario School of Medicine, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario, Canada P7B5E1
| | - Craig D C Bailey
- Centre for Cardiovascular Investigations, Department of Biomedical Sciences/OVC, University of Guelph, Guelph, Ontario, Canada N1G2W1
| | - Nilesh R Ghugre
- Schulich Heart Research Program, Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada M4N 3M5
| | - Cristine Reitz
- Centre for Cardiovascular Investigations, Department of Biomedical Sciences/OVC, University of Guelph, Guelph, Ontario, Canada N1G2W1
| | - Zikra Awosanmi
- Centre for Cardiovascular Investigations, Department of Biomedical Sciences/OVC, University of Guelph, Guelph, Ontario, Canada N1G2W1
| | - Ryan Waines
- Centre for Cardiovascular Investigations, Department of Biomedical Sciences/OVC, University of Guelph, Guelph, Ontario, Canada N1G2W1
| | - Tami A Martino
- Centre for Cardiovascular Investigations, Department of Biomedical Sciences/OVC, University of Guelph, Guelph, Ontario, Canada N1G2W1.
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Jia X, Heiberg E, Ripa MS, Engblom H, Halvorsen S, Arheden H, Atar D, Clemmensen P, Birnbaum Y. Correlation of ST changes in leads V4-V6 to area of ischemia by CMR in inferior STEMI. SCAND CARDIOVASC J 2018; 52:189-195. [PMID: 29595340 DOI: 10.1080/14017431.2018.1458145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aim to determine the correlation between ST-segment changes in leads V4-V6 and the extent of myocardial injury by cardiac magnetic resonance (CMR) in patients with inferior ST elevation (STE) myocardial infarction (iSTEMI). DESIGN Admission electrocardiogram and CMR data from the MITOCARE trial were used. Differences in mean myocardium at risk, infarct size, ejection fraction and myocardial segment involvement by CMR were compared in patients with first iSTEMI with STE, ST depression (STD) or no ST changes (NST) in V4-V6. Myocardial segment involvement was further evaluated by comparing proportion of patients in each group with ≥25% and ≥50% segment involvement. RESULTS Fifty-four patients were included. Patients with STE (n = 22) and STD (n = 16) in V4-V6 had significantly lower ejection fraction compared to NST (n = 16) (48% vs 48% vs 54%, p = .02). STE showed more apical, apical lateral and mid-inferolateral involvement but less basal inferior involvement than NST. STD exhibited greater basal inferoseptal involvement compared to STE. There were more patients with STE that had ≥25% and ≥50% apical lateral involvement compared with STD and NST groups. Patients with STD were more likely to have ≥25% and ≥50% basal inferoseptal involvement compared with STE and NST groups. CONCLUSION Our study suggests that in iSTEMI, ST changes in the precordial leads V4-V6 correlates with greater myocardial injury and distribution of myocardium at risk.
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Affiliation(s)
- Xiaoming Jia
- a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA
| | - Einar Heiberg
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Maria Sejersten Ripa
- c Department of Cardiology, The Heart Centre , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Henrik Engblom
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Sigrun Halvorsen
- d Department of Cardiology, Division of Medicine , Oslo University Hospital and Institute of Clinical Sciences, University of Oslo , Oslo , Norway
| | - Håkan Arheden
- b Department of Clinical Physiology , Lund University and Lund University Hospital , Lund , Sweden
| | - Dan Atar
- d Department of Cardiology, Division of Medicine , Oslo University Hospital and Institute of Clinical Sciences, University of Oslo , Oslo , Norway
| | - Peter Clemmensen
- e Department of Medicine, Division of Cardiology , Nykøbing Falster Hospital , Nykøbing Falster , Denmark.,f Institute of Regional Health Research , University of Southern Denmark , Odense , Denmark.,g Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Yochai Birnbaum
- a Department of Medicine, Section of Cardiology , Baylor College of Medicine , Houston , TX , USA
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Abstract
Modern advanced imaging techniques have allowed increasingly more rigorous assessment of the cardiac structure and function of several types of cardiomyopathies. In contemporary cardiology practice, echocardiography and cardiac magnetic resonance imaging are widely used to provide a basic framework in the evaluation and management of cardiomyopathies. Echocardiography is the quintessential imaging technique owing to its unique ability to provide real-time images of the beating heart with good temporal resolution, combined with its noninvasive nature, cost-effectiveness, availability, and portability. Cardiac magnetic resonance imaging provides data that are both complementary and uniquely distinct, thus allowing for insights into the disease process that until recently were not possible. The new catchphrase in the evaluation of cardiomyopathies is multimodality imaging, which is purported to be the efficient integration of various methods of cardiovascular imaging to improve the ability to diagnose, guide therapy, or predict outcomes. It usually involves an integrated approach to the use of echocardiography and cardiac magnetic resonance imaging for the assessment of cardiomyopathies, and, on occasion, single-photon emission computed tomography and such specialized techniques as pyrophosphate scanning.
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Affiliation(s)
- M Fuad Jan
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI
| | - A Jamil Tajik
- From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI.
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Rodean I, Beganu E, Hodas R, Himcinschi E, Bordi L, Benedek T. Cardiac Magnetic Resonance and Myocardial Viability: Why Is It so Important? JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
For a better assessment of ischemic heart diseases, myocardial viability should be quantified. Current studies underline the importance and the evolution of several techniques and methods used in the evaluation of myocardial viability. Taking into account these considerations, the aim of this manuscript was to present the recent points of view regarding myocardial viability and its clinical significance in patients with ischemic cardiomyopathies and left ventricular dysfunction. On the other hand, the manuscript points out the role of magnetic resonance imaging (MRI), one of the most useful noninvasive imaging techniques, in the assessment of myocardial viability. By comparing the advantages and disadvantages of cardiac MRI, its usefulness can be better appreciated by the clinician. In the following years, it is considered that MRI will be an indispensable imaging tool in the assessment of ischemic heart disease, guiding interventions for revascularization and long-term risk stratification in patients with stable angina or myocardial infarction.
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Affiliation(s)
- Ioana Rodean
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Elena Beganu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Roxana Hodas
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Elisabeta Himcinschi
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Lehel Bordi
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Theodora Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
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Herrmann JL, Goldberg LA, Khan AM, Partington SL, Brothers JA, Mascio CE, Spray TL, Kim YY, Fuller S. A Comparison of Perioperative Management of Anomalous Aortic Origin of a Coronary Artery Between an Adult and Pediatric Cardiac Center. World J Pediatr Congenit Heart Surg 2016; 7:721-726. [DOI: 10.1177/2150135116668333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022]
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) presents in varying age-groups. Assuming management algorithms differ between pediatric and adult institutions, we compared the perioperative management of patients with AAOCA at two such centers. Methods: A retrospective review was conducted at a pediatric and an adult institution of patients 14 years or older who underwent surgical repair of AAOCA between January 2000 and May 2014. Results: Twenty patients from the pediatric center (median age: 16.5 years, range: 14-18 years) and nine patients from the adult center (median age: 40 years, range: 37-52 years) were included. An anomalous aortic origin of a right coronary artery was the most frequent pathology at each institution. Chest pain was the most common presenting symptom at both institutions. Preoperative echocardiography was performed in 95% patients at the pediatric center and in 100% of patients at the adult center. Cardiac catheterization was utilized more frequently at the adult center, and cardiac magnetic resonance imaging more commonly employed at the pediatric center. Isolated coronary unroofing was performed in 19 of 20 cases at the pediatric center and in only 2 (22%) cases at the adult institution, both by congenitally trained cardiac surgeons. More concomitant cardiac procedures were performed at the adult center with associated longer operative times and hospital stays. Conclusion: Management strategies for AAOCA vary depending on both patient-specific factors and expertise of the managing team. Further studies are needed to optimally standardize diagnostic and treatment pathways regardless of location venue.
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Affiliation(s)
- Jeremy L. Herrmann
- Division of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leah A. Goldberg
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail M. Khan
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L. Partington
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julie A. Brothers
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher E. Mascio
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L. Spray
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Bratis K, Henningsson M, Grigoratos C, Omodarme MD, Chasapides K, Botnar R, Nagel E. Clinical evaluation of three-dimensional late enhancement MRI. J Magn Reson Imaging 2016; 45:1675-1683. [DOI: 10.1002/jmri.25512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/27/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
- Konstantinos Bratis
- Division of Imaging Sciences and Biomedical Engineering; King's College London; United Kingdom
| | - Markus Henningsson
- Division of Imaging Sciences and Biomedical Engineering; King's College London; United Kingdom
| | | | | | | | - Rene Botnar
- Division of Imaging Sciences and Biomedical Engineering; King's College London; United Kingdom
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging; Frankfurt/Main Germany
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28
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Krumm P, Martirosian P, Rath D, Zitzelsberger T, Ruff CA, Klumpp BD, Nikolaou K, Gawaz M, Geisler T, Schick F, Kramer U. Signal decay mapping of myocardial edema using dual-contrast fast spin-echo MRI. J Magn Reson Imaging 2015; 44:186-93. [PMID: 26717865 DOI: 10.1002/jmri.25142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/10/2015] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To introduce a dual-contrast fast spin-echo (dcFSE) sequence for signal decay mapping of myocardial edema. MATERIALS AND METHODS After consultation with the Institutional Review Board, 22 acute myocardial infarction (MI) patients were examined with magnetic resonance imaging (MRI) at 1.5T 2 days after revascularization. Edema was evaluated in 16 myocardial segments with an exponential fit for signal decay time (SDT) in dcFSE mapping and T2 signal intensity ratio for single-contrast FSE. Myocardial viability was evaluated in late gadolinium enhancement (LGE). A control group of 10 volunteers was examined for edema imaging. SDT was compared in segment groups: 1) with LGE in MI, 2) penumbra, 3) remote from LGE, 4) controls. Groups 1/3 and 3/4 were tested on difference. Three phantoms providing similar T2 but different T1 relaxation times (low, intermediate, high) were examined with dcFSE and multicontrast spin echo sequence as a reference. RESULTS The SDT/T2 ratio for segment groups was 1) 82msec/1.7 in segments with LGE; 2) 65msec/1.6 for penumbra, 3) 62msec/1.7 for remote segments, and 4) 50msec/1.6 in controls. In dcFSE group 1/3 (P < 0.0001) and in group 3/4 (P = 0.0002) SDT was significantly different. In single-contrast FSE the T2 ratio was not significantly different for both tests: 1/3 P = 0.1889; 3/4 P = 0.8879. T2 -overestimation of dcFSE was 23% in low, 29% in intermediate, and 35% in highly T1 contaminated phantoms. CONCLUSION dcFSE signal decay edema mapping is feasible in volunteers and patients. DcFSE SDT is superior to T2 ratio for detection of high-grade and diffuse myocardial edema. J. Magn. Reson. Imaging 2016;44:186-193.
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Affiliation(s)
- Patrick Krumm
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Petros Martirosian
- Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, Eberhard Karls University, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tübingen, Germany
| | - Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Christer Andreas Ruff
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Bernhard Daniel Klumpp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University, Tübingen, Germany
| | - Fritz Schick
- Department of Diagnostic and Interventional Radiology, Section on Experimental Radiology, Eberhard Karls University, Tübingen, Germany
| | - Ulrich Kramer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
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29
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Madanieh R, Mathew S, Shah P, Vatti SK, Madanieh A, Kosmas CE, Vittorio TJ. Cardiac Magnetic Resonance Imaging Might Complement Two-Dimensional Echocardiography in the Detection of a Reversible Nonischemic Cardiomyopathy. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2015; 8:109-14. [PMID: 26740746 PMCID: PMC4689327 DOI: 10.4137/ccrep.s26054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/29/2015] [Accepted: 10/11/2015] [Indexed: 11/05/2022]
Abstract
We report a case of reversible nonischemic dilated cardiomyopathy in a male in his 60s who presented with an acute heart failure syndrome. Both conventional two-dimensional echocardiography and cardiac magnetic resonance imaging (cMRI) demonstrated severe left ventricular systolic dysfunction; however, both modalities were devoid of significant valvular heart disease as well as the presence of fibrosis, infiltration, inflammation, and scar. After six months of aggressive neurohumoral modulation, there was complete reverse remodeling and normalization of left ventricular function, which highlights the role of cMRI as an adjunct to two-dimensional echocardiography in the detection of a potentially reversible nonischemic cardiomyopathy.
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Affiliation(s)
- Raef Madanieh
- St. Francis Hospital – The Heart Center, The Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Shawn Mathew
- New York Institute of Technology, Old Westbury, NY, USA
| | | | - Satya K. Vatti
- St. Francis Hospital – The Heart Center, The Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Abed Madanieh
- St. Francis Hospital – The Heart Center, The Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Constantine E. Kosmas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital Center, New York, NY, USA
| | - Timothy J. Vittorio
- St. Francis Hospital – The Heart Center, The Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
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30
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Melay M, Oloude E, Hounkpatin B, Ferrier N, Long JL, Croisille P, Marcaggi X. [Atypical MRI image of Tako-Tsubo syndrome: a case report]. Ann Cardiol Angeiol (Paris) 2015; 64:54-58. [PMID: 25281218 DOI: 10.1016/j.ancard.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 08/24/2014] [Indexed: 06/03/2023]
Abstract
Since the 1990s, a new entity cardiomyopathy is described: the Tako-Tsubo syndrome. The Mayo Clinics' criteria have been defined by to help diagnose: LV dysfunction, electrical modifications, and complete recovery. It is a Caucasian woman aged 66 hospitalized for chest pain syndrome occurred during the funeral. In support, we note the presence of STEMI. The patient received the conventional treatment of acute coronary syndrome. Cardiac ultrasound, angiography is in favor of Tako-Tsubo syndrome. MRI shows an unusual location: a delayed enhancement in epicardial associated pericardial effusion mimicking myopericarditis.
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Affiliation(s)
- M Melay
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France.
| | - E Oloude
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - B Hounkpatin
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - N Ferrier
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - J-L Long
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
| | - P Croisille
- Hôpital Nord, service de radiologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - X Marcaggi
- Centre hospitalier Jacques-Lacarin, service de cardiologie, boulevard Denière, BP 2457, 03207 Vichy cedex, France
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Jablonowski R, Wilson MW, Joudi N, Hetts SW, Saeed M. Three-dimensional MRI assessments of patchy and large myocardial infarction in beating and nonbeating swine hearts: validation with microscopy. Acad Radiol 2014; 21:1048-55. [PMID: 25018077 DOI: 10.1016/j.acra.2014.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/28/2014] [Accepted: 03/12/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To measure and validate patchy and large myocardial infarction (MI) at 3 days and 5 weeks in beating and nonbeating hearts using contrast-enhanced three-dimensional (3D) inversion-recovery gradient echo (IR-GRE) magnetic resonance imaging (MRI) and microscopy. MATERIALS AND METHODS Pigs (n = 28) were subjected to 1) patchy MI (group I), 2) large MI (group II), or 3) combined (patchy and large) MI (groups III and IV) using microemboli and/or 90-minute left anterior descending (LAD) occlusion and imaged at 3 days and 5 weeks after interventions. Gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA)-enhanced 3D and two-dimensional (2D) IR-GRE were performed for comparison in beating and nonbeating hearts. Macroscopic histochemical and microscopic histopathologic measurements were used for validation. RESULTS Three-dimensional images demonstrated hyperenhanced patchy microinfarction, large MI, hypoenhanced/hyperenhanced microvascular obstruction, and infarct resorption. Acute and chronic combined MI on 3D was underestimated compared to microscopy (bias: -1.8 ± 3.8%) but overestimated acute large infarction. In beating and nonbeating hearts, close correlations/agreements were found between 3D/2D acquisitions in all groups (beating hearts: r = 0.70-0.99; bias: group I 0.47 ± 2.0%, II 0.33 ± 1.2%, III 0.54 ± 1.5%, and IV 0.28 ± 1.0%). CONCLUSIONS The 3D IR-GRE underestimated the extent of acute and chronic combined MI compared to microscopic measurements. This sequence may have the potential to differentiate patchy from large MI and demonstrate MI healing after coronary interventions.
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Affiliation(s)
- Robert Jablonowski
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
| | - Noor Joudi
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
| | - Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705.
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32
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Sapontis J, Hill J. The role of adjunctive imaging in chronic total occlusions. Interv Cardiol 2013. [DOI: 10.2217/ica.13.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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33
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Khan SA, Williamson EE, Foley TA, Cullen EL, Young PM, Araoz PA. Cardiac MRI of acute coronary syndrome. Future Cardiol 2013; 9:351-70. [DOI: 10.2217/fca.13.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. New serological biomarkers, such as troponins, have improved the diagnosis of ACS; however, the diagnosis of ACS can still be difficult as there is marked heterogeneity in its presentation and significant overlap with other disorders presenting with chest pain. Evidence is accumulating that cardiac MRI provides information that can aid the detection and differential diagnosis of ACS, guide clinical decision-making and improve risk-stratification after an event. In this review, we present the relevant cardiac MRI techniques that can be used to detect ACS accurately, provide differential diagnosis, identify the sequelae of ACS, and determine prognostication after ACS.
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Affiliation(s)
- Shamruz Akerem Khan
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Eric E Williamson
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Thomas A Foley
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Ethany L Cullen
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Phillip M Young
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA
| | - Philip A Araoz
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest Rochester, MN 55905, USA.
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Comparison of (99m)Tc-MIBI SPECT/18F-FDG PET imaging and cardiac magnetic resonance imaging in patients with idiopathic dilated cardiomyopathy: assessment of cardiac function and myocardial injury. Clin Nucl Med 2013; 37:1163-9. [PMID: 23154474 DOI: 10.1097/rlu.0b013e3182708794] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the agreement between myocardial F-FDG PET imaging and cardiac magnetic resonance imaging (cMRI) in assessing cardiac function and relationship of cMRI late gadolinium enhancement (cMRI-LGE) and myocardial perfusion/metabolism pattern in patients with idiopathic dilated cardiomyopathy (IDCM). METHODS Forty-two consecutive patients diagnosed with IDCM were enrolled. All patients underwent Tc-MIBI SPECT, gated F-FDG PET imaging, and cMRI within 3-7 days. Cardiac function parameters were calculated using PET and cMRI. The segments analysis was performed using a 17-segment model. Patterns of perfusion/metabolism were classified as normal, mismatch, mild-to-moderate match, and severe match, and cMRI-LGE was classified into 3 categories (non-LGE, mid-wall LGE, and transmural LGE). RESULTS The correlation between gated PET and cMRI was excellent for end-diastolic volume (EDV; r = 0.948, P < 0.001), end-systolic volume (ESV; r = 0.939, P < 0.001), and left ventricular ejection fraction (LVEF; r = 0.685, P < 0.001). EDV and ESV were underestimated, whereas LVEF was slightly overestimated by gated PET in comparison to cMRI. Perfusion/metabolism patterns varied in 3 different categories of non-LGE, mid-wall LGE, and transmural LGE (χ = 14.276, P < 0.001). Also, 71.0% (44/62) segments with mid-wall LGE had normal perfusion/metabolism patterns, and 75.9% (63/83) perfusion/metabolism mismatch segments were shown as non-LGE. The incidence of LGE was significantly higher in segments with severe match than the other 3 segment groups (χ = 112.53, P < 0.001). CONCLUSION There is an excellent agreement between gated PET and cMRI in assessment of cardiac function. LGE-cMRI is much more sensitive in detecting moderate fibrosis, while PET could detect more impaired but viable myocardium. Combining the 2 imaging modalities is useful for providing more comprehensive evaluations of myocardial injury in patients with IDCM.
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Yin G, Zhao S, Lu M, Ma N, Zuehlsdorff S, Cheng H, Jiang S, Zhao T, Zhang Y, An J, Lv C, He Z. Assessment of left ventricular myocardial scar in coronary artery disease by a three-dimensional MR imaging technique. J Magn Reson Imaging 2012; 38:72-9. [PMID: 23225643 DOI: 10.1002/jmri.23962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/18/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gang Yin
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Shihua Zhao
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Minjie Lu
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Ning Ma
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Sven Zuehlsdorff
- Cardiovascular MR R&D, Siemens Healthcare USA; Chicago; Illinois; USA
| | - Huaibing Cheng
- Department of Cardiology; First Affiliated Hospital of Anhui Medical University; Hefei; Anhui; China
| | - Shiliang Jiang
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Tao Zhao
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Yan Zhang
- Department of Radiology; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
| | - Jing An
- APPL Department; Siemens Shenzhen Magnetic Resonance Ltd; Shenzhen; China
| | - Chuanjian Lv
- Department of Radiology; Henan Provincial People's Hospital; Zhengzhou; Henan; China
| | - Zuoxiang He
- Department of Nuclear Medicine; State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing; China
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Ghugre NR, Pop M, Barry J, Connelly KA, Wright GA. Quantitative magnetic resonance imaging can distinguish remodeling mechanisms after acute myocardial infarction based on the severity of ischemic insult. Magn Reson Med 2012; 70:1095-105. [PMID: 23165643 DOI: 10.1002/mrm.24531] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 08/20/2012] [Accepted: 09/21/2012] [Indexed: 01/20/2023]
Abstract
The type and extent of myocardial infarction encountered clinically is primarily determined by the severity of the initial ischemic insult. The purpose of the study was to differentiate longitudinal fluctuations in remodeling mechanisms in porcine myocardium following different ischemic insult durations. Animals (N = 8) were subjected to coronary balloon occlusion for either 90 or 45 min, followed by reperfusion. Imaging was performed on a 3 T MRI scanner between day-2 and week-6 postinfarction with edema quantified by T2, hemorrhage by T2*, vasodilatory function by blood-oxygenation-level-dependent T2 alterations and infarction/microvascular obstruction by contrast-enhanced imaging. The 90-min model produced large transmural infarcts with hemorrhage and microvascular obstruction, while the 45 min produced small nontransmural and nonhemorrhagic infarction. In the 90-min group, elevation of end-diastolic-volume, reduced cardiac function, persistence of edema, and prolonged vasodilatory dysfunction were all indicative of adverse remodeling; in contrast, the 45-min group showed no signs of adverse remodeling. The 45- and 90-min porcine models seem to be ideal for representing the low- and high-risk patient groups, respectively, commonly encountered in the clinic. Such in vivo characterization will be a key in predicting functional recovery and may potentially allow evaluation of novel therapies targeted to alleviate ischemic injury and prevent microvascular obstruction/hemorrhage.
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Affiliation(s)
- Nilesh R Ghugre
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Zhang J, Yang SW, Wang Z, Wei GR, Zhou YJ. Pseudo-ischaemic ECG in a patient with amyotrophic lateral sclerosis surviving for a decade. BMJ Case Rep 2012; 2012:bcr.01.2012.5543. [PMID: 22665549 DOI: 10.1136/bcr.01.2012.5543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 58-year-old female with no history of heart disease was admitted to our hospital for abnormal ECG mimicking myocardial ischaemia. The ECG revealed persistent T-wave inversion in almost all leads, especially in precordial leads V2-V6. The patient had no complaints of chest pain, chest distress, short of breath or other atypical myocardial ischaemia symptoms. She had a history of amyotrophic lateral sclerosis (ALS) with a disease course more than 20 years. Examinations help rule out other diseases causing persistent T-wave inversion. Importantly, cardiac catheterisation showed nearly normal coronary arteries that could rule out myocardial ischaemia. Accordingly, the authors presumed that the pseudo-ischaemic ECG was associated with ALS in this patient. The findings of the present case provide new evidence that autonomic nervous system may involve in the pathophysiological progress of ALS.
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Affiliation(s)
- Jian Zhang
- Cardiology Department, General Hospital of Beijing Military Command, Beijing, China
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Hasdemir C, Yuksel A, Camli D, Kartal Y, Simsek E, Musayev O, Isayev E, Aydin M, Can LH. Late gadolinium enhancement CMR in patients with tachycardia-induced cardiomyopathy caused by idiopathic ventricular arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:465-70. [PMID: 22303908 DOI: 10.1111/j.1540-8159.2011.03324.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Idiopathic ventricular arrhythmias in the form of monomorphic premature ventricular contractions (PVC) and/or ventricular tachycardia (VT) can cause tachycardia-induced cardiomyopathy (TICMP). The aim of this study was to determine the prevalence of late gadolinium enhancement (LGE) in patients with TICMP caused by idiopathic ventricular arrhythmias. METHODS The study population consisted of 298 consecutive patients (174 F/124 M; mean age 45±17 years) with frequent PVCs and/or VT. TICMP was defined as left ventricular ejection fraction (LVEF) of ≤50% in the absence of any detectable underlying heart disease and improvement of LVEF≥15% after effective treatment of index ventricular arrhythmia. RESULTS Twenty-seven (9.1%) patients found to have LVEF≤50% and diagnosed as presumptive TICMP. Improvement in LVEF after effective treatment of index ventricular arrhythmia was observed in 22 of 27 patients (TICMP group; mean PVC burden of 30.8±9.9%). LVEF did not improve in five of 27 patients (primary cardiomyopathy group; mean PVC burden of 28.8±10.1%). LGE-cardiac magnetic resonance (CMR) imaging was performed in 19 of 22 patients with TICMP and one patient (5%) had LGE. All five patients with primary cardiomyopathy underwent LGE-CMR imaging and four patients (80%) had LGE. CONCLUSIONS LGE is a rare finding in patients with TICMP caused by idiopathic ventricular arrhythmias. LGE-CMR can be used in the diagnostic work-up of patients with TICMP. Further prospective studies are required to determine the role of LGE-CMR in predicting the recovery of left ventricular systolic dysfunction in patients with presumptive TICMP.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Kent Hospital, Izmir, Turkey.
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Child NM, Das R. Is cardiac magnetic resonance imaging assessment of myocardial viability useful for predicting which patients with impaired ventricles might benefit from revascularization? Interact Cardiovasc Thorac Surg 2012; 14:395-8. [PMID: 22279116 DOI: 10.1093/icvts/ivr161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A best evidence topic in cardiac magnetic resonance imaging (MRI) was written according to a structured protocol. The question addressed was: what is the role of cardiac magnetic resonance (CMR) imaging in viability assessment of ischaemic cardiomyopathy? Altogether more than 164 papers were found using the reported search; of which, 6 represented the best available evidence to answer the clinical question and an additional 4 were found by crosschecking the reference lists for further 'best available evidence' papers. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Using late-gadolinium enhancement-cardiac magnetic resonance (LGE-CMR) imaging, infarcted myocardium can be identified by the presence of hyperenhanced signal. The extent of myocardial hyperenhancement correlates inversely with improved myocardial contractility following surgical or percutaneous revascularization. Furthermore, CMR is able to assess not only viability, but also make gold-standard assessment of ventricular function and volume as well as identify stress perfusion deficits, each of which is relevant to estimating patient prognosis. National bodies have also begun to formally recommend CMR imaging for cardiac viability assessment. For example, the Canadian Cardiovascular Society (CCS) has stated that 'assessment of myocardial viability in patients with left ventricle dysfunction or akinetic segments for predicting recovery of ventricular function following revascularization is a class I indication for the use of LGE-CMR'. We conclude that cardiac MRI is an excellent tool for predicting myocardial viability, in the context of acute and chronic ischaemic heart disease whether subsequent revascularization is achieved by surgical or percutaneous means. In addition, the versatility of CMR imaging makes it an increasingly attractive tool for the complete assessment of the patient with ischaemic cardiomyopathy.
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Affiliation(s)
- Nicholas M Child
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
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The natural course of traumatic myocardial infarction in a young patient with angiographically normal coronary arteries. Heart Lung 2011; 41:294-300. [PMID: 22014643 DOI: 10.1016/j.hrtlng.2011.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/03/2011] [Accepted: 07/12/2011] [Indexed: 11/20/2022]
Abstract
A 23-year-old man with no history of heart disease was admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University for an abnormal electrocardiogram of ST-T changes mimicking myocardial infarction. Catheterization revealed normal coronary and peripheral arteries. The echocardiogram and delayed enhancement cardiovascular magnetic resonance imaging indicated a markedly reduced left ventricular function and enlarged left ventricular cavity with evidence of fibrous tissue. Given the patient's history of multiple blunt trauma 7 years previously and acute myocardial infarction diagnosis at that time, he was diagnosed with traumatic myocardial infarction (TMI). We describe the natural course of such a patient with TMI. There is a possibility of spontaneous healing of coronary artery dissection induced by trauma. Although early revascularization may be helpful for preventing cardiac remodeling after TMI in some cases, more data are needed to compare the long-term outcome among different interventions in large sample cases.
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Vandsburger MH, Epstein FH. Emerging MRI methods in translational cardiovascular research. J Cardiovasc Transl Res 2011; 4:477-92. [PMID: 21452060 DOI: 10.1007/s12265-011-9275-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 03/15/2011] [Indexed: 12/11/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) has become a reference standard modality for imaging of left ventricular (LV) structure and function and, using late gadolinium enhancement, for imaging myocardial infarction. Emerging CMR techniques enable a more comprehensive examination of the heart, making CMR an excellent tool for use in translational cardiovascular research. Specifically, emerging CMR methods have been developed to measure the extent of myocardial edema, changes in ventricular mechanics, changes in tissue composition as a result of fibrosis, and changes in myocardial perfusion as a function of both disease and infarct healing. New CMR techniques also enable the tracking of labeled cells, molecular imaging of biomarkers of disease, and changes in calcium flux in cardiomyocytes. In addition, MRI can quantify blood flow velocity and wall shear stress in large blood vessels. Almost all of these techniques can be applied in both pre-clinical and clinical settings, enabling both the techniques themselves and the knowledge gained using such techniques in pre-clinical research to be translated from the lab bench to the patient bedside.
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Affiliation(s)
- Moriel H Vandsburger
- Department of Biological Regulation, Weizmann Institute of Science, 76100, Rehovot, Israel.
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Ghugre NR, Ramanan V, Pop M, Yang Y, Barry J, Qiang B, Connelly KA, Dick AJ, Wright GA. Quantitative tracking of edema, hemorrhage, and microvascular obstruction in subacute myocardial infarction in a porcine model by MRI. Magn Reson Med 2011; 66:1129-41. [PMID: 21337425 DOI: 10.1002/mrm.22855] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/06/2010] [Accepted: 01/05/2011] [Indexed: 12/23/2022]
Abstract
Pathophysiological responses after acute myocardial infarction include edema, hemorrhage, and microvascular obstruction along with cellular damage. The in vivo evolution of these processes simultaneously throughout infarct healing has not been well characterized. The purpose of our study was to quantitatively monitor the time course of these mechanisms by MRI in a porcine model of myocardial infarction. Ten pigs underwent MRI before coronary occlusion with subgroups studied at day 2 and weeks 1, 2, 4, and 6 post-infarction. Tissue characterization was performed using quantitative T2 and T2* maps to identify edema and hemorrhage, respectively. Contrast-enhanced MRI was used for infarct/ microvascular obstruction delineation. Inflammation was reflected by T2 fluctuations, however at day 2, edema and hemorrhage had counter-acting effects on T2. Hemorrhage (all forms) and mineralization (calcium) could be identified by T2* in the presence of edema. Simultaneous resolution of microvascular obstruction and T2* abnormality suggested that the two phenomenon were closely associated during the healing process. Our study demonstrates that quantitative T2 and T2* mapping techniques allow regional, longitudinal, and cross-subject comparisons and give insights into histological and tissue remodeling processes. Such in vivo characterization will be important in grading severity and evaluating treatment strategies for myocardial infarction, potentially improving clinical outcomes.
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Affiliation(s)
- Nilesh R Ghugre
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Jackowski C, Warntjes MJB, Berge J, Bär W, Persson A. Magnetic resonance imaging goes postmortem: noninvasive detection and assessment of myocardial infarction by postmortem MRI. Eur Radiol 2010; 21:70-8. [PMID: 20644937 DOI: 10.1007/s00330-010-1884-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 04/28/2010] [Accepted: 06/10/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Christian Jackowski
- Center for Medical Image Science and Visualization, CMIV, University Hospital, University of Linköping, SE-58185, Linköping, Sweden.
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