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Flett A, Cebula A, Nicholas Z, Adam R, Ewings S, Prasad S, Cleland JG, Eminton Z, Curzen N. Rationale and study protocol for the BRITISH randomized trial (Using cardiovascular magnetic resonance identified scar as the benchmark risk indication tool for implantable cardioverter defibrillators in patients with nonischemic cardiomyopathy and severe systolic heart failure). Am Heart J 2023; 266:149-158. [PMID: 37777041 DOI: 10.1016/j.ahj.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND For patients with nonischemic cardiomyopathy (NICM), current guidelines recommend implantable cardioverter defibrillators (ICD) when left ventricular ejection fraction (LVEF) is ≤35%, but the DANISH trial failed to confirm that ICDs reduced all-cause mortality for such patients. Circumstantial evidence suggests that scar on CMR is predictive of sudden and arrhythmic death in this population. The presence of myocardial scar identified by cardiac magnetic resonance imaging (CMR) in patients with NICM and an LVEF ≤35% might identify patients at higher risk of sudden arrhythmic death, for whom an ICD is more likely to reduce all-cause mortality. METHODS/DESIGN The BRITISH trial is a prospective, multicenter, randomized controlled trial aiming to enrol 1,252 patients with NICM and an LVEF ≤35%. Patients with a nonischemic scar on CMR will be randomized to either: (1) ICD, with or without cardiac resynchronization (CRT-D), or (2) implantable loop recorder (ILR) or cardiac resynchronization (CRT-P). Patients who are screened for the trial but are found not to be eligible, predominantly due to an absence of scar or those who decline to be randomized will be enrolled in an observational registry. The primary endpoint is all-cause mortality, which we plan to assess at 3 years after the last participant is randomized. Secondary endpoints include clinical outcomes, appropriate and inappropriate device therapies, symptom severity and well-being, device-related complications, and analysis of the primary endpoint by subgroups with other risk markers. CONCLUSION The BRITISH trial will assess whether the use of CMR-defined scar to direct ICD implantation in patients with NICM and an LVEF ≤35% is associated with a reduction in mortality.
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Affiliation(s)
- Andrew Flett
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom.
| | - Anna Cebula
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Zoe Nicholas
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Robert Adam
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Sean Ewings
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Sanjay Prasad
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - John Gf Cleland
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Zina Eminton
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Nicholas Curzen
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
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Feng XY, He WF, Zhang TY, Wang LL, Yang F, Feng YL, Li CP, Li R. Association between late gadolinium enhancement and outcome in dilated cardiomyopathy: A meta-analysis. World J Radiol 2023; 15:324-337. [PMID: 38058605 PMCID: PMC10696187 DOI: 10.4329/wjr.v15.i11.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/29/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The prognostic value of late gadolinium enhancement (LGE) derived from cardiovascular magnetic resonance (CMR) is well studied, and several new metrics of LGE have emerged. However, some controversies remain; therefore, further discussion is needed, and more precise risk stratification should be explored. AIM To investigate the associations between the positivity, extent, location, and pattern of LGE and multiple outcomes in dilated cardiomyopathy (DCM). METHODS PubMed, Ovid MEDLINE, and Cochrane Library were searched for studies that investigated the prognostic value of LGE in patients with DCM. Pooled hazard ratios (HRs) and 95% confidence intervals were calculated to assess the role of LGE in the risk stratification of DCM. RESULTS Nineteen studies involving 7330 patients with DCM were included in this meta-analysis and covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 21% and 50%. The meta-analysis revealed that the presence of LGE was associated with an increased risk of multiple adverse outcomes (all-cause mortality, HR: 2.14; arrhythmic events, HR: 5.12; and composite endpoints, HR: 2.38; all P < 0.001). Furthermore, every 1% increment in the extent of LGE was associated with an increased risk of all-cause mortality. Analysis of a subgroup revealed that the prognostic value varied based on different location and pattern of LGE. Additionally, we found that LGE was a stronger predictor of arrhythmic events in patients with greater left ventricular ejection fraction. CONCLUSION LGE by CMR in patients with DCM exhibited a substantial value in predicting adverse outcomes, and the extent, location, and pattern of LGE could provide additional information for risk stratification.
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Affiliation(s)
- Xin-Yi Feng
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Wen-Feng He
- Department of Cardiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Tian-Yue Zhang
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Ling-Li Wang
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Fan Yang
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yu-Ling Feng
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Chun-Ping Li
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Rui Li
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Golukhova EZ, Bulaeva NI, Alexandrova SA, Mrikaev DV, Gromova OI, Ruzina EV, Berdibekov BS. The extent of late gadolinium enhancement predicts mortality, sudden death and major adverse cardiovascular events in patients with nonischaemic cardiomyopathy: a systematic review and meta-analysis. Clin Radiol 2023; 78:e342-e349. [PMID: 36707397 DOI: 10.1016/j.crad.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/26/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023]
Abstract
AIM To conduct a systematic review and meta-analysis with the objective of evaluating the prognostic value of extent of myocardial fibrosis by late gadolinium-enhanced cardiac magnetic resonance imaging (CMR) in non-ischaemic dilated cardiomyopathy (NICM). MATERIAL AND METHODS The databases PubMed, EMBASE, and Google Scholar were searched for studies that investigated the prognostic value of quantification of late gadolinium enhancement (LGE) in patients with NICM. Unadjusted and adjusted hazard ratios (HRs) of uniformly defined predictors were pooled for meta-analysis. RESULTS Fourteen studies were retrieved from 884 publications for this systematic review and meta-analysis. In total, 4,336 patients (mean age 51.2 years; mean follow-up 35.1 months) were included in the analysis. Meta-analysis showed the extent of LGE was associated with an increased risk of all-cause mortality (HR: 1.07/1% LGE; 95% confidence interval [CI]: 1.03-1.11; p=0.0003), composite arrhythmic endpoint (HR: 1.09/1% LGE; 95% CI: 1.03-1.15; p=0.002) and major adverse cardiovascular events (MACE; HR: 1.06/1% LGE; 95% CI: 1.02-1.11; p=0.005). After adjusting for baseline characteristics, the higher extent of LGE remained associated with the risk of all-cause mortality (HRadjusted: 1.07/1% LGE; 95% CI: 1.00-1.14; p=0.04), also strongly associated with the risk of composite arrhythmic endpoint (HRadjusted: 1.07; 95% CI: 1.02-1.012; p=0.004) and MACE (HRadjusted: 1.04; 95% CI: 1.01-1.08; p=0.005). CONCLUSIONS Extent of LGE in CMR predicts all-cause mortality, arrhythmic events, and MACE. Collectively, these findings emphasise that extent of LGE by CMR may have value for optimising current predictive models for clinical events or mortality in patients with NICM.
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Affiliation(s)
- E Z Golukhova
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia
| | - N I Bulaeva
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia
| | - S A Alexandrova
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia
| | - D V Mrikaev
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia
| | - O I Gromova
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia
| | - E V Ruzina
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia
| | - B Sh Berdibekov
- Bakulev Scientific Center for Cardiovascular Surgery, 121552 Moscow, Russia.
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Tsabedze N, du Plessis A, Mpanya D, Vorster A, Wells Q, Scholtz L, Manga P. Cardiovascular Magnetic Resonance Imaging Findings in Africans with Idiopathic Dilated Cardiomyopathy. Diagnostics (Basel) 2023; 13:diagnostics13040617. [PMID: 36832105 PMCID: PMC9954988 DOI: 10.3390/diagnostics13040617] [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: 01/04/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
In sub-Saharan Africa, idiopathic dilated cardiomyopathy (IDCM) is a common yet poorly investigated cause of heart failure. Cardiovascular magnetic resonance (CMR) imaging is the gold standard for tissue characterisation and volumetric quantification. In this paper, we present CMR findings obtained from a cohort of patients with IDCM in Southern Africa suspected of having a genetic cause of cardiomyopathy. A total of 78 IDCM study participants were referred for CMR imaging. The participants had a median left ventricular ejection fraction of 24% [interquartile range, (IQR): 18-34]. Late gadolinium enhancement (LGE) was visualised in 43 (55.1%) participants and localised in the midwall in 28 (65.0%) participants. At the time of enrolment into the study, non-survivors had a higher median left ventricular end diastolic wall mass index of 89.4 g/m2 (IQR: 74.5-100.6) vs. 73.6 g/m2 (IQR: 51.9-84.7), p = 0.025 and a higher median right ventricular end-systolic volume index of 86 mL/m2 (IQR:74-105) vs. 41 mL/m2 (IQR: 30-71), p < 0.001. After one year, 14 participants (17.9%) died. The hazard ratio for the risk of death in patients with evidence of LGE from CMR imaging was 0.435 (95% CI: 0.259-0.731; p = 0.002). Midwall enhancement was the most common pattern, visualised in 65% of participants. Prospective, adequately powered, and multi-centre studies across sub-Saharan Africa are required to determine the prognostic significance of CMR imaging parameters such as late gadolinium enhancement, extracellular volume fraction, and strain patterns in an African IDCM cohort.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Correspondence:
| | - Andre du Plessis
- Diagnostic Radiology, Midstream Mediclinic, Centurion 1692, South Africa
| | - Dineo Mpanya
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Anelia Vorster
- Diagnostic Radiology, Midstream Mediclinic, Centurion 1692, South Africa
| | - Quinn Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Leonie Scholtz
- Diagnostic Radiology, Midstream Mediclinic, Centurion 1692, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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Demir AR, Celik O, Ustündağ S, Uygur B, Somuncu MU, Yilmaz E, Avci Y, Demirci G, Kahraman S, Erturk M. Relationship between Late Gadolinium Enhancement and Ventricular Repolarization Parameters in Heart Failure Patients with Reduced Ejection Fraction. Arq Bras Cardiol 2021; 117:678-687. [PMID: 34231793 PMCID: PMC8528364 DOI: 10.36660/abc.20200149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/15/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) is a highly prevalent disease that requires repeating hospitalizations, causes significant morbidity and mortality. Therefore, early recognition of poor outcome predictors is essential for patient management. OBJECTIVE The aim of the present study is to investigate the relationship between late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) and repolarization parameters such as corrected QT (QTc) interval, Tp-e interval, frontal QRS-T angle detected by 12 lead electrocardiograph (ECG) in HFrEF. METHOD In this single-center, retrospective observational study included 97 consecutive HFrEF patients who had CMR scan. Study population was divided into two groups according to the presence of LGE. Echocardiographic and CMR measurements and demographic features were recorded. QTc intervals, Tp-e intervals, frontal QRS-T angles were calculated from the ECG. A p-value less than 0.05 was considered statistically significant. RESULTS LGE was detected in 52 (53.6%) out of 97 HFrEF patients. QTc intervals (p=0.001), Tp-e intervals (p<0.001), frontal QRS-T angles (p<0.001) were found to be significantly higher in LGE group when compared to non-LGE group. In univariate regression analysis which was performed to investigate the predictors of LGE in HFrEF, all three repolarization parameters were reached significant values but in multivariate analysis the only repolarization parameter remained significant was Tp-e interval (OR=1.085 95% CI 1.032-1.140, p=0.001). CONCLUSION With the prolongation of the Tp-e interval, the presence of myocardial fibrosis which is an arrhythmogenic substrate, can be predicted in patients with HFrEF.
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Affiliation(s)
- Ali Riza Demir
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Omer Celik
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Songül Ustündağ
- Departamento de CardiologiaErzincan Binali Yıldırım University Mengücek Gazi TrainingResearch HospitalErzincanTurquia Departamento de Cardiologia , Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital , Erzincan - Turquia
| | - Begum Uygur
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Mustafa Umut Somuncu
- Departamento de CardiologiaZonguldak Bülent Ecevit UniversityFaculty of MedicineZonguldakTurquia Departamento de Cardiologia , Zonguldak Bülent Ecevit University Faculty of Medicine , Zonguldak - Turquia
| | - Emre Yilmaz
- Departamento de CardiologiaGörele Op. Dr. Ergun Ozdemir State HospitalGiresunTurquia Departamento de Cardiologia , Görele Op. Dr. Ergun Ozdemir State Hospital , Giresun - Turquia
| | - Yalcin Avci
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Gokhan Demirci
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Serkan Kahraman
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
| | - Mehmet Erturk
- Departamento de CardiologiaUniversity of Health ScienceIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstambulTurquia Departamento de Cardiologia , University of Health Science , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Istambul - Turquia
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Liu Y, Yu J, Liu J, Wu B, Cui Q, Shen W, Xia S. Prognostic value of late gadolinium enhancement in arrhythmogenic right ventricular cardiomyopathy: a meta-analysis. Clin Radiol 2021; 76:628.e9-628.e15. [PMID: 34024635 DOI: 10.1016/j.crad.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
AIM To assess systematically the prognostic value of cardiac magnetic resonance imaging (CMRI) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). MATERIALS AND METHODS The full text of studies of the clinical efficacy of late gadolinium enhancement (LGE) in ARVC was retrieved in multiple databases. Stata 14 was adopted for meta-analysis and bias analysis. Heterogeneity was assessed with the I2 statistic. RESULTS After exclusions, 561 patients were included in five studies, and the eligibility criteria were met. The meta-analysis suggested that there was a significant difference between LGE positive and negative patients with ARVC in all-cause mortality (relative risk [RR] = 4.78, 95% confidence interval [CI] = 1.41, 16.23, p=0.012; p for heterogeneity = 0.692, I2 = 0%); major adverse cardiovascular events (MACE) (RR=2.48, 95% CI = 1.24, 4.96, p=0.010; p for heterogeneity = 0.596, I2 = 0%); ventricular tachycardia (RR=3.13, 95% CI = 1.69, 5.78, p<0.001; p for heterogeneity = 0.825, I2 = 0%); implanted cardiac defibrillators (RR=3.15, 95% CI = 1.69, 5.87], p<0.001; p for heterogeneity = 0.353, I2 = 9.4%). CONCLUSION LGE in ARVC patients is a predictor of all-cause mortality and MACE.
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Affiliation(s)
- Y Liu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - J Yu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - J Liu
- Outpatient Department, Tianjin Third Central Hospital, No. 83, Jintang Road, Hedong District, Tianjin, 300000, China
| | - B Wu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - Q Cui
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - W Shen
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China.
| | - S Xia
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China.
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The prognostic value of late gadolinium enhancement in heart diseases: an umbrella review of meta-analyses of observational studies. Eur Radiol 2021; 31:4528-4537. [PMID: 33409800 DOI: 10.1007/s00330-020-07437-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/07/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Cardiac magnetic resonance imaging (CMR) has proven itself as an accurate and robust diagnostic approach and has been widely used in the detection of various heart diseases. An increasing number of studies focusing more on the prognostic aspect of LGE-CMR arose in recent years, contributing to the redundant systematic reviews and meta-analyses in this field. By providing a bird's eye view and performing scrupulous evidence rating, this umbrella review aims to help clinical practitioners and policy-makers interpret the results of the meta-analyses on the prognostic role of late gadolinium enhancement (LGE) in patients with heart diseases. METHODS An umbrella review of meta-analyses of observational studies. RESULTS The 11 included systematic reviews comprise 33 meta-analyses covering 11 types of heart diseases, 19 different outcomes, 23,058 subjects, and 5393 events. Thirty-one of 33 meta-analyses were found supported by weak pieces of evidence and the remaining were deemed not suggestive. The meta-analysis with a p value of 9.21 × 10-15 and 991 events was updated by strictly re-conducting the meta-analysis by Becker et al. The updated meta-analysis on the prognostic role of LGE in subjects with non-ischemic dilated cardiomyopathy (DCM) in terms of major adverse cardiovascular events (MACE) included 1131 events and was rated as highly suggestive evidence. CONCLUSIONS The prognostic role of LGE in DCM patients in terms of MACE is supported by highly suggestive evidence, which may facilitate the optimization of the timing of prophylactic implantable or wearable implantable cardioverter-defibrillators (ICD) considering the high risk of MACE and lower expectation of recovery. KEY POINTS • Cardiac magnetic resonance imaging (CMR) has been widely used in the detection of various heart diseases. Numerous studies focusing on the prognostic aspect of LGE arose in recent years. • The meta-analysis on the prognostic role of LGE in dilated cardiomyopathy (DCM) patients in terms of major adverse cardiovascular events (MACE) by Becker et al was updated and was deemed to be supported by highly suggestive evidence. • The credibility of the meta-analysis supported by highly suggestive evidence may facilitate the optimization of the timing of prophylactic implantable or wearable implantable cardioverter defibrillators (ICD) considering the high risk of MACE and lower expectation of recovery.
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Centurión OA, Alderete JF, Torales JM, García LB, Scavenius KE, Miño LM. Myocardial Fibrosis as a Pathway of Prediction of Ventricular Arrhythmias and Sudden Cardiac Death in Patients With Nonischemic Dilated Cardiomyopathy. Crit Pathw Cardiol 2020; 18:89-97. [PMID: 31094736 DOI: 10.1097/hpc.0000000000000171] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The mechanism of sudden cardiac death (SCD) in patients with nonischemic dilated cardiomyopathy (NIDCM) is mostly due to sustained ventricular tachycardia and ventricular fibrillation. The clinical guidelines for the therapeutic management of this set of patients are mostly based on left ventricular ejection fraction value which has a low specificity to differentiate the risk of SCD from the risk of mortality associated with heart failure or other comorbidities. Moreover, since SCD can occur in patients with normal or mildly depressed ejection fraction, it is necessary to identify new markers to improve the prognostic stratification of SCD. Several studies that analyzed the ventricular arrhythmia substrate found that myocardial fibrosis plays an important role in the genesis of ventricular arrhythmias in patients with NIDCM. The surrounding zone of the area of fibrosis is a heterogeneous medium, where tissue with different levels of fibrosis coexists, resulting in both viable and nonviable myocardium. This myocardial fibrosis may constitute a substrate for ventricular arrhythmias, where slow and heterogeneous conduction may favor the genesis of reentry mechanism increasing the chance to develop sustained ventricular tachycardia or ventricular fibrillation. Therefore, the evaluation of ventricular fibrosis by late gadolinium enhancement (LGE) cardiac magnetic resonance imaging has been suggested as an indicator for SCD risk stratification. Indeed, LGE in patients with NIDCM is associated with increased risk of all-cause mortality, heart failure hospitalization, and SCD. Detection of myocardial fibrosis as LGE by cardiac magnetic resonance imaging can be considered as a useful pathway of prediction of malignant ventricular arrhythmias since it has excellent prognostic characteristics and may help guide risk stratification and management in patients with NIDCM.
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Affiliation(s)
- Osmar Antonio Centurión
- From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.,Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - José Fernando Alderete
- From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay
| | - Judith María Torales
- From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.,Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Laura Beatriz García
- From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay.,Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora, Paraguay
| | - Karina Elizabeth Scavenius
- From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay
| | - Luis Marcelo Miño
- From the Division of Cardiovascular Medicine, Clinic Hospital, Asuncion National University (UNA), San Lorenzo, Paraguay
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Abstract
Cardiac fibrosis is associated with non-ischemic dilated cardiomyopathy, increasing its morbidity and mortality. Cardiac fibroblast is the keystone of fibrogenesis, being activated by numerous cellular and humoral factors. Macrophages, CD4+ and CD8+ T cells, mast cells, and endothelial cells stimulate fibrogenesis directly by activating cardiac fibroblasts and indirectly by synthetizing various profibrotic molecules. The synthesis of type 1 and type 3 collagen, fibronectin, and α-smooth muscle actin is rendered by various mechanisms like transforming growth factor-beta/small mothers against decapentaplegic pathway, renin angiotensin system, and estrogens, which in turn alter the extracellular matrix. Investigating the underlying mechanisms will allow the development of diagnostic and prognostic tools and discover novel specific therapies. Serum biomarkers aid in the diagnosis and tracking of cardiac fibrosis progression. The diagnostic gold standard is cardiac magnetic resonance with gadolinium administration that allows quantification of cardiac fibrosis either by late gadolinium enhancement assessment or by T1 mapping. Therefore, the goal is to stop and even reverse cardiac fibrosis by developing specific therapies that directly target fibrogenesis, in addition to the drugs used to treat heart failure. Cardiac resynchronization therapy had shown to revert myocardial remodeling and to reduce cardiac fibrosis. The purpose of this review is to provide an overview of currently available data.
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10
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Elming MB, Hammer-Hansen S, Voges I, Nyktari E, Raja AA, Svendsen JH, Pehrson S, Signorovitch J, Køber L, Prasad SK, Thune JJ. Myocardial fibrosis and the effect of primary prophylactic defibrillator implantation in patients with non-ischemic systolic heart failure-DANISH-MRI. Am Heart J 2020; 221:165-176. [PMID: 31955812 DOI: 10.1016/j.ahj.2019.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
AIMS Patients with non-ischemic systolic heart failure have an increased risk of sudden cardiac death (SCD). Myocardial fibrosis, detected as late gadolinium enhancement (LGE) with cardiac magnetic resonance (CMR), has been shown to predict all-cause mortality. We hypothesized that LGE can identify patients with non-ischemic heart failure who will benefit from ICD implantation. METHODS AND RESULTS In this prospective observational sub-study of the Danish Study to Assess the Efficacy of ICDs in Patients with Nonischemic Systolic Heart Failure on Mortality (DANISH), 252 patients underwent CMR. LGE was quantified by the full width/half maximum method. The primary endpoint was all-cause mortality. LGE could be adequately assessed in 236 patients, median age was 61 years and median duration of heart failure was 14 months; there were 108 patients (46%) randomized to ICD. Median follow-up time was 5.3 years. Median left ventricular ejection fraction on CMR was 35%. In all, 50 patients died. LGE was present in 113 patients (48%). The presence of LGE was an independent predictor of all-cause mortality (HR 1.82; 95% CI 1.002-3.29; P = .049) after adjusting for known cardiovascular risk factors. ICD implantation did not impact all-cause mortality, for either patients with LGE (HR 1.18; 95% CI 0.59-2.38; P = .63), or for patients without LGE (HR 1.00; 95% CI 0.39-2.53; P = .99), (P for interaction =0.79). CONCLUSION In patients with non-ischemic systolic heart failure, LGE predicted all-cause mortality. However, in this cohort, LGE did not identify a group of patients who survived longer by receiving an ICD.
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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart Lung Circ 2018; 27:1123-1208. [DOI: 10.1016/j.hlc.2018.06.1042] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Ganesan AN, Gunton J, Nucifora G, McGavigan AD, Selvanayagam JB. Impact of Late Gadolinium Enhancement on mortality, sudden death and major adverse cardiovascular events in ischemic and nonischemic cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol 2018; 254:230-237. [PMID: 29407096 DOI: 10.1016/j.ijcard.2017.10.094] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/19/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The central role of left ventricular ejection fraction (LVEF) as the definitive risk marker of adverse outcomes in ischemic and nonischemic cardiomyopathy is increasingly uncertain. The current study aimed to conduct a systematic review and meta-analysis with the objective of evaluating the prognostic importance of Late Gadolinium Enhancement (LGE) in ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) on the key endpoints of all-cause mortality, cardiovascular mortality and sudden death. METHODS The study was prospectively registered in PROPSERO (CRD 42016039034). Electronic databases and reference lists were searched for studies evaluating the impact of LGE-CMR on all-cause mortality, cardiovascular mortality, ventricular arrhythmia or sudden death, or major adverse cardiovascular events. Data were extracted from 36 studies including n=7882 patients. RESULTS LGE was strongly associated with all-cause mortality HR 2.96 (95%CI: 2.37, 3.70, P<0.001), cardiovascular mortality HR 3.27 (95% CI: 2.05, 5.22, P<0.001), ventricular arrhythmia and sudden cardiac death HR 3.76 (95% CI: 3.14, 4.52, P<0.001), and major adverse cardiovascular events HR 3.24 (95% CI: 2.32, 4.52, P<0.001). In subgroup analyses, LGE was associated with all-cause mortality and cardiovascular mortality in both LVEF≤35% and LVEF>35% patients (P<0.001 all endpoints), as well as in nonischemic and ischemic cardiomyopathy. CONCLUSION Late Gadolinium Enhancement (LGE) in CMR predicts all-cause mortality, cardiovascular mortality, ventricular arrhythmia and sudden death, and major adverse cardiovascular events, independent of LVEF. Future trials of investigational therapies in NICM and ICM should consider the utilization of LGE to identify patients at risk of adverse outcomes.
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Affiliation(s)
- Anand N Ganesan
- Flinders University, Australia; Department of Cardiology, Flinders Medical Centre, Australia; South Australian Health and Medical Research Institute, Australia
| | | | - Gaetano Nucifora
- South Australian Health and Medical Research Institute, Australia
| | - Andrew D McGavigan
- Flinders University, Australia; Department of Cardiology, Flinders Medical Centre, Australia
| | - Joseph B Selvanayagam
- Flinders University, Australia; Department of Cardiology, Flinders Medical Centre, Australia; South Australian Health and Medical Research Institute, Australia.
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Zhang K, Wang W, Zhao S, Katz SD, Iervasi G, Gerdes AM, Tang YD. Long-term prognostic value of combined free triiodothyronine and late gadolinium enhancement in nonischemic dilated cardiomyopathy. Clin Cardiol 2018; 41:96-103. [PMID: 29360143 DOI: 10.1002/clc.22858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Thyroid dysfunction and myocardial fibrosis are both associated with cardiovascular events in patients with dilated cardiomyopathy (DCM). HYPOTHESIS The combination of thyroid hormone (TH) and myocardial fibrosis (detected by late gadolinium enhancement [LGE]) is an independent and incremental predictor of adverse events in DCM. METHODS We consecutively enrolled 220 idiopathic DCM patients with thyroid function and LGE assessment at Fuwai Hospital (China) from January 2010 to October 2011 and followed up through December 2015. Patients were divided into 4 groups according to the presence or absence of LGE and FT3 value (median level of 2.79 pg/mL): LGE-positive + FT3 < 2.79 pg/mL, LGE-positive + FT3 ≥ 2.79 pg/mL, LGE-negative + FT3 < 2.79 pg/mL, and LGE-negative + FT3 ≥ 2.79 pg/mL. RESULTS During a median follow-up of 61 months, 56 patients (25.5%) died, with 27/56 (48.2%), 8/45 (17.8%), 12/54 (22.2%), and 9/65 (13.8%) among 4 groups (P = 0.009), respectively. Multivariable Cox regression analysis identified LGE-positive and FT3 < 2.79 pg/mL as a significant independent predictor of all-cause mortality (hazard ratio: 2.893, 95% confidence interval: 1.323-6.326, P = 0.008). Combining the predictive value of FT3 and LGE status significantly improved risk reclassification for all-cause mortality, as indicated by the net reclassification improvement (0.28; P = 0.005) and integrated discrimination improvement (0.058; P = 0.001). CONCLUSIONS The findings suggest that the combination of FT3 and LGE yielded a more accurate predictive value for long-term prognosis in patients with DCM, which may improve patient selection for intensive interventions.
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Affiliation(s)
- Kuo Zhang
- Departments of Cardiology, 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
| | - Wenyao Wang
- Departments of Cardiology, 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 Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, 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
| | - Stuart D Katz
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Giorgio Iervasi
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - A Martin Gerdes
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York
| | - Yi-Da Tang
- Departments of Cardiology, 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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Yu L, Sun J, Sun J, Li J, Dong Y, Zhou X, Greiser A, Han Y, Zhang Q, Xie Q, Chen Y. Early detection of myocardial involvement by T 1 mapping of cardiac MRI in idiopathic inflammatory myopathy. J Magn Reson Imaging 2018; 48:415-422. [PMID: 29328539 DOI: 10.1002/jmri.25945] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Polymyositis (PM) and dermatomyositis (DM) are common types of idiopathic inflammatory myopathy (IIM), wherein patients are prone to adverse cardiovascular events. PURPOSE To explore the value of cardiac magnetic resonance imaging (MRI) for detecting cardiac involvement in PM/DM patients using a T1 mapping technique. STUDY TYPE Prospective observational study. POPULATION In all, 25 PM/DM patients free of cardiovascular symptoms and preserved ventricular systolic function and 25 healthy volunteers matched for age and sex served as controls. FIELD STRENGTH/SEQUENCE Cardiac MRI at 3T, including steady-state free precession (SSFP) cine imaging, late gadolinium enhancement (LGE), and T1 mapping with modified Look-Locker inversion recovery (MOLLI). ASSESSMENT Myocardial native T1 and extracellular volume (ECV) of the left ventricle as well as the correlations with disease activity were analyzed. STATISTICAL TESTS Independent sample's t-test, Fisher's exact test, or chi-square test, Pearson's correlation (r) were applied. P ≤ 0.05 was considered significant. RESULTS Left ventricular end-diastolic/end-systolic volume index (P = 0.643, P = 0.325, respectively), mass index (P = 0.719), and ejection fraction (P = 0.144) were not significantly different between PM/DM patients and controls. LGE was found in 19% of PM/DM patients and none of the control subjects. PM/DM patients showed significantly higher native T1 values (1263.7 ± 84.0 msec vs. 1200.6 ± 43.0 msec, P = 0.002) and expanded extracellular volume (ECV) (32.6 ± 3.7% vs. 26.7 ± 2.3%, P < 0.001) compared with control subjects. ECV values in PM/DM patients had a high proportion (60%) over the 95% percentile of normal controls. Meanwhile, there was a significant correlation between native T1 (r = 0.710, P = 0.0001) or ECV (r = 0.508, P = 0.01) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP). DATA CONCLUSION T1 mapping of cardiac MRI is valuable to detect subclinical myocardial involvement in PM/DM patients, and both myocardial native T1 and ECV could serve as early imaging markers for myocardial impairment in PM/DM. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:415-422.
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Affiliation(s)
- Liuyu Yu
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jianhong Sun
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiayu Sun
- Radiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiangbo Li
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yang Dong
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoyue Zhou
- Northeast Asia MR Collaboration, Siemens Healthcare, Shanghai, China
| | | | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pennsylvania, Pennsylvania, USA
| | - Qing Zhang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yucheng Chen
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Auxiliary diagnostic potential of ventricle geometry and late gadolinium enhancement in left ventricular non-compaction; non-randomized case control study. BMC Cardiovasc Disord 2017; 17:286. [PMID: 29207943 PMCID: PMC5718034 DOI: 10.1186/s12872-017-0721-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/27/2017] [Indexed: 01/30/2023] Open
Abstract
Background There are still ambiguities existing in regard to left ventricular non-compaction (LVNC) diagnostic imaging. The aim of our study was to analyze diagnostic potential of late gadolinium enhancement (LGE) and ventricle geometry in patients with LVNC and controls. Methods Data on cardiac magnetic resonance imaging (CMR) studies for LVNC were reassessed from the hospital’s database (3.75 years; n=1975 exams). Matching sample of controls included cases with no structural heart disease, hypertrophic or dilative cardiomyopathy, arrhythmogenic right ventricular dysplasia or subacute myocarditis. Eccentricity of the left ventricle was measured at end diastole in the region with pronounced NC and maximal to minimal ratio (MaxMinEDDR) was calculated. Results Study included 255 patients referred for CMR, 100 (39.2%) with LVNC (prevalence in the studied period 5.01%) and 155 (60.8%) controls. Existing LGE had sensitivity of 52.5% (95%-CI:42.3–62.5), specificity of 80.4% (95%-CI:73.2–86.5) for LVNC, area under curve (AUC) 0.664 (95%-CI:0.603–0.722);p<0.001. MaxMinEDDR>1.10 had sensitivity of 95.0% (95%-CI:88.7–98.4), specificity of 82.6% (95%-CI: 75.7–88.2) for LVNC, AUC 0.917 (95%-CI:0.876–0.948); p<0.001. LGE correlated with Max-Min-EDD-R (Rho=0.130; p=0.038) and there was significant difference in ROC analysis ΔAUC0.244 (95%-CI:0.175–0.314); p<0.001. LGE also correlated negatively with stroke volume and systolic function (both p<0.05, respectively). Conclusions LGE was found to be frequently expressed in patients with LVNC, but without sufficient power to be used as a discriminative diagnostic parameter. Both LGE and eccentricity of the left ventricle were found to be relatively solid diagnostic landmarks of complex infrastructural and functional changes within the failing heart.
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Liu T, Song D, Dong J, Zhu P, Liu J, Liu W, Ma X, Zhao L, Ling S. Current Understanding of the Pathophysiology of Myocardial Fibrosis and Its Quantitative Assessment in Heart Failure. Front Physiol 2017; 8:238. [PMID: 28484397 PMCID: PMC5402617 DOI: 10.3389/fphys.2017.00238] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/05/2017] [Indexed: 12/12/2022] Open
Abstract
Myocardial fibrosis is an important part of cardiac remodeling that leads to heart failure and death. Myocardial fibrosis results from increased myofibroblast activity and excessive extracellular matrix deposition. Various cells and molecules are involved in this process, providing targets for potential drug therapies. Currently, the main detection methods of myocardial fibrosis rely on serum markers, cardiac magnetic resonance imaging, and endomyocardial biopsy. This review summarizes our current knowledge regarding the pathophysiology, quantitative assessment, and novel therapeutic strategies of myocardial fibrosis.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Capital Medical University, Beijing AnZhen HospitalBeijing, China
| | - Deli Song
- Department of Cardiology, Capital Medical University, Beijing AnZhen HospitalBeijing, China
| | - Jianzeng Dong
- Department of Cardiology, Capital Medical University, Beijing AnZhen HospitalBeijing, China
| | - Pinghui Zhu
- Department of Cardiology, Beijing Changping HospitalBeijing, China
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General HospitalBeijing, China
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Wei Liu
- Department of Cardiology, Capital Medical University, Beijing AnZhen HospitalBeijing, China
| | - Xiaohai Ma
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical UniversityBeijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical UniversityBeijing, China
| | - Shukuan Ling
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training CenterBeijing, China
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Hashimura H, Kimura F, Ishibashi-Ueda H, Morita Y, Higashi M, Nakano S, Iguchi A, Uotani K, Sugimura K, Naito H. Radiologic-Pathologic Correlation of Primary and Secondary Cardiomyopathies: MR Imaging and Histopathologic Findings in Hearts from Autopsy and Transplantation. Radiographics 2017; 37:719-736. [PMID: 28129067 DOI: 10.1148/rg.2017160082] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
RSNA, 2017.
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Affiliation(s)
- Hiromi Hashimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Fumiko Kimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Hatsue Ishibashi-Ueda
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Yoshiaki Morita
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Masahiro Higashi
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Shintaro Nakano
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Atsushi Iguchi
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Kensuke Uotani
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Kazuro Sugimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Hiroaki Naito
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
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Adam RD, Shambrook J, Flett AS. The Prognostic Role of Tissue Characterisation using Cardiovascular Magnetic Resonance in Heart Failure. Card Fail Rev 2017; 3:86-96. [PMID: 29387459 DOI: 10.15420/cfr.2017:19:1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite significant advances in heart failure diagnostics and therapy, the prognosis remains poor, with one in three dying within a year of hospital admission. This is at least in part due to the difficulties in risk stratification and personalisation of therapy. The use of left ventricular systolic function as the main arbiter for entrance into clinical trials for drugs and advanced therapy, such as implantable defibrillators, grossly simplifies the complex heterogeneous nature of the syndrome. Cardiovascular magnetic resonance offers a wealth of data to aid in diagnosis and prognostication. The advent of novel cardiovascular magnetic resonance mapping techniques allows us to glimpse some of the pathophysiological mechanisms underpinning heart failure. We review the growing prognostic evidence base using these techniques.
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Affiliation(s)
- Robert D Adam
- Department of Cardiology, University Hospital Southampton,Southampton, UK
| | - James Shambrook
- Department of Cardiology, University Hospital Southampton,Southampton, UK
| | - Andrew S Flett
- Department of Cardiology, University Hospital Southampton,Southampton, UK
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Di Marco A, Anguera I, Schmitt M, Klem I, Neilan TG, White JA, Sramko M, Masci PG, Barison A, Mckenna P, Mordi I, Haugaa KH, Leyva F, Rodriguez Capitán J, Satoh H, Nabeta T, Dallaglio PD, Campbell NG, Sabaté X, Cequier Á. Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis. JACC-HEART FAILURE 2016; 5:28-38. [PMID: 28017348 DOI: 10.1016/j.jchf.2016.09.017] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging and ventricular arrhythmias or sudden cardiac death (SCD) in patients with dilated cardiomyopathy (DCM). BACKGROUND Risk stratification for SCD in DCM needs to be improved. METHODS A systematic review and meta-analysis were conducted. A systematic search of PubMed and Ovid was performed, and observational studies that analyzed the arrhythmic endpoint (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator [ICD] therapy, or SCD) in patients with DCM, stratified by the presence or absence of LGE, were included. RESULTS Twenty-nine studies were included, accounting for 2,948 patients. The studies covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 20% and 43%. LGE was significantly associated with the arrhythmic endpoint both in the overall population (odds ratio: 4.3; p < 0.001) and when including only those studies that performed multivariate analysis (hazard ratio: 6.7; p < 0.001). The association between LGE and the arrhythmic endpoint remained significant among studies with mean left ventricular ejection fractions >35% (odds ratio: 5.2; p < 0.001) and was maximal in studies that included only patients with primary prevention ICDs (odds ratio: 7.8; p = 0.008). CONCLUSIONS Across a wide spectrum of patients with DCM, LGE is strongly and independently associated with ventricular arrhythmia or SCD. LGE could be a powerful tool to improve risk stratification for SCD in patients with DCM. These results raise 2 major questions to be addressed in future studies: whether patients with LGE could benefit from primary prevention ICDs irrespective of their left ventricular ejection fractions, while patients without LGE might not need preventive ICDs despite having severe left ventricular dysfunction.
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Affiliation(s)
- Andrea Di Marco
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | | | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Tomas G Neilan
- Division of Cardiology and Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, Massachusetts
| | - James A White
- Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pier Giorgio Masci
- Centre for Cardiovascular Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Barison
- Fondazione "G. Monasterio," CNR-Regione Toscana, Pisa, Italy
| | - Peter Mckenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ify Mordi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Francisco Leyva
- Department of Cardiology, The Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan
| | | | | | - Xavier Sabaté
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Ángel Cequier
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
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MEMON SARFARAZ, GANGA HARSHAV, KLUGER JEFFREY. Late Gadolinium Enhancement in Patients with Nonischemic Dilated Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:731-47. [DOI: 10.1111/pace.12873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 01/23/2023]
Affiliation(s)
- SARFARAZ MEMON
- Division of Cardiology; Hartford Hospital; Hartford Connecticut
| | - HARSHA V. GANGA
- Division of Cardiology; Brown University; Providence Rhode Island
| | - JEFFREY KLUGER
- Division of Cardiology; Hartford Hospital; Hartford Connecticut
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