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Zhou Q, Wang L, Craft J, Weber J, Passick M, Ngai N, Khalique OK, Goldfarb JW, Barasch E, Cao JJ. A machine learning-derived risk score to predict left ventricular diastolic dysfunction from clinical cardiovascular magnetic resonance imaging. Front Cardiovasc Med 2024; 11:1382418. [PMID: 38903970 PMCID: PMC11187483 DOI: 10.3389/fcvm.2024.1382418] [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: 02/05/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction The evaluation of left ventricular diastolic dysfunction (LVDD) by clinical cardiac magnetic resonance (CMR) remains a challenge. We aimed to train and evaluate a machine-learning (ML) algorithm for the assessment of LVDD by clinical CMR variables and to investigate its prognostic value for predicting hospitalized heart failure and all-cause mortality. Methods LVDD was characterized by echocardiography following the ASE guidelines. Eight demographic and nineteen common clinical CMR variables including delayed enhancement were used to train Random Forest models with a Bayesian optimizer. The model was evaluated using bootstrap and five-fold cross-validation. Area under the ROC curve (AUC) was utilized to evaluate the model performance. An ML risk score was used to stratify the risk of heart failure hospitalization and all-cause mortality. Results A total of 606 consecutive patients underwent CMR and echocardiography within 7 days for cardiovascular disease evaluation. LVDD was present in 303 subjects by echocardiography. The performance of the ML algorithm was good using the CMR variables alone with an AUC of 0.868 (95% CI: 0.811-0.917), which was improved by combining with demographic data yielding an AUC 0.895 (95% CI: 0.845-0.939). The algorithm performed well in an independent validation cohort with AUC 0.810 (0.731-0.874). Subjects with higher ML scores (>0.4121) were associated with increased adjusted hazard ratio for a composite outcome than subjects with lower ML scores (1.72, 95% confidence interval 1.09-2.71). Discussion An ML algorithm using variables derived from clinical CMR is effective in identifying patients with LVDD and providing prognostication for adverse clinical outcomes.
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Affiliation(s)
- Qingtao Zhou
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Lin Wang
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Jason Craft
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Jonathan Weber
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Michael Passick
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Nora Ngai
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Omar K. Khalique
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - James W. Goldfarb
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - Eddy Barasch
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
| | - J. Jane Cao
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, United States
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY, United States
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Cao JJ, Nashta NF, Weber J, Bano R, Passick M, Cheng YJ, Schapiro W, Grgas M, Gliganic K. Association of pulmonary transit time by cardiac magnetic resonance with heart failure hospitalization in a large prospective cohort with diverse cardiac conditions. J Cardiovasc Magn Reson 2023; 25:57. [PMID: 37821911 PMCID: PMC10568762 DOI: 10.1186/s12968-023-00963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Longer pulmonary transit time (PTT) is closely associated with hemodynamic abnormalities. However, the implications on heart failure (HF) risk have not been investigated broadly in patients with diverse cardiac conditions. In this study we examined the long-term risk of HF hospitalization associated with longer PTT in a large prospective cohort with a broad spectrum of cardiac conditions. METHODS All subjects were prospectively recruited to undergo cardiac magnetic resonance (CMR). The dynamic images of first-pass perfusion were acquired to assess peak-to-peak pulmonary transit time (PTT) which was subsequently normalized to RR interval duration. The risk of HF was examined using Cox proportional hazards models adjusted for baseline confounding risk factors. RESULTS Among 506 consecutively consented patients undergoing clinical cardiac MR with diverse cardiac conditions, the mean age was 63 ± 14 years and 373 (73%) were male. After a mean follow up duration of 4.5 ± 3.0 years, 70 (14%) patients developed hospitalized HF and of these 6 died. A normalized PTT ≥ 8.2 was associated with a significantly increased adjusted HF hazard ratio of 3.69 (95% CI 2.02, 6.73). The HF hazard ratio was 1.26 (95% CI 1.18, 1.33) for each 1 unit increase in PTT which was higher among those preserved (1.70, 95% CI 1.20, 2.41) compared to those with reduced left ventricular ejection fraction (< 50%) (1.18, 95% CI 1.09, 1.27). PTT remained a significant risk factor of hospitalized HF after additional adjustment for N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) or left ventricular global longitudinal strain with additionally demonstrated incremental model improvement through likelihood ratio testing. CONCLUSIONS Our findings support the role of PTT in assessing HF risk among patients with broad spectrum of cardiac conditions with reduced as well as preserved ejection fraction. Longer PTT duration is an incremental risk factor for HF when baseline global longitudinal strain and NT-proBNP are taken into consideration.
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Affiliation(s)
- J Jane Cao
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA.
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA.
| | - Niloofar Fouladi Nashta
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Weber
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Ruqiyya Bano
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Michael Passick
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Y Joshua Cheng
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - William Schapiro
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
| | - Marie Grgas
- DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, Roslyn, NY, USA
| | - Kathleen Gliganic
- Division of Cardiac Imaging, St. Francis Hospital & Heart Center, 100 Port Washington Blvd., Roslyn, NY, 11576, USA
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Yin X, Yin X, Pan X, Zhang J, Fan X, Li J, Zhai X, Jiang L, Hao P, Wang J, Chen Y. Post-myocardial infarction fibrosis: Pathophysiology, examination, and intervention. Front Pharmacol 2023; 14:1070973. [PMID: 37056987 PMCID: PMC10086160 DOI: 10.3389/fphar.2023.1070973] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Cardiac fibrosis plays an indispensable role in cardiac tissue homeostasis and repair after myocardial infarction (MI). The cardiac fibroblast-to-myofibroblast differentiation and extracellular matrix collagen deposition are the hallmarks of cardiac fibrosis, which are modulated by multiple signaling pathways and various types of cells in time-dependent manners. Our understanding of the development of cardiac fibrosis after MI has evolved in basic and clinical researches, and the regulation of fibrotic remodeling may facilitate novel diagnostic and therapeutic strategies, and finally improve outcomes. Here, we aim to elaborate pathophysiology, examination and intervention of cardiac fibrosis after MI.
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Affiliation(s)
- Xiaoying Yin
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xinxin Yin
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Pan
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jingyu Zhang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xinhui Fan
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jiaxin Li
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoxuan Zhai
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Lijun Jiang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Panpan Hao
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jiali Wang
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Jiali Wang, ; Yuguo Chen,
| | - Yuguo Chen
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
- *Correspondence: Jiali Wang, ; Yuguo Chen,
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Cerne JW, Shehata C, Ragin A, Pathrose A, Veer M, Subedi K, Allen BD, Avery RJ, Markl M, Carr JC. Potential Prognostic Value of Native T1 in Pulmonary Hypertension Patients. Life (Basel) 2023; 13:775. [PMID: 36983931 PMCID: PMC10051677 DOI: 10.3390/life13030775] [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: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Native T1, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE) characterize myocardial tissue and relate to patient prognosis in a variety of diseases, including pulmonary hypertension. The purpose of this study was to evaluate if left ventricle (LV) fibrosis measurements have prognostic value for cardiac outcomes in pulmonary hypertension subgroups. 54 patients with suspected pulmonary hypertension underwent right-heart catheterization and were classified into pulmonary hypertension subgroups: pre-capillary component (PreCompPH) and isolated post-capillary (IpcPH). Cardiac magnetic resonance imaging (MRI) scans were performed with the acquisition of balanced cine steady-state free precession, native T1, and LGE pulse sequences to measure cardiac volumes and myocardial fibrosis. Associations between cardiac events and cardiac MRI measurements were analyzed within PreCompPH and IpcPH patients. IpcPH: LV native T1 was higher in patients who experienced a cardiac event within two years vs. those who did not. In patients with LV native T1 > 1050 ms, the rate of cardiac events was higher. ECV and quantitative LGE did not differ between groups. PreCompPH: native T1, ECV, and quantitative/qualitative LGE did not differ between patients who experienced a cardiac event within two years vs. those who did not. LV native T1 may have potential value for forecasting cardiac events in IpcPH, but not in PreCompPH, patients.
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Affiliation(s)
- John W. Cerne
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Christina Shehata
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ann Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Manik Veer
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Kamal Subedi
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern, Chicago, IL 60611, USA
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Lewandowski D, Yang EY, Nguyen DT, Khan MA, Malahfji M, El Tallawi C, Chamsi Pasha MA, Graviss EA, Shah DJ, Nagueh SF. Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk Stratification. JACC Cardiovasc Imaging 2023:S1936-878X(23)00032-3. [PMID: 37038874 DOI: 10.1016/j.jcmg.2022.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis. OBJECTIVES In this study, the authors sought to determine the association of LV diastolic function by to echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations. METHODS A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV). RESULTS Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03). CONCLUSIONS Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.
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Affiliation(s)
| | - Eric Y Yang
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Mohammad A Khan
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Maan Malahfji
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Power Modulation Echocardiography to Detect and Quantify Myocardial Scar. J Am Soc Echocardiogr 2022; 35:1146-1155. [PMID: 35798123 DOI: 10.1016/j.echo.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/28/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Myocardial scar correlates with clinical outcomes. Traditionally, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is used to detect and quantify scar. In this prospective study using LGE CMR as reference, the authors hypothesized that nonlinear ultrasound imaging, namely, power modulation, can detect and quantify myocardial scar in selected patients with previous myocardial infarction. In addition, given the different histopathology between ischemic and nonischemic scar, a further aim was to test the diagnostic performance of this echocardiographic technique in unselected consecutive individuals with ischemic and nonischemic LGE or no LGE on CMR. METHODS Seventy-one patients with previous myocardial infarction underwent power modulation echocardiography following CMR imaging (group A). Subsequently, 101 consecutive patients with or without LGE on CMR, including individuals with nonischemic LGE, were scanned using power modulation echocardiography (group B). RESULTS In group A, echocardiography detected myocardial scar in all 71 patients, with good scar volume agreement with CMR (bias = -1.9 cm3; limits of agreement [LOA], -8.0 to 4.2 cm3). On a per-segment basis, sensitivity was 82%, specificity 97%, and accuracy 92%. Sensitivity was higher in the inferior and posterior segments and lower in the anterior and lateral walls. In group B, on a per-subject basis, the sensitivity of echocardiography was 62% (91% for ischemic and 30% for nonischemic LGE), with specificity and accuracy of 89% and 72%, respectively. The bias for scar volume between modalities was 5.9 cm3, with LOA of 34.6 to 22.9 cm3 (bias = -1.9 cm3 [LOA, -11.4 to 7.6 cm3] for ischemic LGE, and bias = 18.9 cm3 [LOA, -67.4 to 29.7.6 cm3] for nonischemic LGE). CONCLUSIONS Power modulation echocardiography can detect myocardial scar in both selected and unselected individuals with previous myocardial infarction and has good agreement for scar volume quantification with CMR. In an unselected cohort with nonischemic LGE, sensitivity is low.
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Marcos-Garcés V, Rios-Navarro C, Gómez-Torres F, Gavara J, de Dios E, Diaz A, Miñana G, Chorro FJ, Bodi V, Ruiz-Sauri A. Fourier analysis of collagen bundle orientation in myocardial infarction scars. Histochem Cell Biol 2022; 158:471-483. [PMID: 35948735 PMCID: PMC9630212 DOI: 10.1007/s00418-022-02132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
Collagen bundle orientation (CBO) in myocardial infarct scars plays a major role in scar mechanics and complications after infarction. We aim to compare four histopathological methods for CBO measurement in myocardial scarring. Myocardial infarction was induced in 21 pigs by balloon coronary occlusion. Scar samples were obtained at 4 weeks, stained with Masson’s trichrome, Picrosirius red, and Hematoxylin–Eosin (H&E), and photographed using light, polarized light microscopy, and confocal microscopy, respectively. Masson’s trichrome images were also optimized to remove non-collagenous structures. Two observers measured CBO by means of a semi-automated, Fourier analysis protocol. Interrater reliability and comparability between techniques were studied by the intraclass correlation coefficient (ICC) and Bland–Altman (B&A) plots and limits of agreement. Fourier analysis showed an almost perfect interrater reliability for each technique (ICC ≥ 0.95, p < 0.001 in all cases). CBO showed more randomly oriented values in Masson’s trichrome and worse comparability with other techniques (ICC vs. Picrosirius red: 0.79 [0.47–0.91], p = 0.001; vs. H&E-confocal: 0.70 [0.26–0.88], p = 0.005). However, optimized Masson’s trichrome showed almost perfect agreement with Picrosirius red (ICC 0.84 [0.6–0.94], p < 0.001) and H&E-confocal (ICC 0.81 [0.54–0.92], p < 0.001), as well as these latter techniques between each other (ICC 0.84 [0.60–0.93], p < 0.001). In summary, a semi-automated, Fourier-based method can provide highly reproducible CBO measurements in four different histopathological techniques. Masson’s trichrome tends to provide more randomly oriented CBO index values, probably due to non-specific visualization of non-collagenous structures. However, optimization of Masson’s trichrome microphotographs to remove non-collagenous components provides an almost perfect comparability between this technique, Picrosirius red and H&E-confocal.
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Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.,INCLIVA Health Research Institute, Valencia, Spain
| | | | - Fabián Gómez-Torres
- Universidad Industrial de Santander, Escuela de Medicina, Bucaramanga, Colombia
| | - Jose Gavara
- INCLIVA Health Research Institute, Valencia, Spain
| | - Elena de Dios
- Center for Networked Biomedical Research-Cardiovascular (CIBER-CV), Madrid, Spain
| | - Ana Diaz
- Central Unit for Research in Medicine (UCIM), University of Valencia, Valencia, Spain
| | - Gema Miñana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.,INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Francisco Javier Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.,INCLIVA Health Research Institute, Valencia, Spain.,Center for Networked Biomedical Research-Cardiovascular (CIBER-CV), Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain. .,INCLIVA Health Research Institute, Valencia, Spain. .,Center for Networked Biomedical Research-Cardiovascular (CIBER-CV), Madrid, Spain. .,Department of Medicine, University of Valencia, Valencia, Spain. .,Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain. .,Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, Blasco Ibanez 17, 46010, Valencia, Spain.
| | - Amparo Ruiz-Sauri
- INCLIVA Health Research Institute, Valencia, Spain. .,Department of Pathology, University of Valencia, Valencia, Spain. .,Departamento de Patología, Facultad de Medicina y Odontología, Universitat de València, Avda/Blasco Ibáñez nº15, 46010, València, Spain.
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García AG, Fabregate M, Manzano L, Guillén del Castillo A, Rivas MR, Argibay A, Ballvé AM, Pintó IR, Salas XP, Marí-Alfonso B, Moraga EC, Argüelles DC, Comet LS, González-Echávarri C, Ortego-Centeno N, Hitos JAV, Parra JAT, Martínez LT, Marín MTH, Freire M, Chamorro AJ, Fraile IP, Vuelta ABM, Trigo SS, Vilella CT, Pla VF, Aznar CPS. Left Ventricular Diastolic Dysfunction in Systemic Sclerosis: Clinical, immunological and survival differences in the Spanish RESCLE Registry. Semin Arthritis Rheum 2022; 55:152033. [DOI: 10.1016/j.semarthrit.2022.152033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022]
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Jia F, Li X, Zhang D, Jiang S, Yin J, Feng X, Zhu Y, Liu Y, Zhu Y, Lai J, Yang H, Fang L, Chen W, Wang Y. Predictive Value of Echocardiographic Strain for Myocardial Fibrosis and Adverse Outcomes in Autoimmune Diseases. Front Cardiovasc Med 2022; 9:836942. [PMID: 35265686 PMCID: PMC8899104 DOI: 10.3389/fcvm.2022.836942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/28/2022] [Indexed: 12/20/2022] Open
Abstract
BackgroundMyocardial fibrosis is an important pathophysiologic mechanism of cardiac involvement that leads to increased mortality in patients with autoimmune diseases (AIDs). The aim of this study was to evaluate the association between myocardial strain from speckle-tracking echocardiography (STE) and fibrosis on cardiovascular magnetic resonance (CMR) and to further explore their prognostic implications in patients with AIDs.MethodsWe prospectively included 102 AIDs patients with clinically suspected cardiac involvement and 102 age- and sex-matched healthy individuals. Patients underwent CMR for evaluation of myocardial fibrosis by late gadolinium enhancement (LGE) and T1 mapping. A semiquantitative evaluation based on the extent of LGE was used to calculate the total (tLGEs) and segmental (sLGEs) LGE score. Global longitudinal strain (GLS) was evaluated by STE in all subjects. All patients were regularly followed up every 6 months. The primary endpoint was the composite incidence of all-cause death and cardiovascular hospitalization.ResultsCompared to healthy controls, AIDs patients had impaired GLS (−17.9 ± 5.1% vs. −21.2 ± 2.5%, p < 0.001). LGE was detected in 70% of patients. Patients with LGE presented worse GLS (−17.1 ± 5.3% vs. −19.6 ± 4.1%, p = 0.018) than those without LGE. On multivariate logistic analysis, GLS ≥ −15% was an independent predictor of LGE presence (OR = 4.98, 95%CI 1.35–18.33, p = 0.016). Moreover, a marked and stepwise impairment of segmental longitudinal strain (−19.3 ± 6.6 vs. −14.9 ± 6.5 vs. −8.9 ± 6.3, p < 0.001) was observed as sLGEs increased. During a median follow-up time of 25 months, 6 patients died, and 14 patients were hospitalized for cardiovascular reasons. Both GLS ≥ −15% (HR 3.56, 95%CI 1.28–9.86, p = 0.015) and tLGEs ≥ 6 (HR 4.13, 95%CI 1.43–11.92, p = 0.009) were independently associated with the primary endpoint.ConclusionsIn AIDs patients, impaired myocardial strain on STE could reflect the presence and extent of myocardial fibrosis and provide incremental prognostic value in addition to LGE in the prediction of adverse outcomes.
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Affiliation(s)
- Fuwei Jia
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dingding Zhang
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shu Jiang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Yin
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojin Feng
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanlin Zhu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yingxian Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanyuan Zhu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Huaxia Yang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Wei Chen
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Yining Wang
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Nguyen J, Weber J, Hsu B, Mulyala RR, Wang L, Cao JJ. Comparing left atrial indices by CMR in association with left ventricular diastolic dysfunction and adverse clinical outcomes. Sci Rep 2021; 11:21331. [PMID: 34716361 PMCID: PMC8556227 DOI: 10.1038/s41598-021-00596-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Left atrial (LA) features are altered when diastolic dysfunction (DD) is present. The relations of LA features to the DD severity and to adverse outcomes remain unclear using CMR images. We sought to compare LA features including volumes, emptying fraction, and strains as predictors of left ventricular (LV) DD and adverse outcomes. We compared four groups including normal controls (n = 32), grade I DD (n = 69), grade II DD (n = 42), and grade III DD (n = 21). DD was graded by echocardiography following the current ASE guidelines. Maximum LA volume (LAVmax), minimum LA volume (LAVmin), and LA emptying fraction (LAEF) were assessed using CMR cine images. Phasic LA strains including reservoir, conduit, and booster pump strain were assessed by feature tracking. The outcome was a composite of hospital admissions for heart failure and all-cause mortality analyzed using Cox proportional hazard models. LAVmax and LAVmin were progressively larger while LAEF and LA strain measures were lower with worsening degree of DD (all p < 0.001). Among 132 patients with DD, 61 reached the composite outcome after on average 36-months of follow-up. Each of the LA parameters except for LA conduit strain was an independent predictor of the outcome in the adjusted Cox proportional hazard models (all p < 0.001). They remained significant outcome predictors after the model additionally adjusted for LV longitudinal strain. The AUC of outcome prediction was highest by LAEF (0.760) followed by LA reservoir strain (0.733) and LAVmin (0.725). Among all the LA features, increased LA volumes, reduced LAEF, reduced LA reservoir and booster pump strains were all associated with DD and DD severity. While LA strains are valuable, conventional parameters such as LAEF and LAVmin remain to be highly effective in outcome prediction with comparable performance.
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Affiliation(s)
- James Nguyen
- Department of Research, Department of Cardiovascular Imaging, The Heart Center, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Jonathan Weber
- Department of Research, Department of Cardiovascular Imaging, The Heart Center, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Brittany Hsu
- Department of Research, Department of Cardiovascular Imaging, The Heart Center, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Rajasekhar R Mulyala
- Department of Research, Department of Cardiovascular Imaging, The Heart Center, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, USA
| | - Lin Wang
- Department of Research, Department of Cardiovascular Imaging, The Heart Center, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, USA.,State University of New York at Stony Brook, Stony Brook, NY, USA
| | - J Jane Cao
- Department of Research, Department of Cardiovascular Imaging, The Heart Center, St Francis Hospital, 100 Port Washington Blvd, Roslyn, NY, USA. .,State University of New York at Stony Brook, Stony Brook, NY, USA.
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