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Gil KE, Mikrut K, Mazur J, Black AL, Truong VT, Smart S, Zareba KM. Risk stratification in patients with structurally normal hearts: Does fibrosis type matter? PLoS One 2023; 18:e0295519. [PMID: 38117807 PMCID: PMC10732365 DOI: 10.1371/journal.pone.0295519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES The study sought to assess the prognostic significance of nonischemic myocardial fibrosis (MF) on cardiovascular magnetic resonance (CMR)-both macroscopic MF assessed by late gadolinium enhancement (LGE) and diffuse microscopic MF quantified by extracellular volume fraction (ECV)-in patients with structurally normal hearts. BACKGROUND The clinical relevance of tissue abnormalities identified by CMR in patients with structurally normal hearts remains unclear. METHODS Consecutive patients undergoing CMR were screened for inclusion to identify those with LGE imaging and structurally normal hearts. ECV was calculated in patients with available T1 mapping. The associations between myocardial fibrosis and the outcomes of all-cause mortality, new-onset heart failure [HF], and an arrhythmic outcome were evaluated. RESULTS In total 525 patients (mean age 43.1±14.2 years; 30.5% males) were included. Over a median follow-up of 5.8 years, 13 (2.5%) patients died and 18 (3.4%) developed new-onset HF. Nonischemic midwall /subepicardial LGE was present in 278 (52.9%) patients; isolated RV insertion fibrosis was present in 80 (15.2%) patients. In 276 patients with available T1 mapping, the mean ECV was 25.5 ± 4.4%. There was no significant association between LGE and all-cause mortality (HR: 1.36, CI: 0.42-4.42, p = 0.61), or new-onset HF (HR: 0.64, CI: 0.25-1.61, p = 0.34). ECV (per 1% increase) correlated with all-cause mortality (HR: 1.19, CI: 1.04-1.36, p = 0.009), but not with new-onset HF (HR: 0.97, CI: 0.86-1.10, p = 0.66). There was no significant association between arrhythmic outcomes and LGE (p = 0.60) or ECV (p = 0.49). In a multivariable model after adjusting for covariates, ECV remained significantly associated with all-cause mortality (HR per 1% increase in ECV: 1.26, CI: 1.06-1.50, p = 0.009). CONCLUSION Nonischemic LGE in patients with structurally normal hearts is common and does not appear to be associated with adverse outcomes, whereas elevated ECV is associated with all-cause mortality and may be an important risk stratification tool.
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Affiliation(s)
- Katarzyna E. Gil
- The Ohio State University Division of Cardiovascular Medicine, Columbus, OH, United States of America
| | - Katarzyna Mikrut
- Advocate Heart Institute, Advocate Lutheran General Hospital, Chicago, IL, United States of America
| | - Jan Mazur
- University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Ann Lowery Black
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Vien T. Truong
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA, United States of America
| | - Suzanne Smart
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
| | - Karolina M. Zareba
- The Ohio State University Division of Cardiovascular Medicine, Columbus, OH, United States of America
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
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The Traditional Chinese Medicine Gedan Jiangya Decoction Alleviates Left Ventricular Hypertrophy via Suppressing the Ras/ERK1/2 Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6924197. [PMID: 36437833 PMCID: PMC9699742 DOI: 10.1155/2022/6924197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/31/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022]
Abstract
Gedan Jiangya Decoction (GJD), a Chinese herbal medicine composed of six botanical medicines, was designed to treat hypertension (patent published number (CN114246896A)). The overexpression of the ERK (extracellular signal-regulated kinase) signaling pathway is essential in developing left ventricular hypertrophy (LVH). This study aimed to evaluate GJD's effects on LVH in spontaneously hypertensive rats (SHRs) and examine its potential mechanisms on Ras/ERK1/2 pathway regulation. Thirty-five ten-week-old SHRs were randomly assigned to one of five groups: GJD low dosage, medium dose, high dose, model, and captopril. Wistar–Kyoto (WKY) rats served as the control group. All rats received a 6-week treatment. The following parameters were measured: systolic (SBP) and diastolic blood pressure (DBP), left ventricular mass index (LVMI), and serum TGF-beta1. The pathologic structure was determined by H & E staining and Masson. TGF-beta1, Ras, ERK1/2, and C-Fos levels were determined using western blotting and real-time qPCR. SBP, DBP, and LVMI were reduced significantly in the GJD group compared with the model group. GJD inhibited TGF-beta1, Ras, ERK1/2, and C-Fos expression in LVH. In conclusion, GJD reduced the Ras/ERK1/2 pathway expression, which decreased hypertension-induced heart hypertrophy. GJD may protect hypertension-induced myocardial hypertrophy by altering gene expression patterns in the heart.
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Iyer NR, Le TT, Kui MSL, Tang HC, Chin CT, Phua SK, Bryant JA, Pua CJ, Ang B, Toh DF, Aw TC, Lee CH, Cook SA, Ugander M, Chin CWL. Markers of Focal and Diffuse Nonischemic Myocardial Fibrosis Are Associated With Adverse Cardiac Remodeling and Prognosis in Patients With Hypertension: The REMODEL Study. Hypertension 2022; 79:1804-1813. [PMID: 35603595 PMCID: PMC9278715 DOI: 10.1161/hypertensionaha.122.19225] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognostic significance of focal and diffuse myocardial fibrosis in patients with cardiovascular risk factors is unclear. METHODS REMODEL (Response of the Myocardium to Hypertrophic Conditions in the Adult Population) is an observational cohort of asymptomatic patients with essential hypertension. All participants underwent cardiovascular magnetic resonance to assess for myocardial fibrosis: nonischemic late gadolinium enhancement (LGE), native myocardial T1, postcontrast myocardial T1, extracellular volume fraction including/excluding LGE regions, interstitial volume (extracellular volume×myocardial volume), and interstitial/myocyte ratio. Primary outcome was a composite of first occurrence acute coronary syndrome, heart failure hospitalization, strokes, and cardiovascular mortality. Patients were recruited from February 2016 and followed until June 2021. RESULTS Of the 786 patients with hypertension (58±11 years; 39% women; systolic blood pressure, 130±14 mm Hg), 145 (18%) had nonischemic LGE. Patients with nonischemic LGE were more likely to be men, have diabetes, be current smokers, and have higher blood pressure (P<0.05 for all). Compared with those without LGE, patients with nonischemic LGE had greater left ventricular mass (66±22 versus 49±9 g/m2; P<0.001), worse multidirectional strain (P<0.001 for all measures), and elevated circulating markers of myocardial wall stress and myocardial injury, adjusted for potential confounders. Twenty-four patients had primary outcome over 39 (30-50) months of follow-up. Of all the cardiovascular magnetic resonance markers of myocardial fibrosis assessed, only nonischemic LGE (hazard ratio, 6.69 [95% CI, 2.54-17.60]; P<0.001) and indexed interstitial volume (hazard ratio, 1.11 [95% CI, 1.04-1.19]; P=0.002) demonstrated independent association with primary outcome. CONCLUSIONS In patients with hypertension, myocardial fibrosis on cardiovascular magnetic resonance is associated with adverse cardiac remodeling and outcomes.
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Affiliation(s)
- Nithin R Iyer
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Thu-Thao Le
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).,National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).,Cardiovascular ACP, Duke-NUS Medical School, Singapore (T.-T.L., C.W.L.C.)
| | - Michelle S L Kui
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Hak-Chiaw Tang
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Chee-Tang Chin
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.)
| | - Soon-Kieng Phua
- Department of Laboratory Medicine, Changi General Hospital, Singapore (S.-K.P., T.-C.A.)
| | - Jennifer A Bryant
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).,National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Chee-Jian Pua
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Briana Ang
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Desiree-Faye Toh
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.)
| | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore (S.-K.P., T.-C.A.)
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore (C.-H.L., S.A.C.)
| | - Stuart A Cook
- Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).,National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).,Department of Cardiology, National University Heart Centre Singapore (C.-H.L., S.A.C.)
| | - Martin Ugander
- Faculty of Medicine and Health, The University of Sydney, Australia (M.U.).,Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden (M.U.)
| | - Calvin W L Chin
- National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).,Cardiovascular ACP, Duke-NUS Medical School, Singapore (T.-T.L., C.W.L.C.)
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Xiao B, Liu F, Jin YH, Jin YQ, Wang L, Lu JC, Yang XC. Renal sympathetic denervation attenuates left ventricle hypertrophy in spontaneously hypertensive rats by suppressing the Raf/MEK/ERK signaling pathway. Clin Exp Hypertens 2020; 43:142-150. [PMID: 33070656 DOI: 10.1080/10641963.2020.1833022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the effect of renal sympathetic denervation (RSD) on left ventricle hypertrophy and the Raf/MEK/ERK signaling pathway in spontaneously hypertensive rats (SHRs). METHODS SHRs were divided into SHR, SHR + Sham, SHR + RSD and SHR + U0126 groups, with WKY rats as the baseline controls. The blood pressure of rats was observed, while myocardial fibrosis was evaluated through Masson staining. Thereafter, real-time quantitative polymerase chain reaction (qRT-PCR) was carried out to determine the levels of myocardial-hypertrophy-related markers, and Western blotting was used to measure the activity of the Raf/MEK/ERK signaling pathway. RESULTS In comparison with the WKY group, significant increases were observed in the systolic pressure and diastolic pressure of rats from the other four groups at different time points after surgery. In addition, rats in these groups had obvious increases in LVMI, renal NE and IVSd and decreases in LVEDd, LVEF and LVFS. In addition, the CVF of myocardial tissues was increased, with the upregulation of ANP, BNP and β-MHC and the downregulation of α-MHC. For the activity of the Raf/MEK/ERK signaling pathway, the levels of p-Raf/Raf, p-MEK/MEK and p-ERK1/2/ERK1/2 were all remarkably elevated (all P < .05). Further comparison with the SHR group showed that the above indexes in the rats were significantly improved in the RSD group and SHR + U0126 group (all P < .05). CONCLUSION RSD may decrease blood pressure, mitigate hypertension-induced left ventricle hypertrophy and improve cardiac function efficiently in SHRs via the suppression of the Raf/MEK/ERK signaling pathway.
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Affiliation(s)
- Bing Xiao
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Fan Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Ye-Hui Jin
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Ya-Qiong Jin
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Li Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Jing-Chao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Xiu-Chun Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
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5
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D’Ascenzi F, Fiorentini C, Anselmi F, Mondillo S. Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete’s heart. Eur J Prev Cardiol 2020; 28:1125-1133. [PMID: 33611377 DOI: 10.1177/2047487320911850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Athlete’s heart is typically accompanied by a remodelling of the cardiac chambers induced by exercise. However, although competitive athletes are commonly considered healthy, they can be affected by cardiac disorders characterised by an increase in left ventricular mass and wall thickness, such as hypertension. Unfortunately, training-induced increase in left ventricular mass, wall thickness, and atrial and ventricular dilatation observed in competitive athletes may mimic the pathological remodelling of pathological hypertrophy. As a consequence, distinguishing between athlete’s heart and hypertension can sometimes be challenging. The present review aimed to focus on the differential diagnosis between hypertensive heart disease and athlete’s heart, providing clinical information useful to distinguish between physiological and pathological remodelling.
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Affiliation(s)
- Flavio D’Ascenzi
- Department of Medical Biotechnologies, University of Siena, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, University of Siena, Italy
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6
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Rosenbohm A, Buckert D, Kassubek J, Rottbauer W, Ludolph AC, Bernhardt P. Sporadic inclusion body myositis: no specific cardiac involvement in cardiac magnetic resonance tomography. J Neurol 2020; 267:1407-1413. [PMID: 31997038 PMCID: PMC7184047 DOI: 10.1007/s00415-020-09724-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 11/23/2022]
Abstract
Objective To investigate cardiac involvement in patients with sporadic inclusion body myositis (IBM) by cardiac magnetic resonance tomography (CMR). Methods A case series of 20 patients with IBM underwent basic cardiac assessment and CMR including functional imaging, native and contrast-enhanced T1-weighted, and late gadolinium enhancement (LGE) imaging. Results All IBM patients reported no cardiac symptoms. Echocardiography was normal in 16/17 IBM patients. In CMR, IBM patients had normal ejection fractions (mean LVEF 63 ± 7%) and ventricular mass. They had reduced left (mean 55 versus 88 ml) and right ventricular stroke volumes (mean 54 versus 86 ml) and increased early myocardial enhancement (pathological T1 Ratio in 44% versus 5%), as compared to age- and gender-matched controls. Since arterial hypertension was more often observed in IBM patients, hypertensive heart disease can also be causative for these changes. Late gadolinium enhancement did not differ statistically from healthy controls. There was no apparent association between elevated biomarkers, echocardiography and CMR. Conclusion CMR revealed subtle changes in cardiac geometry and tissue characterization in IBM patients when compared to a gender- and age-matched control group. Findings in CMR indicated a higher extent of diffuse myocardial fibrosis as well as smaller left ventricular stroke volumes. These alterations may be due to a higher prevalence of arterial hypertension in the IBM cohort.
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Affiliation(s)
- Angela Rosenbohm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | | | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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7
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Wang NC, Hussain A, Adelstein EC, Althouse AD, Sharbaugh MS, Jain SK, Shalaby AA, Voigt AH, Saba S. Myocardial recovery after cardiac resynchronization therapy in left bundle branch block-associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy. Ann Noninvasive Electrocardiol 2019; 24:e12603. [PMID: 30267454 PMCID: PMC6931814 DOI: 10.1111/anec.12603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Baseline predictors of myocardial recovery after cardiac resynchronization therapy (CRT) in left bundle branch block (LBBB)-associated idiopathic nonischemic cardiomyopathy (NICM) are unknown. METHODS A retrospective study included subjects with idiopathic NICM, left ventricular ejection fraction (LVEF) ≤35%, and LBBB. Myocardial recovery was defined as post-CRT LVEF ≥50%. Logistic regression analyses described associations between baseline characteristics and myocardial recovery. Cox regression analyses estimated the hazard ratio (HR) between myocardial recovery status and adverse clinical events. RESULTS In 105 subjects (mean age 61 years, 44% male, mean initial LVEF 22.6% ± 6.6%, 81% New York Heart Association class III, and 98% CRT-defibrillators), myocardial recovery after CRT was observed in 56 (54%) subjects. Hypertension, heart rate, and serum blood urea nitrogen (BUN) had negative associations with myocardial recovery in univariable analyses. These associations persisted in multivariable analysis: hypertension (odds ratio (OR), 0.40; 95% confidence interval (CI), 0.17-0.95; p = 0.04), heart rate (OR per 10 bpm, 0.69; 95% CI, 0.48-0.997; p = 0.048), and serum BUN (OR per 1 mg/dl, 0.94; 95% CI, 0.88-0.99; p = 0.04). Subjects with post-CRT LVEF ≥50%, when compared to <50%, had lower risk for adverse clinical events (heart failure hospitalization, appropriate implantable cardioverter-defibrillator shock, appropriate anti-tachycardia pacing therapy, ventricular assist device implantation, heart transplantation, and death) over a median follow-up of 75.9 months (HR, 0.38; 95% CI, 0.16-0.88; p = 0.02). CONCLUSION In LBBB-associated idiopathic NICM, myocardial recovery after CRT was associated with absence of hypertension, lower heart rate, and lower serum BUN. Those with myocardial recovery had fewer adverse clinical events.
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Affiliation(s)
- Norman C. Wang
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Aliza Hussain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Evan C. Adelstein
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Andrew D. Althouse
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Michael S. Sharbaugh
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Sandeep K. Jain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Alaa A. Shalaby
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Andrew H. Voigt
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Samir Saba
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
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8
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Romano S, Judd RM, Kim RJ, Kim HW, Heitner JF, Shah DJ, Devereux RB, Salazar P, Trybula M, Chia RC, Evans K, Farzaneh-Far A. Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging: A Multicenter Study. JACC Cardiovasc Imaging 2018; 12:1769-1779. [PMID: 30409557 DOI: 10.1016/j.jcmg.2018.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/17/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived mitral annular plane systolic excursion (MAPSE) in a large multicenter population of patients with hypertension. BACKGROUND In patients with hypertension, cardiac abnormalities are powerful predictors of adverse outcomes. Long-axis mitral annular movement plays a fundamental role in cardiac mechanics and is an early marker for a number of pathological processes. Given the adverse consequences of cardiac involvement in hypertension, the authors hypothesized that lateral MAPSE may provide incremental prognostic information in these patients. METHODS Consecutive patients with hypertension and a clinical indication for CMR at 4 U.S. medical centers were included in this study (n = 1,735). Lateral MAPSE was measured in the 4-chamber cine view. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models. RESULTS Over a median follow-up period of 5.1 years, 235 patients died. By Kaplan-Meier analysis, risk of death was significantly higher in patients with a lateral MAPSE < median (10 mm) (log-rank; p < 0.0001). Lateral MAPSE was associated with risk of death after adjustment for clinical and imaging risk factors (hazard ratio [HR]: 1.402-per-millimeter decrease; p < 0.001). Addition of lateral MAPSE in this model resulted in significant improvement in the C-statistic (0.735 to 0.815; p < 0.0001). Continuous net reclassification improvement was 0.739 (95% confidence interval: 0.601 to 0.902). Lateral MAPSE remained significantly associated with death even after adjustment for feature tracking global longitudinal strain (HR: 1.192-per-millimeter decrease; p < 0.001). Lateral MAPSE was independently associated with death among the subgroups of patients with preserved ejection fraction (HR = 1.339; p < 0.001) and in those without history of myocardial infarction (HR: 1.390; p < 0.001). CONCLUSIONS CMR-derived lateral MAPSE is a powerful, independent predictor of mortality in patients with hypertension and a clinical indication for CMR, incremental to common clinical and CMR risk factors. These findings may suggest a role for CMR-derived lateral MAPSE in identifying hypertensive patients at highest risk of death.
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Affiliation(s)
- Simone Romano
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, University of Verona, Verona, Italy
| | - Robert M Judd
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
| | - Raymond J Kim
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
| | - Han W Kim
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
| | - John F Heitner
- Department of Cardiology, New York Methodist Hospital, New York, New York
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Pablo Salazar
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Michael Trybula
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Richard C Chia
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Kaleigh Evans
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Afshin Farzaneh-Far
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
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Clinical applications of multiparametric CMR in left ventricular hypertrophy. Int J Cardiovasc Imaging 2018; 34:577-585. [DOI: 10.1007/s10554-018-1320-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/16/2017] [Indexed: 12/22/2022]
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10
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Amano Y, Kitamura M, Takano H, Yanagisawa F, Tachi M, Suzuki Y, Kumita S, Takayama M. Cardiac MR Imaging of Hypertrophic Cardiomyopathy: Techniques, Findings, and Clinical Relevance. Magn Reson Med Sci 2018; 17:120-131. [PMID: 29343659 PMCID: PMC5891337 DOI: 10.2463/mrms.rev.2017-0145] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common myocardial genetic disease having a wide variety of symptoms and prognoses. The most serious complications of HCM are sudden cardiac death induced by ventricular arrhythmia or inappropriate changes in blood pressure, and heart failure. Cardiac MR imaging is a valuable imaging method for detecting HCM because of its accurate measurement of wall thickness and myocardial mass without limited view and the unique ability of late gadolinium enhancement (LGE) to identify myocardial fibrosis related to the prognosis of HCM. Tagging and T1 or T2 mapping MR imaging techniques have emerged as quantitative methods for the evaluation of disease severity. In this review, we introduce the MR imaging techniques applied to HCM and demonstrate the typical phenotypes and some morphological characteristics of HCM. In addition, we discuss the clinical relevance of MR imaging for risk stratification and management of HCM.
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Affiliation(s)
- Yasuo Amano
- Department of Radiology, Nihon University Hospital
| | | | | | - Fumi Yanagisawa
- Department of Radiology, Nihon University Hospital.,Department of Radiology, Nippon Medical School
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Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006580. [DOI: 10.1161/circimaging.117.006580] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
Background—
Severe aortic stenosis (AS) most often presents with reduced aortic valve area (<1 cm
2
), normal stroke volume index (≥35 mL/m
2
), and either high mean gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit.
Methods and Results—
Eighty-seven consecutive patients with reduced aortic valve area and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging. Patients were stratified as NFLG or normal-flow high-gradient. In total, 33 patients (38%) had NFLG. Before AVR, they were characterized by similar symptom burden but less severe AS measured by aortic valve area index (0.50±0.09 versus 0.40±0.08 cm
2
/m
2
;
P
<0.0001), lower LV mass index (74±18 versus 90±26 g/m
2
;
P
=0.01), but the same degree of myocardial fibrosis. After AVR, NFLG had a smaller reduction in LV mass index (−3±10 versus −±18 g/m
2
;
P
<0.0001) and a smaller reduction in natriuretic peptides. Both groups experienced similar symptomatic improvement. Normal-flow high-gradient condition independently predicted change in LV mass index.
Conclusions—
Patients with NFLG had less severe AS and LV remodeling than patients with normal-flow high-gradient. Furthermore, NFLG patients experienced less reverse remodeling but the same symptomatic benefit.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02316587.
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12
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Rosenbohm A, Schmid B, Buckert D, Rottbauer W, Kassubek J, Ludolph AC, Bernhardt P. Cardiac Findings in Amyotrophic Lateral Sclerosis: A Magnetic Resonance Imaging Study. Front Neurol 2017; 8:479. [PMID: 29021775 PMCID: PMC5623666 DOI: 10.3389/fneur.2017.00479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/29/2017] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to investigate the potential involvement of cardiac structure and function by cardiac magnetic resonance (CMR) imaging in amyotrophic lateral sclerosis (ALS) patients. Our study included 35 patients with ALS without a history of cardiac disease and an age- and gender-matched healthy control group (n = 34). All subjects received a CMR in a 1.5-T whole-body scanner. Patients were also screened with Holter monitoring, echocardiography, and a blood test of cardiac markers. Myocardial mass in ALS hearts was reduced compared to the control group, and ejection volumes in the left and right heart were severely decreased in ALS patients, as shown by echocardiography and CMR. The myocardium showed increased T1 enhancement in 77% of the patients compared to 27% of controls (p = 0.0001). A trend toward late gadolinium enhancement patterns consistent with myocardial fibrosis was observed in 23.5% of the patients (9.1% of controls). Holter monitoring was normal in all patients as well as troponin T. Cardiac involvement seems to be present in ALS patients without clinical cardiac symptoms and with a normal cardiac routine assessment. Structural myocardial defects in CMR may be due to sympathetic dysfunction and may account for reported cardiac deaths in late-stage ALS patients.
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Affiliation(s)
| | - Benjamin Schmid
- Department of Neurology, University of Ulm, Ulm, Germany.,Department of Internal Medicine, Kreiskrankenhaus Ehingen, Ehingen, Germany
| | - Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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13
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Fulton N, Rajiah P. Utility of magnetic resonance imaging in the evaluation of left ventricular thickening. Insights Imaging 2017; 8:279-293. [PMID: 28281159 PMCID: PMC5359150 DOI: 10.1007/s13244-017-0549-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete's heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establishing aetiology, quantification, identifying prognostic factors, serial follow-up and treatment response. In this article, we review the aetiologies and pathophysiology of LV thickening, and demonstrate the comprehensive role of MRI in the evaluation of LV thickening. TEACHING POINTS • MRI plays an important role in the evaluation of LV thickening. • LV thickening can be due to either hypertrophy or remodelling. • Pathological thickening can be due to pressure/volume overload or infiltrative disorders.
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Affiliation(s)
- Nicholas Fulton
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA.
- Department of Radiology Cardiothoracic Imaging, UT Southwestern Medical Center, E6.120 B, Mail code 9316, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA.
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14
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Abstract
The risks associated with hypertension emerge through a series of complex interactions. Myocardial ischemia is the major contributor to this risk. The mechanisms driving ischemia reflect many of the key factors in hypertension, including endothelial and neurohumoral factors, fibrosis, and hemodynamics. Left ventricular hypertrophy and fibrosis are of fundamental importance and together with hemodynamics provide an optimal template for myocardial ischemia. Understanding the pathophysiology has aided a more rational management approach but challenges remain which, if surmounted, will have an impact on the morbidity and mortality caused by myocardial ischemia in patients with hypertension.
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Affiliation(s)
- Tony Stanton
- Nambour Hospital, School of Medicine, University of Queensland, Medical Suites, Level 2, Nambour, Queensland 4556, Australia
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15
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Fast 3-Breath-Hold 3-Dimensional Tagging Cardiac Magnetic Resonance in Patients with Hypertrophic Myocardial Diseases: A Feasibility Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3749489. [PMID: 27022609 PMCID: PMC4789016 DOI: 10.1155/2016/3749489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
Tagging CMR has been established as the standard reference for measurement of myocardial strain. The current 2D tagging technique requires multiple breath-holds to cover the whole heart and cannot show the 3D motions of the left ventricle. We performed fast 3-breath-hold 3D tagging with localized tagging preparation and complementary spatial modulation of magnetization in 10 patients with hypertrophic myocardial diseases and 6 normal volunteers. The left wall motion was observed at any view angle, which allowed for the identification of regional and global hypokinesis using the fast 3D tagging. Although a decrease in the circumferential strain and LGE were observed at the basal septum in hypertrophic cardiomyopathy, they were not located together in each patient. In hypertensive heart disease, the decrease in circumferential strain was observed more widely than LGE, and the summed strain of all segments was significantly decreased. The decrease in strain and LGE were observed diffusely in cardiac amyloidosis. In conclusion, fast 3-breath-hold 3D tagging is feasible for the regional and global strain analysis. The location of reduced circumferential strain is not necessarily the same as that of LGE and is related to the global cardiac function in patients with hypertrophic myocardial diseases.
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16
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Alexanderson-Rosas E, Berríos-Bárcenas E, Meave A, de la Fuente-Mancera JC, Oropeza-Aguilar M, Barrero-Mier A, Monroy-González ADG, Cruz-Mendoza R, Guinto-Nishimura GY. Novel contributions of multimodality imaging in hypertension: A narrative review. World J Hypertens 2015; 5:28-40. [DOI: 10.5494/wjh.v5.i2.28] [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: 09/29/2014] [Revised: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.
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17
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Emrich T, Emrich K, Abegunewardene N, Oberholzer K, Dueber C, Muenzel T, Kreitner KF. Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries. Br J Radiol 2015; 88:20150025. [PMID: 25782462 DOI: 10.1259/bjr.20150025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. METHODS This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data. RESULTS MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established. CONCLUSION CMR performed early after the onset of symptoms revealed a broad spectrum of diseases. CMR delivered a correct final diagnosis in 90% of patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. ADVANCES IN KNOWLEDGE Diagnosing patients with acute coronary syndrome but unobstructed coronary arteries remains a challenge for cardiologists. CMR performed early after catheterization reveals a broad spectrum of diseases with only a simple and quick examination protocol, and there is a high concordance between MRI-based diagnoses and final reference diagnoses.
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Affiliation(s)
- T Emrich
- 1 Department of Diagnostic and Interventional Radiology, Universitätsmedizin, Johannes Gutenberg University of Mainz, Mainz, Germany
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18
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Penela D, De Riva M, Herczku C, Catto V, Pala S, Fernández-Armenta J, Acosta J, Cipolletta L, Andreu D, Borras R, Rios J, Mont L, Brugada J, Carbucicchio C, Zeppenfeld K, Berruezo A. An easy-to-use, operator-independent, clinical model to predict the left vs. right ventricular outflow tract origin of ventricular arrhythmias. Europace 2015; 17:1122-8. [DOI: 10.1093/europace/euu373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/25/2014] [Indexed: 01/18/2023] Open
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19
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Takeda M, Amano Y, Tachi M, Tani H, Mizuno K, Kumita S. MRI differentiation of cardiomyopathy showing left ventricular hypertrophy and heart failure: differentiation between cardiac amyloidosis, hypertrophic cardiomyopathy, and hypertensive heart disease. Jpn J Radiol 2013; 31:693-700. [PMID: 23996116 DOI: 10.1007/s11604-013-0238-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/14/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the capability of MRI to differentiate cardiac amyloidosis (CA), end-stage hypertrophic cardiomyopathy (HCM), and hypertensive heart disease (HHD), which are important etiologies of left ventricular hypertrophy (LVH) and heart failure. MATERIALS AND METHODS We enrolled 26 patients presenting with both LVH and heart failure: six with CA, nine with end-stage HCM, and 11 with HHD. Cardiac function, presence of pericardial or pleural effusion, and the extent and patterns of late gadolinium enhancement (LGE) were compared among the three diseases. RESULTS Myocardial LGE was observed in all six CA patients, eight end-stage HCM patients, and six HHD patients. The number of LGE segments was significantly greater in CA than in HCM or HHD (p = 0.02 for both), and all patients with CA showed a global endocardial pattern of LGE. There were significant differences among CA, HCM, and HHD in ejection fraction and end-diastolic and end-systolic volume indices (p < 0.05 for all). Pericardial effusion was observed more frequently in CA than in HCM or HHD (p = 0.04 or 0.01, respectively). CONCLUSION MRI is valuable for distinguishing among CA, end-stage HCM, and HHD, all of which present with LVH and heart failure.
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Affiliation(s)
- Minako Takeda
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan,
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20
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Bennett CJ, Maleszewski JJ, Araoz PA. CT and MR imaging of the aortic valve: radiologic-pathologic correlation. Radiographics 2013; 32:1399-420. [PMID: 22977027 DOI: 10.1148/rg.325115727] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Valvular disease is estimated to account for as many as 20% of cardiac surgical procedures performed in the United States. It may be congenital in origin or secondary to another disease process. One congenital anomaly, bicuspid aortic valve, is associated with increased incidence of stenosis, regurgitation, endocarditis, and aneurysmal dilatation of the aorta. A bicuspid valve has two cusps instead of the normal three; resultant fusion or poor excursion of the valve leaflets may lead to aortic stenosis, the presence of which is signaled by dephasing jets on magnetic resonance (MR) images. Surgery is generally recommended for patients with severe stenosis who are symptomatic or who have significant ventricular dysfunction; transcatheter aortic valve implantation (TAVI) is an emerging therapeutic option for patients who are not eligible for surgical treatment. Computed tomography (CT) is an essential component of preoperative planning for TAVI; it is used to determine the aortic root dimensions, severity of peripheral vascular disease, and status of the coronary arteries. Aortic regurgitation, which is caused by incompetent closure of the aortic valve, likewise leads to the appearance of jets on MR images. The severity of regurgitation is graded on the basis of valvular morphologic parameters; qualitative assessment of dephasing jets at Doppler ultrasonography; or measurements of the regurgitant fraction, volume, and orifice area. Mild regurgitation is managed conservatively, whereas severe or symptomatic regurgitation usually leads to valve replacement surgery, especially in the presence of substantial left ventricular enlargement or dysfunction. Bacterial endocarditis, although less common than aortic stenosis and regurgitation, is associated with substantial morbidity and mortality. Electrocardiographically gated CT reliably demonstrates infectious vegetations and benign excrescences of 1 cm or more on the valve surface, allowing the assessment of any embolic complications.
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21
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Parsai C, O’Hanlon R, Prasad SK, Mohiaddin RH. Diagnostic and prognostic value of cardiovascular magnetic resonance in non-ischaemic cardiomyopathies. J Cardiovasc Magn Reson 2012; 14:54. [PMID: 22857649 PMCID: PMC3436728 DOI: 10.1186/1532-429x-14-54] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 07/10/2012] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular Magnetic Resonance (CMR) is recognised as a valuable clinical tool which in a single scan setting can assess ventricular volumes and function, myocardial fibrosis, iron loading, flow quantification, tissue characterisation and myocardial perfusion imaging. The advent of CMR using extrinsic and intrinsic contrast-enhanced protocols for tissue characterisation have dramatically changed the non-invasive work-up of patients with suspected or known cardiomyopathy. Although the technique initially focused on the in vivo identification of myocardial necrosis through the late gadolinium enhancement (LGE) technique, recent work highlighted the ability of CMR to provide more detailed in vivo tissue characterisation to help establish a differential diagnosis of the underlying aetiology, to exclude an ischaemic substrate and to provide important prognostic markers. The potential application of CMR in the clinical approach of a patient with suspected non-ischaemic cardiomyopathy is discussed in this review.
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Affiliation(s)
- Chirine Parsai
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- Cardiology and CMR Unit, Polyclinique Les Fleurs, Toulon, France
| | - Rory O’Hanlon
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland
| | - Sanjay K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raad H Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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22
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Maceira AM, Mohiaddin RH. Cardiovascular magnetic resonance in systemic hypertension. J Cardiovasc Magn Reson 2012; 14:28. [PMID: 22559053 PMCID: PMC3372443 DOI: 10.1186/1532-429x-14-28] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 05/06/2012] [Indexed: 12/28/2022] Open
Abstract
Systemic hypertension is a highly prevalent potentially modifiable cardiovascular risk factor. Imaging plays an important role in the diagnosis of underlying causes for hypertension, in assessing cardiovascular complications of hypertension, and in understanding the pathophysiology of the disease process. Cardiovascular magnetic resonance (CMR) provides accurate and reproducible measures of ventricular volumes, mass, function and haemodynamics as well as uniquely allowing tissue characterization of diffuse and focal fibrosis. In addition, CMR is well suited for exclusion of common secondary causes for hypertension. We review the current and emerging clinical and research applications of CMR in hypertension.
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Affiliation(s)
- Alicia M Maceira
- Cardiac Imaging Unit, ERESA Clinic, C/ Marqués de San Juan, 6, 46015, Valencia, Spain
| | - Raad H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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23
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Di Bello V, Cucco C, Giannini C, Delle Donne MG. Myocardial tissue characterization and aortic stenosis. J Am Soc Echocardiogr 2011; 23:1067-70. [PMID: 20868956 DOI: 10.1016/j.echo.2010.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Duckett SG, Chiribiri A, Ginks MR, Sinclair S, Knowles BR, Botnar R, Carr-White GS, Rinaldi CA, Nagel E, Razavi R, Schaeffter T. Cardiac MRI to investigate myocardial scar and coronary venous anatomy using a slow infusion of dimeglumine gadobenate in patients undergoing assessment for cardiac resynchronization therapy. J Magn Reson Imaging 2010; 33:87-95. [PMID: 21182125 DOI: 10.1002/jmri.22387] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Simon G Duckett
- King's College London, BHF Centre, Division of Imaging Sciences, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK.
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25
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Jellis C, Martin J, Narula J, Marwick TH. Assessment of Nonischemic Myocardial Fibrosis. J Am Coll Cardiol 2010; 56:89-97. [DOI: 10.1016/j.jacc.2010.02.047] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 01/19/2010] [Accepted: 02/01/2010] [Indexed: 01/19/2023]
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26
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Hennersdorf M, Schannwell C, Motz W. Hochdruck und Herz. Internist (Berl) 2010; 51:815-25. [DOI: 10.1007/s00108-009-2556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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