1
|
Penso M, Babbaro M, Moccia S, Baggiano A, Carerj ML, Guglielmo M, Fusini L, Mushtaq S, Andreini D, Pepi M, Pontone G, Caiani EG. A deep-learning approach for myocardial fibrosis detection in early contrast-enhanced cardiac CT images. Front Cardiovasc Med 2023; 10:1151705. [PMID: 37424918 PMCID: PMC10325686 DOI: 10.3389/fcvm.2023.1151705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Aims Diagnosis of myocardial fibrosis is commonly performed with late gadolinium contrast-enhanced (CE) cardiac magnetic resonance (CMR), which might be contraindicated or unavailable. Coronary computed tomography (CCT) is emerging as an alternative to CMR. We sought to evaluate whether a deep learning (DL) model could allow identification of myocardial fibrosis from routine early CE-CCT images. Methods and results Fifty consecutive patients with known left ventricular (LV) dysfunction (LVD) underwent both CE-CMR and (early and late) CE-CCT. According to the CE-CMR patterns, patients were classified as ischemic (n = 15, 30%) or non-ischemic (n = 35, 70%) LVD. Delayed enhancement regions were manually traced on late CE-CCT using CE-CMR as reference. On early CE-CCT images, the myocardial sectors were extracted according to AHA 16-segment model and labeled as with scar or not, based on the late CE-CCT manual tracing. A DL model was developed to classify each segment. A total of 44,187 LV segments were analyzed, resulting in accuracy of 71% and area under the ROC curve of 76% (95% CI: 72%-81%), while, with the bull's eye segmental comparison of CE-CMR and respective early CE-CCT findings, an 89% agreement was achieved. Conclusions DL on early CE-CCT acquisition may allow detection of LV sectors affected with myocardial fibrosis, thus without additional contrast-agent administration or radiational dose. Such tool might reduce the user interaction and visual inspection with benefit in both efforts and time.
Collapse
Affiliation(s)
- Marco Penso
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Mario Babbaro
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria Ludovica Carerj
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, Netherlands
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Daniele Andreini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mauro Pepi
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Enrico G. Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Milan, Italy
| |
Collapse
|
2
|
CMRSegTools: An open-source software enabling reproducible research in segmentation of acute myocardial infarct in CMR images. PLoS One 2022; 17:e0274491. [PMID: 36099286 PMCID: PMC9469999 DOI: 10.1371/journal.pone.0274491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 12/19/2022] Open
Abstract
In the last decade, a large number of clinical trials have been deployed using Cardiac Magnetic Resonance (CMR) to evaluate cardioprotective strategies aiming at reducing the irreversible myocardial damage at the time of reperfusion. In these studies, segmentation and quantification of myocardial infarct lesion are often performed with a commercial software or an in-house closed-source code development thus creating a barrier for reproducible research. This paper introduces CMRSegTools: an open-source application software designed for the segmentation and quantification of myocardial infarct lesion enabling full access to state-of-the-art segmentation methods and parameters, easy integration of new algorithms and standardised results sharing. This post-processing tool has been implemented as a plug-in for the OsiriX/Horos DICOM viewer leveraging its database management functionalities and user interaction features to provide a bespoke tool for the analysis of cardiac MR images on large clinical cohorts. CMRSegTools includes, among others, user-assisted segmentation of the left-ventricle, semi- and automatic lesion segmentation methods, advanced statistical analysis and visualisation based on the American Heart Association 17-segment model. New segmentation methods can be integrated into the plug-in by developing components based on image processing and visualisation libraries such as ITK and VTK in C++ programming language. CMRSegTools allows the creation of training and testing data sets (labeled features such as lesion, microvascular obstruction and remote ROI) for supervised Machine Learning methods, and enables the comparative assessment of lesion segmentation methods via a single and integrated platform. The plug-in has been successfully used by several CMR imaging studies.
Collapse
|
3
|
Mukherjee P, Jain M. Effect of ischemic postconditioning during primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A single-center cross-sectional study. Ann Card Anaesth 2020; 22:347-352. [PMID: 31621667 PMCID: PMC6813695 DOI: 10.4103/aca.aca_126_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Objective Reperfusion therapy for acute myocardial infarction has been shown to reduce mortality, yet it may also have deleterious effects, including myocardial necrosis and no-reflow. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model. Postconditioning is known measure for cardioprotection from reperfusion injury in animal model and human studies have shown inconsistent results. Materials and Methods From February 2013 through October 2014, at Institute of Postgraduate Medical Education and Research, Kolkata Cardiology department, we randomized 43 patients with acute ST-segment elevation myocardial infarction (STEMI) who were undergoing conventional primary percutaneous coronary intervention (PCI) (22 patients) and PCI with postconditioning by repeated transient balloon occlusion after establishment of flow (21 patients). Total creatine kinase-muscle/brain (CPK-MB) released within 72 h was compared as a surrogate marker of infarct size. Myocardial blush grade between two groups was also compared. Results The area under curve of serum creatine kinase (CK) release during the 1st 72 h of reperfusion was significantly reduced (P = 0.0347) in the postconditioned group compared with the control group, averaging 9632 IU in postconditioned compared with 13493 IU in control group which represented 29% of reduction of infarct size. The peak of CPK-MB release was markedly lower in the postconditioned (290 ± 16.24 IU/L) than in the control (414.2 ± 51.34 IU/L) group (P ≤ 0.0001). Blush grading was also significantly improved in postconditioned group (P = 0.005). Mean ST-segment deviation at 48 h between cases and control groups was 0.87 ± 0.68 and 1.4 ± 0.94, respectively (P = 0.08). Conclusion In patients with STEMI, postconditioning significantly improves blush grading and enzymatic infarct size reduction with a trend toward significant reduction of mean ST-segment deviation.
Collapse
Affiliation(s)
- Priyam Mukherjee
- Department of Cardiology, Fortis Health Care, Kolkata, West Bengal, India
| | - Mayank Jain
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| |
Collapse
|
4
|
Li W. Biomechanics of infarcted left Ventricle-A review of experiments. J Mech Behav Biomed Mater 2020; 103:103591. [PMID: 32090920 DOI: 10.1016/j.jmbbm.2019.103591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023]
Abstract
Myocardial infarction (MI) is one of leading diseases to contribute to annual death rate of 5% in the world. In the past decades, significant work has been devoted to this subject. Biomechanics of infarcted left ventricle (LV) is associated with MI diagnosis, understanding of remodelling, MI micro-structure and biomechanical property characterizations as well as MI therapy design and optimization, but the subject has not been reviewed presently. In the article, biomechanics of infarcted LV was reviewed in terms of experiments achieved in the subject so far. The concerned content includes experimental remodelling, kinematics and kinetics of infarcted LVs. A few important issues were discussed and several essential topics that need to be investigated further were summarized. Microstructure of MI tissue should be observed even carefully and compared between different methods for producing MI scar in the same animal model, and eventually correlated to passive biomechanical property by establishing innovative constitutive laws. More uniaxial or biaxial tensile tests are desirable on MI, border and remote tissues, and viscoelastic property identification should be performed in various time scales. Active contraction experiments on LV wall with MI should be conducted to clarify impaired LV pumping function and supply necessary data to the function modelling. Pressure-volume curves of LV with MI during diastole and systole for the human are also desirable to propose and validate constitutive laws for LV walls with MI.
Collapse
Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, Glasgow, G12 8QQ, UK.
| |
Collapse
|
5
|
Bochaton T, Claeys MJ, Garcia-Dorado D, Mewton N, Bergerot C, Jossan C, Amaz C, Boussaha I, Thibault H, Ovize M. Importance of infarct size versus other variables for clinical outcomes after PPCI in STEMI patients. Basic Res Cardiol 2019; 115:4. [PMID: 31832789 DOI: 10.1007/s00395-019-0764-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/21/2019] [Indexed: 12/16/2022]
Abstract
Despite promising experimental studies and encouraging proof-of-concept clinical trials, interventions aimed at limiting infarct size have failed to improve clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Our objective was to examine whether variables (cardiovascular risk factors, comorbidities, post-procedural variables, cotreatments) might be associated with clinical outcomes in STEMI patients independently from infarct size reduction. The present study was based on a post hoc analysis of the CIRCUS trial database (Clinicaltrials.gov NCT01502774) that assessed the clinical benefit of a single intravenous bolus of cyclosporine in 969 patients with anterior STEMI. Since cyclosporine had no detectable effect on clinical outcomes as well as on any measured variable, we here considered the whole study population as one group. Multivariate analysis was performed to address the respective weight of infarct size and variables in clinical outcomes. Multivariate analysis revealed that several variables (including gender, hypertension, renal dysfunction, TIMI flow grade post-PCI < 3, and treatment administered after PCI with betablockers and angiotensin-converting enzyme inhibitors) had per se a significant influence on the occurrence of [death or hospitalization for heart failure] at 1 year. The relative weight of infarct size and variables on the composite endpoint of [death or hospitalization for heart failure] at 1 year was 18% and 82%, respectively. Several variables contribute strongly to the clinical outcomes of STEMI patients suggesting that cardioprotective strategy might not only focus on infarct size reduction.
Collapse
Affiliation(s)
- Thomas Bochaton
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - David Garcia-Dorado
- Hospital Universitari Vall d´Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red-CV, Barcelona, Spain
| | - Nathan Mewton
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Cyrille Bergerot
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France.,Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Claire Jossan
- Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Camille Amaz
- Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Inesse Boussaha
- Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Hélène Thibault
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France.,Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France
| | - Michel Ovize
- INSERM UMR 1060, CarMeN Laboratory, University Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France. .,Service d'Explorations Fonctionnelles Cardiovasculaires CIC 1407 de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Lyon, France. .,Service d'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, 59 Bd Pinel, 69394, Bron, France.
| |
Collapse
|
6
|
Development and testing of a deep learning-based strategy for scar segmentation on CMR-LGE images. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 32:187-195. [PMID: 30460430 DOI: 10.1007/s10334-018-0718-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this paper is to investigate the use of fully convolutional neural networks (FCNNs) to segment scar tissue in the left ventricle from cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) images. METHODS A successful FCNN in the literature (the ENet) was modified and trained to provide scar-tissue segmentation. Two segmentation protocols (Protocol 1 and Protocol 2) were investigated, the latter limiting the scar-segmentation search area to the left ventricular myocardial tissue region. CMR-LGE from 30 patients with ischemic-heart disease were retrospectively analyzed, for a total of 250 images, presenting high variability in terms of scar dimension and location. Segmentation results were assessed against manual scar-tissue tracing using one-patient-out cross validation. RESULTS Protocol 2 outperformed Protocol 1 significantly (p value < 0.05), with median sensitivity and Dice similarity coefficient equal to 88.07% [inter-quartile range (IQR) 18.84%] and 71.25% (IQR 31.82%), respectively. DISCUSSION Both segmentation protocols were able to detect scar tissues in the CMR-LGE images but higher performance was achieved when limiting the search area to the myocardial region. The findings of this paper represent an encouraging starting point for the use of FCNNs for the segmentation of nonviable scar tissue from CMR-LGE images.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW The purpose of the present paper is to analytically review the diagnostic and prognostic role of CMR in ST-segment elevation myocardial infarction (STEMI) survivors. Percutaneous coronary intervention (PCI) is the treatment of choice in patients STEMI. However, risk of future events remains substantial. Assessment of the extent of myocardial infarction (MI), cardiac function and ventricular remodelling has become the focus of recent studies. Electrocardiography, angiography and echocardiography parameters, as well as risk scores, lack sensitivity and reproducibility in predicting future cardiovascular events. A major advantage of cardiac magnetic resonance imaging (CMR) is that it provides myocardial tissue characterization. RECENT FINDINGS CMR is able to quantify both reversible and irreversible myocardial injury and correlates with future events. This review will illustrate how microvascular function indices (myocardial salvage index, presence and amount of microvascular obstruction and intramyocardial haemorrhage) detectable by CMR add prognostic information and could impact on future strategies to improve outcomes in revascularized patients.
Collapse
|
8
|
Souto ALM, Souto RM, Teixeira ICR, Nacif MS. Myocardial Viability on Cardiac Magnetic Resonance. Arq Bras Cardiol 2017; 108:458-469. [PMID: 28591322 PMCID: PMC5444893 DOI: 10.5935/abc.20170056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022] Open
Abstract
The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability. Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.
Collapse
Affiliation(s)
| | | | | | - Marcelo Souto Nacif
- Universidade Federal Fluminense, Niterói, RJ - Brazil.,Centro de Imagem Complexo Hospitalar de Niterói, Niterói, RJ - Brazil.,Unidade de Radiologia Clínica - Hospital Vivalle - Rede D´Or - São Luiz, São José dos Campo, SP - Brazil
| |
Collapse
|
9
|
Bulluck H, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M, Weinmann S, Sirker A, Herrey AS, Manisty C, Moon JC, Hausenloy DJ. Impact of microvascular obstruction on semiautomated techniques for quantifying acute and chronic myocardial infarction by cardiovascular magnetic resonance. Open Heart 2016; 3:e000535. [PMID: 28008358 PMCID: PMC5174824 DOI: 10.1136/openhrt-2016-000535] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/27/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
Aims The four most promising semiautomated techniques (5-SD, 6-SD, Otsu and the full width half maximum (FWHM)) were compared in paired acute and follow-up cardiovascular magnetic resonance (CMR), taking into account the impact of microvascular obstruction (MVO) and using automated extracellular volume fraction (ECV) maps for reference. Furthermore, their performances on the acute scan were compared against manual myocardial infarct (MI) size to predict adverse left ventricular (LV) remodelling (≥20% increase in end-diastolic volume). Methods 40 patients with reperfused ST segment elevation myocardial infarction (STEMI) with a paired acute (4±2 days) and follow-up CMR scan (5±2 months) were recruited prospectively. All CMR analysis was performed on CVI42. Results Using manual MI size as the reference standard, 6-SD accurately quantified acute (24.9±14.0%LV, p=0.81, no bias) and chronic MI size (17.2±9.7%LV, p=0.88, no bias). The performance of FWHM for acute MI size was affected by the acquisition sequence used. Furthermore, FWHM underestimated chronic MI size in those with previous MVO due to the significantly higher ECV in the MI core on the follow-up scans previously occupied by MVO (82 (75–88)% vs 62 (51–68)%, p<0.001). 5-SD and Otsu were precise but overestimated acute and chronic MI size. All techniques were performed with high diagnostic accuracy and equally well to predict adverse LV remodelling. Conclusions 6-SD was the most accurate for acute and chronic MI size and should be the preferred semiautomatic technique in randomised controlled trials. However, 5-SD, FWHM and Otsu could also be used when precise MI size quantification may be adequate (eg, observational studies).
Collapse
Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | | | | | - Anish N Bhuva
- Barts Heart Centre, St Bartholomew's Hospital , London , UK
| | | | - Marianna Fontana
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Shane Weinmann
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London , London , UK
| | - Alex Sirker
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Anna S Herrey
- Barts Heart Centre, St Bartholomew's Hospital , London , UK
| | - Charlotte Manisty
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - James C Moon
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| |
Collapse
|
10
|
Mewton N, Dernis A, Bresson D, Zouaghi O, Croisille P, Flocard E, Douek P, Bonnefoy-Cudraz E. Myocardial biomarkers and delayed enhanced cardiac magnetic resonance relationship in clinically suspected myocarditis and insight on clinical outcome. J Cardiovasc Med (Hagerstown) 2016; 16:696-703. [PMID: 24933194 DOI: 10.2459/jcm.0000000000000024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The relationship of cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) with myocardial biomarkers and markers of inflammation in acute viral myocarditis is not clearly defined. We assessed the relationship of LGE with myocardial and inflammatory biomarkers measured during the acute phase of myocarditis and their predictive value on clinical outcome. METHODS Patients with first clinical episode of acute viral myocarditis and complete CMR study, including cine and LGE images, were included. The peak values of troponin I, creatine kinase, C-reactive protein value at admission and LGE extent were reported for each case. A 29-month clinical follow-up was performed, and cardiac symptoms and adverse cardiac events (all-cause death, heart transplant, hospitalization for heart failure) were reported. RESULTS Forty-one patients (39 ± 15 years and 78% men) were included. Median LGE extent was 13% [interquartile range (IQR) (9%, 19%)] of left-ventricular mass and mean left-ventricular ejection fraction was 56 ± 11%. There was a significant correlation between peak troponin I and LGE extent (r = 0.51, P < 0.001), and between peak creatine kinase and LGE extent (r = 0.66, P < 0.001). There was no correlation between C-reactive protein at admission and LGE extent (r = 0.27, P = 0.09). At follow-up, eight (20%) patients had an adverse clinical event. LGE extent was significantly associated with a worse New York Heart Association status at follow-up [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.07, 1.37, P = 0.002]. After adjustment for left-ventricular ejection fraction, age and clinical presentation category, LGE extent remained an independent predictor of cardiovascular events (hazard ratio 1.42; 95% CI 1.05, 1.95, P = 0.027). CONCLUSIONS LGE extent on CMR studies is significantly correlated to biomarkers of myocardial injury in patients with acute viral myocarditis, and is a significant independent predictor of adverse cardiovascular outcome.
Collapse
Affiliation(s)
- Nathan Mewton
- aHôpital Cardiovasculaire Louis Pradel, Department of Intensive and Coronary Care, Hospices Civils de Lyon, Bron bDepartment of Biostatistics, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon cHôpital Cardiovasculaire Louis Pradel, Centre d'Investigation CliniqueUnité INSERM 1407 dHôpital Cardiovasculaire Louis Pradel, Department of Radiology, Hospices Civils de Lyon, Bron, France
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Comparison of Image Processing Techniques for Nonviable Tissue Quantification in Late Gadolinium Enhancement Cardiac Magnetic Resonance Images. J Thorac Imaging 2016; 31:168-76. [DOI: 10.1097/rti.0000000000000206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
12
|
Zhang L, Huttin O, Marie PY, Felblinger J, Beaumont M, Chillou CDE, Girerd N, Mandry D. Myocardial infarct sizing by late gadolinium-enhanced MRI: Comparison of manual, full-width at half-maximum, and n-standard deviation methods. J Magn Reson Imaging 2016; 44:1206-1217. [PMID: 27096741 DOI: 10.1002/jmri.25285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/31/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare three widely used methods for myocardial infarct (MI) sizing on late gadolinium-enhanced (LGE) magnetic resonance (MR) images: manual delineation and two semiautomated techniques (full-width at half-maximum [FWHM] and n-standard deviation [SD]). MATERIALS AND METHODS 3T phase-sensitive inversion-recovery (PSIR) LGE images of 114 patients after an acute MI (2-4 days and 6 months) were analyzed by two independent observers to determine both total and core infarct sizes (TIS/CIS). Manual delineation served as the reference for determination of optimal thresholds for semiautomated methods after thresholding at multiple values. Reproducibility and accuracy were expressed as overall bias ± 95% limits of agreement. RESULTS Mean infarct sizes by manual methods were 39.0%/24.4% for the acute MI group (TIS/CIS) and 29.7%/17.3% for the chronic MI group. The optimal thresholds (ie, providing the closest mean value to the manual method) were FWHM30% and 3SD for the TIS measurement and FWHM45% and 6SD for the CIS measurement (paired t-test; all P > 0.05). The best reproducibility was obtained using FWHM. For TIS measurement in the acute MI group, intra-/interobserver agreements, from Bland-Altman analysis, with FWHM30%, 3SD, and manual were -0.02 ± 7.74%/-0.74 ± 5.52%, 0.31 ± 9.78%/2.96 ± 16.62% and -2.12 ± 8.86%/0.18 ± 16.12, respectively; in the chronic MI group, the corresponding values were 0.23 ± 3.5%/-2.28 ± 15.06, -0.29 ± 10.46%/3.12 ± 13.06% and 1.68 ± 6.52%/-2.88 ± 9.62%, respectively. A similar trend for reproducibility was obtained for CIS measurement. However, semiautomated methods produced inconsistent results (variabilities of 24-46%) compared to manual delineation. CONCLUSION The FWHM technique was the most reproducible method for infarct sizing both in acute and chronic MI. However, both FWHM and n-SD methods showed limited accuracy compared to manual delineation. J. Magn. Reson. Imaging 2016;44:1206-1217.
Collapse
Affiliation(s)
- Lin Zhang
- INSERM, U947, IADI, Nancy, F-54000, France.,Université de Lorraine, Nancy, F-54000, France
| | - Olivier Huttin
- CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France
| | - Pierre-Yves Marie
- Université de Lorraine, Nancy, F-54000, France.,INSERM, U961, Nancy, F-54000, France.,CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France
| | - Jacques Felblinger
- INSERM, U947, IADI, Nancy, F-54000, France.,Université de Lorraine, Nancy, F-54000, France.,CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France.,INSERM, CIC-IT 1433, Nancy, F-54000, France
| | - Marine Beaumont
- INSERM, U947, IADI, Nancy, F-54000, France.,INSERM, CIC-IT 1433, Nancy, F-54000, France
| | - Christian DE Chillou
- INSERM, U947, IADI, Nancy, F-54000, France.,Université de Lorraine, Nancy, F-54000, France.,CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France
| | - Nicolas Girerd
- Université de Lorraine, Nancy, F-54000, France.,CHRU Nancy, Departement de Cardiologie, Nancy, F-54000, France.,INSERM, CIC-P 9501, Nancy, F-54000, France
| | - Damien Mandry
- INSERM, U947, IADI, Nancy, F-54000, France. .,Université de Lorraine, Nancy, F-54000, France. .,CHRU Nancy, Pôle Imagerie, Nancy, F-54000, France.
| |
Collapse
|
13
|
|
14
|
Zhang C, Liu R, Yuan J, Cui J, Hu F, Yang W, Zhang Y, Chen Y, Qiao S. Predictive Values of N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin I for Myocardial Fibrosis in Hypertrophic Obstructive Cardiomyopathy. PLoS One 2016; 11:e0146572. [PMID: 26765106 PMCID: PMC4713160 DOI: 10.1371/journal.pone.0146572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/18/2015] [Indexed: 11/28/2022] Open
Abstract
Background Both high-sensitivity cardiac troponin T and B-type natriuretic peptide are useful in detecting myocardial fibrosis, as determined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR), in patients with non-obstructive hypertrophic cardiomyopathy. However, their values to predict myocardial fibrosis in hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. We investigated the role of N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and cardiac troponin I (cTnI) to identify LGE-CMR in patients with HOCM. Methods Peripheral concentrations of NT-proBNP and cTnI were determined in patients with HOCM (n = 163; age = 47.2 ± 10.8 years; 38.7% females). Contrast-enhanced CMR was performed to identify and quantify myocardial fibrosis. Results LGE was detected in 120 of 163 patients (73.6%). Patients with LGE had significantly higher levels of NT-proBNP and cTnI than those without LGE (1386.2 [904.6–2340.8] vs. 866.6 [707.2–1875.2] pmol/L, P = 0.003; 0.024 [0.010–0.049] vs. 0.010 [0.005–0.021] ng/ml, P <0.001, respectively). The extent of LGE was positively correlated with log cTnI (r = 0.371, P <0.001) and log NT-proBNP (r = 0.211, P = 0.007). On multivariable analysis, both log cTnI and maximum wall thickness (MWT) were independent predictors of the presence of LGE (OR = 3.193, P = 0.033; OR = 1.410, P < 0.001, respectively), whereas log NT-proBNP was not. According to the ROC curve analysis, combined measurements of MWT ≥21 mm and/or cTnI ≥0.025ng/ml indicated good diagnostic performance for the presence of LGE, with specificity of 95% or sensitivity of 88%. Conclusions Serum cTnI is an independent predictor useful for identifying myocardial fibrosis, while plasma NT-proBNP is only associated with myocardial fibrosis on univariate analysis. Combined measurements of serum cTnI with MWT further improve its value in detecting myocardial fibrosis in patients with HOCM.
Collapse
Affiliation(s)
- Changlin Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Cui
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenghuan Hu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youzhou Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
| |
Collapse
|
15
|
Pöyhönen P, Kivistö S, Holmström M, Hänninen H. Quantifying late gadolinium enhancement on CMR provides additional prognostic information in early risk-stratification of nonischemic cardiomyopathy: a cohort study. BMC Cardiovasc Disord 2014; 14:110. [PMID: 25160650 PMCID: PMC4153898 DOI: 10.1186/1471-2261-14-110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/19/2014] [Indexed: 01/04/2023] Open
Abstract
Background Suspected nonischemic cardiomyopathy (NICM) is a common clinical setting with highly variable prognosis. Early noninvasive risk-stratification is important for justification of invasive examinations, specific treatment and patient surveillance. We studied the additional prognostic value of late gadolinium enhancement (LGE) and segmental wall motion abnormality (SWMA) extent on cardiovascular magnetic resonance (CMR) compared to traditional risk factors in suspected NICM. Methods In this observational cohort study, we enrolled 86 consecutive patients referred for CMR due to suspected NICM. Patients with ischemic cardiomyopathy were excluded. CMR images were analysed for left ventricular LGE and SWMA extents and patients were followed-up for major adverse cardiac events (MACE), including cardiovascular death, aborted sudden death and cardiac transplantation. Results Of 86 patients (median age: 53 years, 45% female), mainly presenting with ventricular arrhythmias (40%) and congestive heart failure (44%), 76% were finally diagnosed with NICM, 17% with left ventricle hypertrophy and 7% with idiopathic arrhythmia. On CMR, 61 patients (71%) had LGE and 56 (65%) SWMA. During median follow-up of 835 days, 15 patients (17%) reached MACE. In univariant analysis, LGE volume (hazard ratio [HR] 1.028 per 1% increase in LGE, p < 0.001), left ventricular ejection fraction (LVEF) (HR 0.959, p = 0.009) and SWMA score (HR 1.067, p = 0.012) had strongest associations with MACE. In multivariate analysis, the best overall model for event prediction included LGE volume (HR 1.027, p = 0.003), sustained ventricular tachycardia (HR 4.7, p = 0.011) and LVEF (HR 0.962, p = 0.034). Among patients with LGE, there was an event rate of 26% (14 of 61) versus 4% (1 of 25) in patients without LGE (p = 0.041, Log-rank). The highest event rate was observed in patients with LGE volume of ≥17%. Patients without SWMA did not experience MACE (p = 0.002, Log-rank), giving additional information in the subgroup of patients with preserved LVEF (≥50%). Conclusions In suspected NICM, presenting with ventricular arrhythmias or heart failure, LGE extent gives additional prognostic information compared to traditional risk factors, while the absence of SWMA may give prognostic information beyond normal LVEF. Even though the final diagnosis is uncertain in NICM, extensive amount of LGE should be considered as a sign of poor prognosis.
Collapse
Affiliation(s)
- Pauli Pöyhönen
- Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital, Po BOX 340, 00029 HUCH Helsinki, Finland.
| | | | | | | |
Collapse
|
16
|
Baron N, Kachenoura N, Cluzel P, Frouin F, Herment A, Grenier P, Montalescot G, Beygui F. Comparison of various methods for quantitative evaluation of myocardial infarct volume from magnetic resonance delayed enhancement data. Int J Cardiol 2013; 167:739-44. [DOI: 10.1016/j.ijcard.2012.03.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/12/2012] [Accepted: 03/03/2012] [Indexed: 11/25/2022]
|
17
|
Wang L, Wang J, Xu H, Li B. Postconditioning in patients treated with primary percutaneous coronary intervention: An updated meta-analysis. Catheter Cardiovasc Interv 2013; 82:E662-71. [PMID: 23804529 DOI: 10.1002/ccd.25095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/01/2013] [Accepted: 06/16/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Lei Wang
- Graduate School; Shanxi Medical University; Taiyuan Shanxi People's Republic of China
| | - Jingping Wang
- Department of Cardiology; Shanxi Cardiovascular Hospital; Taiyuan Shanxi People's Republic of China
| | - Huiyu Xu
- Department of Cardiology; Shanxi Cardiovascular Hospital; Taiyuan Shanxi People's Republic of China
| | - Bao Li
- Department of Cardiology; Shanxi Cardiovascular Hospital; Taiyuan Shanxi People's Republic of China
| |
Collapse
|
18
|
Fine NM, Tandon S, Kim HW, Shah DJ, Thompson T, Drangova M, White JA. Validation of sub-segmental visual scoring for the quantification of ischemic and nonischemic myocardial fibrosis using late gadolinium enhancement MRI. J Magn Reson Imaging 2013; 38:1369-76. [DOI: 10.1002/jmri.24116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 02/13/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nowell M. Fine
- Division of Cardiology; Department of Medicine; Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Shruti Tandon
- Division of Cardiology; Department of Medicine; Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Han W. Kim
- Duke Cardiovascular Magnetic Resonance Center; Division of Cardiology; Duke University; Durham North Carolina USA
| | - Dipan J. Shah
- The Methodist DeBakey Heart Center; Houston Texas USA
| | - Terry Thompson
- Lawson Health Research Institute; London Ontario Canada
- Department of Medical Biophysics; University of Western Ontario; London Ontario Canada
| | - Maria Drangova
- Department of Medical Biophysics; University of Western Ontario; London Ontario Canada
- Imaging Research Laboratories; Robarts Research Institute; London Ontario Canada
| | - James A. White
- Division of Cardiology; Department of Medicine; Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
- Department of Medical Biophysics; University of Western Ontario; London Ontario Canada
| |
Collapse
|
19
|
Sarafoff N, Schuster T, Vochem R, Fichtner S, Martinoff S, Schwaiger M, Schömig A, Ibrahim T. Association of ST-elevation and non-ST-elevation presentation on ECG with transmurality and size of myocardial infarction as assessed by contrast-enhanced magnetic resonance imaging. J Electrocardiol 2013; 46:100-6. [DOI: 10.1016/j.jelectrocard.2012.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Indexed: 01/07/2023]
|
20
|
Turkbey EB, Nacif MS, Noureldin RA, Sibley CT, Liu S, Lima JAC, Bluemke DA. Differentiation of myocardial scar from potential pitfalls and artefacts in delayed enhancement MRI. Br J Radiol 2013; 85:e1145-54. [PMID: 23091294 DOI: 10.1259/bjr/25893477] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Delayed enhancement cardiac magnetic resonance (DE-CMR) imaging is used increasingly to identify and quantify focal myocardial scar. Our objective is to describe factors used in the interpretation of DE-CMR images and to highlight potential pitfalls and artefacts that mimic myocardial scar. Inversion recovery gradient recalled echo sequence is commonly accepted as the standard of reference for DE-CMR. There are also alternative sequences that can be performed in a single breath-hold or with free breathing. Radiologists need to be aware of factors affecting image quality, and potential pitfalls and artefacts that may generate focal hyperintense areas that mimic myocardial scar.
Collapse
Affiliation(s)
- E B Turkbey
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, Bethesda, MD 20892, USA
| | | | | | | | | | | | | |
Collapse
|
21
|
Tacke CE, Romeih S, Kuipers IM, Spijkerboer AM, Groenink M, Kuijpers TW. Evaluation of cardiac function by magnetic resonance imaging during the follow-up of patients with Kawasaki disease. Circ Cardiovasc Imaging 2012. [PMID: 23197079 DOI: 10.1161/circimaging.112.976969] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although histopathologic studies suggest persistent myocardial abnormalities after Kawasaki disease (KD), the long-term effects on cardiac function remain to be revealed. We investigated biventricular volumes, function, and the presence of myocardial fibrosis by cardiac magnetic resonance imaging during long-term follow-up of KD. METHODS AND RESULTS Sixty patients with a history of KD (mean age, 16.9 years; 67% men; median interval after KD onset, 11.6 years) and 20 healthy control subjects (mean age, 17.9 years; 55% men) 12 to 24 years of age underwent cardiac magnetic resonance imaging. Biventricular end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were determined. Volumetric measurements were indexed for body surface area. Late contrast enhancement was used to detect areas of myocardial fibrosis. Biventricular volumes and function did not differ significantly between patients and control subjects. There were also no significant differences between patients with and without a history of left ventricular dysfunction resulting from KD-associated myocarditis or between patients with and without coronary artery aneurysms. Only those with prior ischemic heart disease had a significantly lower left ventricular ejection fraction compared with unaffected KD cases (left ventricular ejection fraction, 51% versus 57%; P=0.012). Late contrast enhancement was observed in only 2 patients with severe coronary artery aneurysms and was typical for myocardial infarction. CONCLUSIONS In this cardiac magnetic resonance imaging study evaluating the cardiac function of patients with KD at long-term follow-up, we did not observe a difference in cardiac function between KD patients and control subjects, except for a subgroup of patients with ischemic heart disease as a result of severe coronary artery pathology.
Collapse
Affiliation(s)
- Carline E Tacke
- Departments of Pediatric Hematology, Immunology, and Infectious Diseases, Academic Medical Center, Amsterdam, Netherlands.
| | | | | | | | | | | |
Collapse
|
22
|
Mäki MT, Koskenvuo JW, Ukkonen H, Saraste A, Tuunanen H, Pietilä M, Nesterov SV, Aalto V, Airaksinen KEJ, Pärkkä JP, Lautamäki R, Kervinen K, Miettinen JA, Mäkikallio TH, Niemelä M, Säily M, Koistinen P, Savolainen ER, Ylitalo K, Huikuri HV, Knuuti J. Cardiac Function, Perfusion, Metabolism, and Innervation following Autologous Stem Cell Therapy for Acute ST-Elevation Myocardial Infarction. A FINCELL-INSIGHT Sub-Study with PET and MRI. Front Physiol 2012; 3:6. [PMID: 22363288 PMCID: PMC3277266 DOI: 10.3389/fphys.2012.00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 01/10/2012] [Indexed: 01/04/2023] Open
Abstract
Purpose: Beneficial mechanisms of bone marrow cell (BMC) therapy for acute ST-segment elevation myocardial infarct (STEMI) are largely unknown in humans. Therefore, we evaluated the feasibility of serial positron emission tomography (PET) and MRI studies to provide insight into the effects of BMCs on the healing process of ischemic myocardial damage. Methods: Nineteen patients with successful primary reteplase thrombolysis (mean 2.4 h after symptoms) for STEMI were randomized for BMC therapy (2.9 × 106 CD34+ cells) or placebo after bone marrow aspiration in a double-blind, multi-center study. Three days post-MI, coronary angioplasty, and paclitaxel eluting stent implantation preceded either BMC or placebo therapy. Cardiac PET and MRI studies were performed 7–12 days after therapies and repeated after 6 months, and images were analyzed at a central core laboratory. Results: In BMC-treated patients, there was a decrease in [11C]-HED defect size (−4.9 ± 4.0 vs. −1.6 ± 2.2%, p = 0.08) and an increase in [18F]-FDG uptake in the infarct area at risk (0.06 ± 0.09 vs. −0.05 ± 0.16, p = 0.07) compared to controls, as well as less left ventricular dilatation (−4.4 ± 13.3 vs. 8.0 ± 16.7 mL/m2, p = 0.12) at 6 months follow-up. However, BMC treatment was inferior to placebo in terms of changes in rest perfusion in the area at risk (−0.09 ± 0.17 vs. 0.10 ± 0.17, p = 0.03) and infarct size (0.4 ± 4.2 vs. −5.1 ± 5.9 g, p = 0.047), and no effect was observed on ejection fraction (p = 0.37). Conclusion: After the acute phase of STEMI, BMC therapy showed only minor trends of long-term benefit in patients with rapid successful thrombolysis. There was a trend of more decrease in innervation defect size and enhanced glucose metabolism in the infarct-related myocardium and also a trend of less ventricular dilatation in the BMC-treated group compared to placebo. However, no consistently better outcome was observed in the BMC-treated group compared to placebo.
Collapse
Affiliation(s)
- Maija T Mäki
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital Turku, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Vähäsilta T, Malmberg M, Saraste A, Koskenvuo JW, Pärkkä JP, Valtonen M, Leino K, Nuutila K, Saukko P, Kuttila K, Savunen T. Cardiomyocyte apoptosis after antegrade and retrograde cardioplegia during aortic valve surgery. Ann Thorac Surg 2011; 92:1351-7. [PMID: 21958782 DOI: 10.1016/j.athoracsur.2011.05.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 05/02/2011] [Accepted: 05/17/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Retrograde delivery is associated with inadequate perfusion of cardioplegia to all regions of the heart, but the effects on cardiomyocyte death and functional outcome remain unknown. We compared antegrade and retrograde cardioplegia in a randomized clinical trial to see whether it has effect on cardiomyocyte apoptosis and left ventricular function. METHODS Patients underwent elective aortic valve replacement surgery due to aortic valve stenosis. They were randomly allocated to receive antegrade (n = 10) or retrograde (n = 10) cardioplegia. Apoptotic cardiomyocytes (terminal transferase-mediated dUTP nick end labeling, caspase activation) and RNA levels of apoptosis-regulating proteins were studied in transmyocardial biopsies obtained before and after the operation. Magnetic resonance imaging and transesophageal echocardiography were performed, and cardiac enzymes were measured. RESULTS Clinical outcome and cardiac enzyme release were comparable between the groups. Cardiomyocyte apoptosis was significantly increased (terminal transferase-mediated dUTP nick end labeling) in the left ventricle after the operation in the retrograde, but not in the antegrade group (respectively, 0.00% [0.039%] versus 0.092% [0.205%], p = 0.01; and 0.00% [0.00%] versus 0.023% [0.054%], p = 0.14). Expression of apoptosis-regulating proteins BAX, BAD, and BCL-2 were comparable between groups. By transesophageal echocardiography, the systolic mitral annulus movement was decreased immediately after the operation in the retrograde group. By magnetic resonance imaging, the left ventricle mass index was reduced preoperatively to 9 months postoperatively in the antegrade group. CONCLUSIONS In contrast to antegrade cardioplegia, retrograde cardioplegia is associated with increased cardiomyocyte apoptosis, impaired immediate postoperative systolic function, and lack of long-term favorable left ventricle remodeling after aortic valve replacement, suggesting inadequate myocardial protection.
Collapse
Affiliation(s)
- Tommi Vähäsilta
- Department of Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Viallon M, Jacquier A, Rotaru C, Delattre BMA, Mewton N, Vincent F, Croisille P. Head-to-head comparison of eight late gadolinium-enhanced cardiac MR (LGE CMR) sequences at 1.5 tesla: from bench to bedside. J Magn Reson Imaging 2011; 34:1374-87. [PMID: 21972032 DOI: 10.1002/jmri.22783] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/28/2011] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare-theoretically and experimentally-clinically available two-dimensional/three-dimensional (2D/3D), breathhold and non-breathhold, inversion-recovery (IR) gradient-echo (GRE) sequences used to differentiate between nonviable injured and normal myocardium with late gadolinium-enhanced techniques (IR-GRE2D sequence is used as a reference), and to evaluate their respective clinical benefit. MATERIALS AND METHODS Six breathhold (2D-IR-GRE, 3D-IR-GRE, balanced steady-state free precession 2D-IR-bSSFP and 3D-IR-bSSFP, phase-sensitive 2D-PSIR-GRE, and 2D-PSIR-bSSFP) and two non-breathhold late gadolinium-enhanced techniques (single-shot 2D-ssbSSFP and 2D-PSIR-ssbSSFP) were consecutively performed in 32 coronary artery disease patients with chronic myocardial infarction. Qualitative assessment and manual planimetry were performed by two independent observers. Quantitative assessment was based on percentage signal intensity elevation between injured and normal myocardium and contrast-to-noise ratio. Theoretical simulations were compared with experimental measurements performed on phantoms with various concentrations of gadolinium. RESULTS The 3D-IR-GRE image quality appeared better than the other 2D and 3D sequences, showing better delineation of complex nontransmural lesions, with significantly higher percentage signal intensity and contrast-to-noise ratio. PSIR techniques appeared more limited in differentiating sub-endocardial lesions and intracavity blood pool, but in all other cases were comparable to the other techniques. Single-shot PSIR-ssbSSFP appeared to be a valuable alternative technique when breathhold cannot be achieved. CONCLUSION We recommend 3D-IR-GRE as the method of choice for late gadolinium-enhanced cardiac magnetic resonance imaging in clinical practice.
Collapse
|
25
|
Tacke CE, Kuipers IM, Groenink M, Spijkerboer AM, Kuijpers TW. Cardiac magnetic resonance imaging for noninvasive assessment of cardiovascular disease during the follow-up of patients with Kawasaki disease. Circ Cardiovasc Imaging 2011; 4:712-20. [PMID: 21921132 DOI: 10.1161/circimaging.111.965996] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is the most common cause of acquired coronary artery disease in childhood. In KD, the American Heart Association recommends echocardiography for routine coronary artery surveillance and nuclear perfusion scans and conventional coronary angiography in select patients. Cardiac MRI (CMRI) may be a noninvasive and radiation-free alternative. We applied CMRI during the follow-up of patients with KD and assessed the performance of CMRI compared with echocardiography. METHODS AND RESULTS Patients with KD aged ≥8 years were consecutively included. Sixty-three patients (median age, 14.6 years; 74.6% male sex) underwent a comprehensive CMRI protocol including adenosine stress testing to evaluate coronary artery anatomy, ischemia, and myocardial infarction. All patients underwent CMRI without significant complications. On CMRI, 23 coronary artery aneurysms (CAAs) were identified in 15 patients. CMRI detected thrombus formation in 6 CAAs in 4 patients, wall motion disturbances and ischemia in 4 patients, and delayed hyperenhancement indicating myocardial infarction in 5 patients. Wall motion and perfusion abnormalities were noted in territories supplied by affected coronary arteries. CMRI results were compared with recent echocardiography findings. In 6 of the 15 patients with CAAs on CMRI, CAAs were not detected by echocardiography. CONCLUSIONS A comprehensive CMRI protocol including adenosine stress testing is feasible to identify coronary artery pathology, ischemia, and myocardial infarction in former patients with KD and compares favorably with echocardiography. CMRI may be used as a noninvasive and radiation-free imaging method for coronary artery surveillance during the long-term follow-up of patients with KD.
Collapse
Affiliation(s)
- Carline E Tacke
- Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|