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Sun Z, Wang Y, Hu Y, Wu F, Zhang N, Liu Z, Lu J, Li K. Left ventricular dyssynchrony measured by cardiovascular magnetic resonance-feature tracking in anterior ST-elevation myocardial infarction: relationship with microvascular occlusion myocardial damage. Front Cardiovasc Med 2023; 10:1255063. [PMID: 37900576 PMCID: PMC10602888 DOI: 10.3389/fcvm.2023.1255063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Cardiovascular magnetic resonance-feature tracking (CMR-FT) enables quantification of myocardial deformation and may be used as an objective measure of myocardial involvement in ST-elevation myocardial infarction (STEMI). We sought to investigate the associations between myocardial dyssynchrony parameters and myocardium damage for STEMI. Methods We analyzed 65 patients (45-80 years old) with anterior STEMI after primary percutaneous coronary intervention during 3-7 days [observational (STEMI) group] and 60 healthy volunteers [normal control (NC) group]. Myocardial dyssynchrony parameters were derived, including global and regional strain, radial rebound stretch and displacement, systolic septal time delay, and circumferential stretch. Results CMR characteristics, including morphologic parameters such as left ventricular ejection fraction (LVEF) (45.3% ± 8.2%) and myocardium damage in late gadolinium enhancement (LGE) (19.4% ± 4.7% LV), were assessed in the observation group. The global radial strain (GRS) and global longitudinal strain (GLS) substantially decreased in anterior STEMI compared with the NC group (GRS: 19.4% ± 5.1% vs. 24.8% ± 4.0%, P < 0.05; GLS: -10.1% ± 1.7% vs. -13.7% ± 1.0%, P < 0.05). Among 362 infarcted segments, radial and circumferential peak strains of the infarcted zone were the lowest (14.4% ± 3.2% and -10.7% ± 1.6%, respectively). The radial peak displacement of the infarct zone significantly decreased (2.6 ± 0.4 mm) (P < 0.001) and manifested in the circumferential displacement (3.5° ± 0.7°) in the STEMI group (P < 0.01). As microvascular occlusion (MVO) was additionally present, some strain parameters were significantly impaired in LGE+/MVO+ segments (radial strain [RS]: 12.2% ± 2.1%, circumferential strain [CS]: -9.6% ± 0.7%, longitudinal strain [LS]: -6.8% ± 1.0%) compared to LGE+/MVO- (RS: 14.6% ± 3.2%, CS: -10.8% ± 1.8%, LS: -9.2% ± 1.3%) (P < 0.05). When the extent of transmural myocardial infarction is greater than 75%, the parameter of the systolic septal delay (mean, 148 ms) was significantly reduced compared to fewer degrees of infarction (P < 0.01). Conclusion In anterior STEMI, the infarcted septum swings in a bimodal mode, and myocardial injury reduces the radial strain contractility. A more than 75% transmural degree was the septal strain-contraction reserve cut-off point.
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Affiliation(s)
- Zheng Sun
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yu Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Yingying Hu
- Department of Radiology, The Peking University International Hospital, Beijing, China
| | - Fang Wu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Nan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Zhi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Kuncheng Li
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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Ge Y, Steel K, Antiochos P, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Shanbhag SM, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Nawaz H, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Stress CMR in patients with obesity: insights from the Stress CMR Perfusion Imaging in the United States (SPINS) registry. Eur Heart J Cardiovasc Imaging 2021; 22:518-527. [PMID: 33166994 DOI: 10.1093/ehjci/jeaa281] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Non-invasive assessment and risk stratification of coronary artery disease in patients with large body habitus is challenging. We aim to examine whether body mass index (BMI) modifies the prognostic value and diagnostic utility of stress cardiac magnetic resonance imaging (CMR) in a multicentre registry. METHODS AND RESULTS The SPINS Registry enrolled consecutive intermediate-risk patients who presented with a clinical indication for stress CMR in the USA between 2008 and 2013. Baseline demographic data including BMI, CMR indices, and ratings of study quality were collected. Primary outcome was defined by a composite of cardiovascular death and non-fatal myocardial infarction. Of the 2345 patients with available BMI included in the SPINS cohort, 1177 (50%) met criteria for obesity (BMI ≥ 30) with 531 (23%) at or above Class 2 obesity (BMI ≥ 35). In all BMI categories, >95% of studies were of diagnostic quality for cine, perfusion, and late gadolinium enhancement (LGE) sequences. At a median follow-up of 5.4 years, those without ischaemia and LGE experienced a low annual rate of hard events (<1%), across all BMI strata. In patients with obesity, both ischaemia [hazard ratio (HR): 2.14; 95% confidence interval (CI): 1.30-3.50; P = 0.003] and LGE (HR: 3.09; 95% CI: 1.83-5.22; P < 0.001) maintained strong adjusted association with the primary outcome in a multivariable Cox regression model. Downstream referral rates to coronary angiography, revascularization, and cost of care spent on ischaemia testing did not significantly differ within the BMI categories. CONCLUSION In this large multicentre registry, elevated BMI did not negatively impact the diagnostic quality and the effectiveness of risk stratification of patients referred for stress CMR.
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Affiliation(s)
- Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, TX 78234, USA
| | - Panagiotis Antiochos
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | - Shuaib Abdullah
- Veteran Administration North Texas Healthcare System, UT Southwestern Medical Center, Dallas, TX 75216, USA
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, PA 16148, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health (NHLBI/NIH), Bethesda, MD 20814, USA
| | - W Patricia Bandettini
- National Heart, Lung and Blood Institute, National Institutes of Health (NHLBI/NIH), Bethesda, MD 20814, USA
| | - Sujata M Shanbhag
- National Heart, Lung and Blood Institute, National Institutes of Health (NHLBI/NIH), Bethesda, MD 20814, USA
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY 40536, USA
| | - Jorge A Gonzalez
- Division of Cardiology & Radiology, Scripps Clinic, La Jolla, CA 92037, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Haseeb Nawaz
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin 13125, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital (CHUV), University of Lausanne (UNIL), Lausanne 1011, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Doeblin P, Kelle S. Cardiac magnetic resonance imaging: the echo of the obese? Eur Heart J Cardiovasc Imaging 2021; 22:528-529. [PMID: 33230522 DOI: 10.1093/ehjci/jeaa327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.,Division of Cardiology, Medical Department, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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Stoiber L, Schnackenburg B, Gebker R, Hireche-Chikaoui H, Pieske B, Kelle S. CMR stress testing in a patient with morbid obesity (BMI 58 kg/m 2) and suspected coronary artery disease. BMC Cardiovasc Disord 2018; 18:47. [PMID: 29506495 PMCID: PMC5838924 DOI: 10.1186/s12872-018-0779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Severe obesity is asscociated with an increased risk of coronary artery disease (CAD) but non-invasive cardiac imaging modalities have important technical limits. Case presentation We report a case of a 58-year old patient with suspected CAD and severely elevated BMI of 58 kg/m2. Conclusions Stress-CMR was able to non-invasively stratify risk with good imaging quality despite the body dimensions of the patient.
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Affiliation(s)
- Lukas Stoiber
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
| | | | - Rolf Gebker
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Bigvava T, Zamani SM, Pieske-Kraigher E, Gebker R, Pieske B, Kelle S. Prognostic value of non-invasive stress testing for coronary artery disease in obese patients. Expert Rev Cardiovasc Ther 2015; 13:1325-32. [PMID: 26536394 DOI: 10.1586/14779072.2015.1102054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Detecting coronary artery disease (CAD) in obese patients remains a challenge but can have substantial prognostic implications for this patient group. Until now, sufficient data was not available on which to base the selection of the imaging modality in obese patients. The decision on which imaging modality to use should therefore follow the general guidelines. In this article, the authors discuss the prognostic value of the different non-invasive stress testing methods for CAD in obese patients.
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Affiliation(s)
- Tamar Bigvava
- a Tbilisi Heart and Vascular Clinic , Tbilisi , Georgia
| | - Seyedeh Mahsa Zamani
- b Department of Cardiology , Charité, University Medicine Berlin , Berlin , Germany
| | | | - Rolf Gebker
- c Department of Internal Medicine/Cardiology , Deutsches Herzzentrum Berlin , Berlin , Germany
| | - Burkert Pieske
- b Department of Cardiology , Charité, University Medicine Berlin , Berlin , Germany.,c Department of Internal Medicine/Cardiology , Deutsches Herzzentrum Berlin , Berlin , Germany
| | - Sebastian Kelle
- c Department of Internal Medicine/Cardiology , Deutsches Herzzentrum Berlin , Berlin , Germany
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