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Gissler MC, Antiochos P, Ge Y, Heydari B, Gräni C, Kwong RY. Cardiac Magnetic Resonance Evaluation of LV Remodeling Post-Myocardial Infarction: Prognosis, Monitoring and Trial Endpoints. JACC Cardiovasc Imaging 2024:S1936-878X(24)00127-X. [PMID: 38819335 DOI: 10.1016/j.jcmg.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 06/01/2024]
Abstract
Adverse left ventricular remodeling (ALVR) and subsequent heart failure after myocardial infarction (MI) remain a major cause of patient morbidity and mortality worldwide. Overt inflammation has been identified as the common pathway underlying myocardial fibrosis and development of ALVR post-MI. With its ability to simultaneously provide information about cardiac structure, function, perfusion, and tissue characteristics, cardiac magnetic resonance (CMR) is well poised to inform prognosis and guide early surveillance and therapeutics in high-risk cohorts. Further, established and evolving CMR-derived biomarkers may serve as clinical endpoints in prospective trials evaluating the efficacy of novel anti-inflammatory and antifibrotic therapies. This review provides an overview of post-MI ALVR and illustrates how CMR may help clinical adoption of novel therapies via mechanistic or prognostic imaging markers.
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Affiliation(s)
- Mark Colin Gissler
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Panagiotis Antiochos
- Cardiology and Cardiac MR Centre, University Hospital Lausanne, Lausanne, Switzerland
| | - Yin Ge
- Division of Cardiology, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Bobak Heydari
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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2
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Tiller C, Reindl M, Holzknecht M, Lechner I, Troger F, Oberhollenzer F, von der Emde S, Kremser T, Mayr A, Bauer A, Metzler B, Reinstadler SJ. Relation of plasma neuropeptide-Y with myocardial function and infarct severity in acute ST-elevation myocardial infarction. Eur J Intern Med 2024:S0953-6205(24)00137-7. [PMID: 38555253 DOI: 10.1016/j.ejim.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Acute myocardial infarction is associated with the release of the co-transmitter neuropeptide-Y (NPY). NPY acts as a potent vasoconstrictor and is associated with microvascular dysfunction after ST-elevation myocardial infarction (STEMI). This study comprehensively evaluated the association of plasma NPY with myocardial function and infarct severity, visualized by cardiac magnetic resonance (CMR) imaging, in STEMI patients revascularized by primary percutaneous coronary intervention (PCI). METHODS In this observational study, we included 260 STEMI patients enrolled in the prospective MARINA-STEMI (NCT04113356) study. Plasma NPY concentrations were measured by an immunoassay 24h after PCI from peripheral venous blood samples. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), infarct size (IS) and microvascular obstruction (MVO) were determined using CMR imaging. RESULTS Median plasma concentrations of NPY were 70 [interquartile range (IQR):35-115] pg/ml. NPY levels above median were significantly associated with lower LVEF (48%vs.52%, p=0.004), decreased GLS (-8.8%vs.-12.6%, p<0.001) and larger IS (17%vs.13%, p=0.041) in the acute phase after infarction as well as after 4 months (LVEF:50%vs.52%, p=0.030, GLS:-10.5vs.-12.9,p<0.001,IS:13%vs.10%,p=0.011). In addition, NPY levels were significantly related to presence of MVO (58%vs.52%, p=0.041). Moreover, in multivariable linear regression analysis, NPY remained significantly associated with all investigated CMR parameters (LVEF:p<0.001,GLS:p<0.001,IS:p=0.003,MVO:p=0.042) independent of other established clinical variables including high-sensitivity cardiac troponin T, pre-interventional TIMI flow 0 and left anterior descending artery as culprit lesion location. CONCLUSION High plasma levels of NPY, measured 24h after STEMI, were independently associated with lower LVEF, decreased GLS, larger IS as well as presence of MVO, indicating plasma NPY as a novel clinical risk marker post STEMI.
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Affiliation(s)
- Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Fritz Oberhollenzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian von der Emde
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Thomas Kremser
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Salatzki J, Giannitsis E, Hegenbarth A, Mueller-Hennessen M, André F, Frey N, Biener M. Absence of visible infarction on cardiac magnetic resonance imaging despite the established diagnosis of myocardial infarction by 4th Universal Definition of Myocardial Infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:24-35. [PMID: 37875124 DOI: 10.1093/ehjacc/zuad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/12/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
AIMS Myocardial scarring due to acute myocardial infarction (AMI) can be visualized by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. However, a recent study revealed a group of Type 1 AMI patients with undetectable myocardial injury on LGE. This study aims to describe these cases in detail and explore possible explanations for this new phenomenon. METHODS AND RESULTS A total of 137 patients diagnosed with either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (non-STEMI) diagnosed according to the 4th Universal Definition of Myocardial Infarction underwent LGE-CMR after invasive coronary angiography. Fourteen of them (10.2%) showed no LGE and were included in the final study population. Most patients presented with acute chest pain, 3 patients were diagnosed as STEMI, and 11 as non-STEMI. Peak high-sensitive cardiac troponin T ranged from 45 to 1173 ng/L. A culprit lesion was identified in 12 patients. Severe coronary stenoses were found in five patients, while seven patients had subtotal to total coronary artery occlusion. Percutaneous coronary intervention was performed in 10 patients, while 2 patients required coronary artery bypass grafting and no intervention was required in 2 patients. Cardiac magnetic resonance was performed 30 (4-140) days after the initial presentation. Most patients showed preserved left ventricular ejection fraction on CMR. No alternative reasons for the rise/fall of high-sensitive cardiac troponin T were found. CONCLUSION The absence of LGE on CMR in patients with Type 1 AMI is a new finding. While insufficient spatial resolution of LGE imaging, delayed CMR performance, spontaneous reperfusion, and coronary collaterals may provide some explanations, further investigations are required to fully understand this phenomenon.
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Affiliation(s)
- Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Anastasia Hegenbarth
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Matthias Mueller-Hennessen
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Moritz Biener
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Bergamaschi L, Foà A, Paolisso P, Renzulli M, Angeli F, Fabrizio M, Bartoli L, Armillotta M, Sansonetti A, Amicone S, Stefanizzi A, Rinaldi A, Niro F, Lovato L, Gherbesi E, Carugo S, Pasquale F, Casella G, Galiè N, Rucci P, Bucciarelli-Ducci C, Pizzi C. Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries. JACC Cardiovasc Imaging 2024; 17:149-161. [PMID: 37480903 DOI: 10.1016/j.jcmg.2023.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/10/2023] [Accepted: 05/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) plays a pivotal diagnostic role in myocardial infarction with nonobstructive coronary arteries (MINOCA). To date, a prognostic stratification of these patients is still lacking. OBJECTIVES This study aims to assess the prognostic role of CMR in MINOCA. METHODS The authors assessed 437 MINOCA from January 2017 to October 2021. They excluded acute myocarditis, takotsubo syndromes, cardiomyopathies, and other nonischemic etiologies. Patients were classified into 3 subgroups according to the CMR phenotype: 1) presence of late gadolinium enhancement (LGE) and abnormal mapping (M) values (LGE+/M+); 2) regional ischemic injury with abnormal mapping and no LGE (LGE-/M+); and 3) nonpathological CMRs (LGE-/M-). The primary outcome was the presence of major adverse cardiovascular events (MACE). The mean follow-up was 33.7 ± 12.0 months and CMR was performed on average at 4.8 ± 1.5 days from the acute presentation. RESULTS The final cohort included 198 MINOCA; 116 (58.6%) comprised the LGE+/M+ group. During follow-up, MACE occurred significantly more frequently in MINOCA LGE+/M+ than in the LGE+/M- and normal-CMR (LGE-/M-) subgroups (20.7% vs 6.7% and 2.7%; P = 0.006). The extension of myocardial damage at CMR was significantly greater in patients who developed MACE. In multivariable Cox regression, %LGE was an independent predictor of MACE (HR: 1.123 [95% CI: 1.064-1.185]; P < 0.001) together with T2 mapping values (HR: 1.190 [95% CI: 1.145-1.237]; P = 0.001). CONCLUSIONS In MINOCA with early CMR execution, the %LGE and abnormal T2 mapping values were identified as independent predictors of adverse cardiac events at ∼3.0 years of follow-up. These parameters can be considered as high-risk markers in MINOCA.
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Affiliation(s)
- Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michele Fabrizio
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lorenzo Bartoli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabio Niro
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Pediatric and Adult CardioThoracic and Vascular, Onchoematologic and Emergency Radiology Unit
| | - Luigi Lovato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Pediatric and Adult CardioThoracic and Vascular, Onchoematologic and Emergency Radiology Unit
| | - Elisa Gherbesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | - Ferdinando Pasquale
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Milosevic M, Jin Q, Singh A, Amal S. Applications of AI in multi-modal imaging for cardiovascular disease. FRONTIERS IN RADIOLOGY 2024; 3:1294068. [PMID: 38283302 PMCID: PMC10811170 DOI: 10.3389/fradi.2023.1294068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024]
Abstract
Data for healthcare is diverse and includes many different modalities. Traditional approaches to Artificial Intelligence for cardiovascular disease were typically limited to single modalities. With the proliferation of diverse datasets and new methods in AI, we are now able to integrate different modalities, such as magnetic resonance scans, computerized tomography scans, echocardiography, x-rays, and electronic health records. In this paper, we review research from the last 5 years in applications of AI to multi-modal imaging. There have been many promising results in registration, segmentation, and fusion of different magnetic resonance imaging modalities with each other and computer tomography scans, but there are still many challenges that need to be addressed. Only a few papers have addressed modalities such as x-ray, echocardiography, or non-imaging modalities. As for prediction or classification tasks, there have only been a couple of papers that use multiple modalities in the cardiovascular domain. Furthermore, no models have been implemented or tested in real world cardiovascular clinical settings.
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Affiliation(s)
- Marko Milosevic
- Roux Institute, Northeastern University, Portland, ME, United States
| | - Qingchu Jin
- Roux Institute, Northeastern University, Portland, ME, United States
| | - Akarsh Singh
- College of Engineering, Northeastern University, Boston, MA, United States
| | - Saeed Amal
- Roux Institute, Northeastern University, Portland, ME, United States
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Myhr KA, Zinglersen AH, Pecini R, Jacobsen S. Myocardial fibrosis associates with lupus anticoagulant in patients with systemic lupus erythematosus. Int J Cardiovasc Imaging 2024; 40:127-137. [PMID: 37814154 PMCID: PMC10774215 DOI: 10.1007/s10554-023-02970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that carries increased risk of cardiovascular disease; however, the underlying pathophysiological mechanisms remain poorly understood. We aimed to investigate the prevalence and degree of myocardial fibrosis in SLE patients and associated disease characteristics. Forty-nine SLE patients (89% female, mean age 52 ± 13 years, median disease duration 19 (11-25) years) and 79 sex-and age-matched healthy controls were included. CMR with T1 mapping was performed on SLE patients and healthy controls. Fifty-one SLE patients received gadolinium contrast for the evaluation of late gadolinium enhancement (LGE) and extra cellular volume (ECV). Multiple linear regression analyses were performed to investigate the association between markers of myocardial fibrosis on CMR (LGE, T1, ECV) and SLE-related variables [clinical disease activity, lupus nephritis, chronic kidney disease, anti-cardiolipin and/or anti-beta-2 glycoprotein I antibodies, and lupus anticoagulant (LAC)] with adjustment for traditional risk factors. T1 values were elevated in SLE patients compared to healthy controls (1031 ± 36 ms vs. 1019 ± 25 ms, p = 0.01). LGE was present in 20% of SLE patients who received gadolinium contrast. On multivariable analysis, LAC was associated with LGE in SLE patients (β = 3.87, p = 0.02). Neither T1 nor ECV associated with SLE disease characteristics; however, there was a trend towards an association between LAC and T1 (β = 16.9, p = 0.08). SLE patients displayed signs of myocardial fibrosis on CMR that were associated with the presence of LAC. These findings support the pathophysiological understanding of LAC as a mediator of microvascular and subsequent myocardial dysfunction.
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Affiliation(s)
- Katrine A Myhr
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Amanda H Zinglersen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
| | - Redi Pecini
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Søren Jacobsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
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7
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Gertz RJ, Wagner A, Sokolowski M, Lennartz S, Gietzen C, Grunz JP, Goertz L, Kaya K, ten Freyhaus H, Persigehl T, Bunck AC, Doerner J, Naehle CP, Maintz D, Weiss K, Katemann C, Pennig L. Compressed SENSE accelerated 3D single-breath-hold late gadolinium enhancement cardiovascular magnetic resonance with isotropic resolution: clinical evaluation. Front Cardiovasc Med 2023; 10:1305649. [PMID: 38099228 PMCID: PMC10720442 DOI: 10.3389/fcvm.2023.1305649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Aim The purpose of this study was to investigate the clinical application of Compressed SENSE accelerated single-breath-hold LGE with 3D isotropic resolution compared to conventional LGE imaging acquired in multiple breath-holds. Material & Methods This was a retrospective, single-center study including 105 examinations of 101 patients (48.2 ± 16.8 years, 47 females). All patients underwent conventional breath-hold and 3D single-breath-hold (0.96 × 0.96 × 1.1 mm3 reconstructed voxel size, Compressed SENSE factor 6.5) LGE sequences at 1.5 T in clinical routine for the evaluation of ischemic or non-ischemic cardiomyopathies. Two radiologists independently evaluated the left ventricle (LV) for the presence of hyperenhancing lesions in each sequence, including localization and transmural extent, while assessing their scar edge sharpness (SES). Confidence of LGE assessment, image quality (IQ), and artifacts were also rated. The impact of LV ejection fraction (LVEF), heart rate, body mass index (BMI), and gender as possible confounders on IQ, artifacts, and confidence of LGE assessment was evaluated employing ordinal logistic regression analysis. Results Using 3D single-breath-hold LGE readers detected more hyperenhancing lesions compared to conventional breath-hold LGE (n = 246 vs. n = 216 of 1,785 analyzed segments, 13.8% vs. 12.1%; p < 0.0001), pronounced at subendocardial, midmyocardial, and subepicardial localizations and for 1%-50% of transmural extent. SES was rated superior in 3D single-breath-hold LGE (4.1 ± 0.8 vs. 3.3 ± 0.8; p < 0.001). 3D single-breath-hold LGE yielded more artifacts (3.8 ± 1.0 vs. 4.0 ± 3.8; p = 0.002) whereas IQ (4.1 ± 1.0 vs. 4.2 ± 0.9; p = 0.122) and confidence of LGE assessment (4.3 ± 0.9 vs. 4.3 ± 0.8; p = 0.374) were comparable between both techniques. Female gender negatively influenced artifacts in 3D single-breath-hold LGE (p = 0.0028) while increased heart rate led to decreased IQ in conventional breath-hold LGE (p = 0.0029). Conclusions In clinical routine, Compressed SENSE accelerated 3D single-breath-hold LGE yields image quality and confidence of LGE assessment comparable to conventional breath-hold LGE while providing improved delineation of smaller LGE lesions with superior scar edge sharpness. Given the fast acquisition of 3D single-breath-hold LGE, the technique holds potential to drastically reduce the examination time of CMR.
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Affiliation(s)
- Roman Johannes Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, Krankenhaus der Augustinerinnen, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kenan Kaya
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henrik ten Freyhaus
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Kontraste Radiologie-Praxis Köln West, Cologne, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Pec J, Buchner S, Wester M, Debl K, Hamer OW, Poschenrieder F, Maier LS, Arzt M, Stadler S. Association of Coronary Collaterals and Myocardial Salvage Measured by Serial Cardiac Magnetic Resonance Imaging after Acute Myocardial Infarction. J Cardiovasc Dev Dis 2023; 10:473. [PMID: 38132641 PMCID: PMC10743778 DOI: 10.3390/jcdd10120473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Coronary collateral flow in angiography has been linked with lower mortality rates in patients with coronary artery disease. However, the relevance of the underlying mechanism is sparse. Therefore, we tested the hypothesis that in patients with acute myocardial infarction (AMI), relevant coronary collateral flow is associated with more salvaged myocardium and lower risk of developing heart failure. METHODS AND RESULTS Patients with first AMI who received a percutaneous coronary intervention within 24 h after symptom onset were classified visually by assigning a Cohen-Rentrop Score (CRS) ranging between 0 (no collaterals) and 3 (complete retrograde filling of the occluded vessel). All 36 patients included in the analysis underwent cardiac magnetic resonance examination within 3 to 5 days after myocardial infarction and after 12 weeks. Patients with relevant collateral flow (CRS 2-3) to the infarct-related artery had significantly smaller final infarct size compared to those without (7 ± 4% vs. 20 ± 12%, p < 0.001). In addition, both groups showed improvement in left ventricular ejection fraction early after AMI, whereas the recovery was greater in CRS 2-3 (+8 ± 5% vs. +3 ± 5%, p = 0.015). CONCLUSION In patients with first AMI, relevant collateral flow to the infarct-related artery was associated with more salvaged myocardium at 12 weeks, translating into greater improvement of systolic left ventricular function. The protective effect of coronary collaterals and the variance of infarct location should be further investigated in larger studies.
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Affiliation(s)
- Jan Pec
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine, Cham Hospital, 93413 Cham, Germany
| | - Michael Wester
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Okka W. Hamer
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | | | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
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9
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Coletti C, Fotaki A, Tourais J, Zhao Y, van de Steeg-Henzen C, Akçakaya M, Tao Q, Prieto C, Weingärtner S. Robust cardiac T 1 ρ $$ {\mathrm{T}}_{1_{\boldsymbol{\rho}}} $$ mapping at 3T using adiabatic spin-lock preparations. Magn Reson Med 2023; 90:1363-1379. [PMID: 37246420 PMCID: PMC10984724 DOI: 10.1002/mrm.29713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study is to develop and optimize an adiabaticT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ (T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ ) mapping method for robust quantification of spin-lock (SL) relaxation in the myocardium at 3T. METHODS Adiabatic SL (aSL) preparations were optimized for resilience againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities using Bloch simulations. OptimizedB 0 $$ {\mathrm{B}}_0 $$ -aSL, Bal-aSL andB 1 $$ {\mathrm{B}}_1 $$ -aSL modules, each compensating for different inhomogeneities, were first validated in phantom and human calf. MyocardialT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ mapping was performed using a single breath-hold cardiac-triggered bSSFP-based sequence. Then, optimizedT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ preparations were compared to each other and to conventional SL-preparedT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ maps (RefSL) in phantoms to assess repeatability, and in 13 healthy subjects to investigate image quality, precision, reproducibility and intersubject variability. Finally, aSL and RefSL sequences were tested on six patients with known or suspected cardiovascular disease and compared with LGE,T 1 $$ {\mathrm{T}}_1 $$ , and ECV mapping. RESULTS The highestT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ preparation efficiency was obtained in simulations for modules comprising 2 HS pulses of 30 ms each. In vivoT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ maps yielded significantly higher quality than RefSL maps. Average myocardialT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ values were 183.28± $$ \pm $$ 25.53 ms, compared with 38.21± $$ \pm $$ 14.37 ms RefSL-preparedT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ .T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ maps showed a significant improvement in precision (avg. 14.47± $$ \pm $$ 3.71% aSL, 37.61± $$ \pm $$ 19.42% RefSL, p < 0.01) and reproducibility (avg. 4.64± $$ \pm $$ 2.18% aSL, 47.39± $$ \pm $$ 12.06% RefSL, p < 0.0001), with decreased inter-subject variability (avg. 8.76± $$ \pm $$ 3.65% aSL, 51.90± $$ \pm $$ 15.27% RefSL, p < 0.0001). Among aSL preparations,B 0 $$ {\mathrm{B}}_0 $$ -aSL achieved the better inter-subject variability. In patients,B 1 $$ {\mathrm{B}}_1 $$ -aSL preparations showed the best artifact resilience among the adiabatic preparations.T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ times show focal alteration colocalized with areas of hyper-enhancement in the LGE images. CONCLUSION Adiabatic preparations enable robust in vivo quantification of myocardial SL relaxation times at 3T.
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Affiliation(s)
- Chiara Coletti
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Anastasia Fotaki
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
| | - Joao Tourais
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Yidong Zhao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | | | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minnesota, USA
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Claudia Prieto
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Milleniun Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Sebastian Weingärtner
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
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10
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Li L, Ding W, Huang L, Zhuang X, Grau V. Multi-modality cardiac image computing: A survey. Med Image Anal 2023; 88:102869. [PMID: 37384950 DOI: 10.1016/j.media.2023.102869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/01/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
Multi-modality cardiac imaging plays a key role in the management of patients with cardiovascular diseases. It allows a combination of complementary anatomical, morphological and functional information, increases diagnosis accuracy, and improves the efficacy of cardiovascular interventions and clinical outcomes. Fully-automated processing and quantitative analysis of multi-modality cardiac images could have a direct impact on clinical research and evidence-based patient management. However, these require overcoming significant challenges including inter-modality misalignment and finding optimal methods to integrate information from different modalities. This paper aims to provide a comprehensive review of multi-modality imaging in cardiology, the computing methods, the validation strategies, the related clinical workflows and future perspectives. For the computing methodologies, we have a favored focus on the three tasks, i.e., registration, fusion and segmentation, which generally involve multi-modality imaging data, either combining information from different modalities or transferring information across modalities. The review highlights that multi-modality cardiac imaging data has the potential of wide applicability in the clinic, such as trans-aortic valve implantation guidance, myocardial viability assessment, and catheter ablation therapy and its patient selection. Nevertheless, many challenges remain unsolved, such as missing modality, modality selection, combination of imaging and non-imaging data, and uniform analysis and representation of different modalities. There is also work to do in defining how the well-developed techniques fit in clinical workflows and how much additional and relevant information they introduce. These problems are likely to continue to be an active field of research and the questions to be answered in the future.
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Affiliation(s)
- Lei Li
- Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Wangbin Ding
- College of Physics and Information Engineering, Fuzhou University, Fuzhou, China
| | - Liqin Huang
- College of Physics and Information Engineering, Fuzhou University, Fuzhou, China
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China
| | - Vicente Grau
- Department of Engineering Science, University of Oxford, Oxford, UK
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11
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Wang W, Yu X, Fang B, Zhao Y, Chen Y, Wei W, Chen J. Cross-Modality LGE-CMR Segmentation Using Image-to-Image Translation Based Data Augmentation. IEEE/ACM TRANSACTIONS ON COMPUTATIONAL BIOLOGY AND BIOINFORMATICS 2023; 20:2367-2375. [PMID: 34982688 DOI: 10.1109/tcbb.2022.3140306] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Accurate segmentation of ventricle and myocardium from the late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is an important tool for myocardial infarction (MI) analysis. However, the complex enhancement pattern of LGE-CMR and the lack of labeled samples make its automatic segmentation difficult to be implemented. In this paper, we propose an unsupervised LGE-CMR segmentation algorithm by using multiple style transfer networks for data augmentation. It adopts two different style transfer networks to perform style transfer of the easily available annotated balanced-Steady State Free Precession (bSSFP)-CMR images. Then, multiple sets of synthetic LGE-CMR images are generated by the style transfer networks and used as the training data for the improved U-Net. The entire implementation of the algorithm does not require the labeled LGE-CMR. Validation experiments demonstrate the effectiveness and advantages of the proposed algorithm.
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12
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Mochula AV, Mochula OV, Maltseva AN, Suleymanova AS, Cygikalo AA, Ryabov VV, Zavadovsky KV. Association of coronary microvascular dysfunction and cardiac muscle injury in acute myocardial infarction: results of comparison of dynamic SPECT and cardiac MRI. KARDIOLOGIIA 2023; 63:37-44. [PMID: 37470732 DOI: 10.18087/cardio.2023.6.n2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/17/2023] [Indexed: 07/21/2023]
Abstract
Aim To study the interrelation of changes in coronary microcirculation by data of dynamic single photon emission computed tomography (SPECT) and myocardial injury by data of magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).Material and methods The study included patients admitted to the emergency cardiology department with new-onset AMI. Contrast-enhanced cardiac MRI was performed for all patients on day 2-7 of admission. Dynamic SPECT of the myocardium with evaluation of semiquantitative and quantitative parameters of perfusion was performed on day 7-10.Results All patients were divided into two groups based on the type of MR contrast agent accumulation: 1) patients with the ischemic type of contrast enhancement (n=34; 62 %); 2) patients with the non-ischemic type of contrast enhancement (n=21; 38 %). According to data of myocardial perfusion scintigraphy (MPS), the group of ischemic MR pattern had larger perfusion defects at rest and during a stress test. Moreover, this group was characterized by lower global stress-induced blood flow and absolute and relative myocardial flow reserve (MFR). When the study group was divided into patients with transmural (n=32; 58 %) and non-transmural (n=23; 42 %) accumulation of the MR-contrast agent, lower values of global stress-induced blood flow and of absolute and relative MFR were observed in the group of transmural MR-enhancement pattern. A moderate inverse correlation was found between the stress-induced myocardial blood flow and the volume of myocardial edema (r= -0.47), infarct area (r= -0.48) and microvascular obstruction area (r= -0.38).Conclusion The variables of dynamic SPECT characterizing microcirculatory disorders that are independent on or due to injuries of the epicardial coronary vasculature reflect the severity and depth of structural changes of the myocardium in AMI. In this process, quantitative variables of myocardial perfusion are interrelated with the myocardial injury more closely than semiquantitative MPS indexes. The findings of the present study can also contribute to the heterogenicity of a patient group with acute coronary syndrome and AMI. Further study is required for understanding the prognostic significance of dynamic SPECT parameters.
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Affiliation(s)
- A V Mochula
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - O V Mochula
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - A N Maltseva
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - A S Suleymanova
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - A A Cygikalo
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - V V Ryabov
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
| | - K V Zavadovsky
- Research Institute of Cardiology, Affiliation of the Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk
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13
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Juul AS, Kyhl K, Ekström K, Madsen JM, Sabbah M, Ahtarovski KA, Nepper-Christensen L, Vejlstrup N, Høfsten D, Kelbaek H, Køber L, Lønborg J, Engstrøm T. The Incidence and Impact of Permanent Right Ventricular Infarction on Left Ventricular Infarct Size in Patients With Inferior ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 186:43-49. [PMID: 36343445 DOI: 10.1016/j.amjcard.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Mounting evidence shows that right ventricle (RV) function carries independent prognostic influence in various disease states. This study aimed to investigate the incidence and impact of permanent RV infarction in patients with inferior ST-segment elevation myocardial infarction (STEMI) and culprit lesion in the right coronary artery (RCA). In this substudy of the DANAMI-3 (DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction) trial, cardiac magnetic resonance was performed in 291 patients at day 1 and follow-up 3 months after primary percutaneous coronary intervention of 674 patients with STEMI with the culprit lesion in the RCA. Final infarct was assessed using late gadolinium enhancement on cardiac magnetic resonance at 3 months. Patients with permanent RV infarction (20%) had lower ventricular function at follow-up; RV ejection fraction (EF) 47% ±6 versus 50% ± 5 (p <0.005) and left ventricular (LV) EF 56% ± 8 versus 60% ± 9 (p <0.006). Furthermore, patients with permanent RV infarction had a higher incidence of microvascular obstruction 39 (67%) versus 81 (39%) (p <0.001), larger final LV infarct size 16% ±8 versus 10% ± 8 (p <0.001) and larger LV area at risk 33% ± 10 versus 29% ± 9 (p <0.001). Permanent RV infarction was an independent predictor of final LV infarct size (p <0.001) but was not associated with LVEF (β = -0.0; p = 0.13) in multivariable analyses. In conclusion, permanent RV infarction was seen in 20% of patients with inferior STEMI and culprit lesion in RCA and independently predicted final LV infarct size. However, permanent RV infarction did not predict overall LV function. LGE was used to detect infarct location and quantify infarct size.17 LGE in RV free wall on follow-up CMR was considered as permanent infarction. LGE images were obtained 10 minutes after intravenous injection of 0.1-mmol/kg body weight of gadolinium-based contrast (Gadovist; Bayer Schering, Berlin, Germany) using an electrocardiogram (ECG)-triggered inversion-recovery sequence. The inversion time was adjusted to null the signal from the normal myocardium. Short-axis images were acquired from the atrioventricular plane to the apex with adjacent 8-mm slices. The remaining protocol has been described previously.16.
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Affiliation(s)
- Anne-Sophie Juul
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Faculty of Health Science, University of Copenhagen.
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Kathrine Ekström
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Muhammad Sabbah
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Dan Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Henning Kelbaek
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jacob Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
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14
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Kaolawanich Y, Azevedo CF, Kim HW, Jenista ER, Wendell DC, Chen EL, Parker MA, Judd RM, Kim RJ. Native T1 Mapping for the Diagnosis of Myocardial Fibrosis in Patients With Chronic Myocardial Infarction. JACC. CARDIOVASCULAR IMAGING 2022; 15:2069-2079. [PMID: 36481075 DOI: 10.1016/j.jcmg.2022.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myocardial fibrosis is a fundamental process in cardiac injury. Cardiac magnetic resonance native T1 mapping has been proposed for diagnosing myocardial fibrosis without the need for gadolinium contrast. However, recent studies suggest that T1 measurements can be erroneous in the presence of intramyocardial fat. OBJECTIVES The purpose of this study was to investigate whether the presence of fatty metaplasia affects the accuracy of native T1 maps for the diagnosis of myocardial replacement fibrosis in patients with chronic myocardial infarction (MI). METHODS Consecutive patients (n = 312) with documented chronic MI (>6 months old) and controls without MI (n = 50) were prospectively enrolled. Presence and size of regions with elevated native T1 and infarction were quantitatively determined (mean + 5SD) on modified look-locker inversion-recovery and delayed-enhancement images, respectively, at 3.0-T. The presence of fatty metaplasia was determined using an out-of-phase steady-state free-precession cine technique and further verified with standard fat-water Dixon methods. RESULTS Native T1 mapping detected chronic MI with markedly higher sensitivity in patients with fatty metaplasia than those without fatty metaplasia (85.6% vs 13.3%) with similar specificity (100% vs 98.9%). In patients with fatty metaplasia, the size of regions with elevated T1 significantly underestimated infarct size and there was a better correlation with fatty metaplasia size than infarct size (r = 0.76 vs r = 0.49). In patients without fatty metaplasia, most of the modest elevation in T1 appeared to be secondary to subchronic infarcts that were 6 to 12 months old; the T1 of infarcts >12 months old was not different from noninfarcted myocardium. CONCLUSIONS Native T1 mapping is poor at detecting replacement fibrosis but may indirectly detect chronic MI if there is associated fatty metaplasia. Native T1 mapping for the diagnosis and characterization of myocardial fibrosis is unreliable.
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Affiliation(s)
- Yodying Kaolawanich
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert M Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
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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.
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16
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Chong JH, Abdulkareem M, Petersen SE, Khanji MY. Artificial intelligence and cardiovascular magnetic resonance imaging in myocardial infarction patients. Curr Probl Cardiol 2022; 47:101330. [PMID: 35870544 DOI: 10.1016/j.cpcardiol.2022.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular magnetic resonance (CMR) is an important cardiac imaging tool for assessing the prognostic extent of myocardial injury after myocardial infarction (MI). Within the context of clinical trials, CMR is also useful for assessing the efficacy of potential cardioprotective therapies in reducing MI size and preventing adverse left ventricular (LV) remodelling in reperfused MI. However, manual contouring and analysis can be time-consuming with interobserver and intraobserver variability, which can in turn lead to reduction in accuracy and precision of analysis. There is thus a need to automate CMR scan analysis in MI patients to save time, increase accuracy, increase reproducibility and increase precision. In this regard, automated imaging analysis techniques based on artificial intelligence (AI) that are developed with machine learning (ML), and more specifically deep learning (DL) strategies, can enable efficient, robust, accurate and clinician-friendly tools to be built so as to try and improve both clinician productivity and quality of patient care. In this review, we discuss basic concepts of ML in CMR, important prognostic CMR imaging biomarkers in MI and the utility of current ML applications in their analysis as assessed in research studies. We highlight potential barriers to the mainstream implementation of these automated strategies and discuss related governance and quality control issues. Lastly, we discuss the future role of ML applications in clinical trials and the need for global collaboration in growing this field.
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Affiliation(s)
- Jun Hua Chong
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore.
| | - Musa Abdulkareem
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; National Institute for Health Research Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Health Data Research UK, London, United Kingdom
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; National Institute for Health Research Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Health Data Research UK, London, United Kingdom; The Alan Turing Institute, London, United Kingdom
| | - Mohammed Y Khanji
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; National Institute for Health Research Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
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Terenicheva MA, Stukalova OV, Shakhnovich RM, Ternovoy SK. The role of cardiac magnetic resonance imaging in defining the prognosis of patients with acute <i>ST</i>-segment elevation myocardial infarction. Part 2. Assessment of the disease prognosis. TERAPEVT ARKH 2022; 94:552-557. [DOI: 10.26442/00403660.2022.04.201458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
Currently the incidence of congestive heart failure after ST-segment elevation myocardial infarction (STEMI) tends to increase. Reperfusion therapy is still the only effective method to reduce an infarct size. Therefore, there is a high unmet need of novel cardioprotective treatments that would improve outcomes in such patients. Recent advances in cardiovascular magnetic resonance (CMR) methods enabled the identification of certain new infarct characteristics associated with the development of heart failure and sudden cardiac death. These characteristics can help identify new groups of high risk patients and used as a targets for novel cardioprotective treatments. This part of the review summarizes novel CMR-based characteristics of myocardial infarction and their role in the prognostic stratification of STEMI patients.
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Determination of scar area using native and post-contrast T1 mapping: Agreement with late gadolinium enhancement. Eur J Radiol 2022; 150:110242. [DOI: 10.1016/j.ejrad.2022.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/15/2022]
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Nguyen Nguyen N, Assad JG, Femia G, Schuster A, Otton J, Nguyen TL. Role of cardiac magnetic resonance imaging in troponinemia syndromes. World J Cardiol 2022; 14:190-205. [PMID: 35582465 PMCID: PMC9048277 DOI: 10.4330/wjc.v14.i4.190] [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: 03/18/2021] [Revised: 11/13/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is an evolving technology, proving to be a highly accurate tool for quantitative assessment. Most recently, it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia. Although an elevation in troponin is a nonspecific marker of myocardial tissue damage, it is a frequently ordered investigation leaving many patients without a specific diagnosis. Fortunately, the advent of newer cardiac MRI protocols can provide additional information. In this review, we discuss several conditions associated with an elevation in troponin such as myocardial infarction, myocarditis, Takotsubo cardiomyopathy, coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.
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Affiliation(s)
- Nhung Nguyen Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Joseph George Assad
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Campbelltown Hospital, Campbelltown 2560, NSW, Australia
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Göttingen 37075, Germany
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Tuan Le Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
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20
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Wang KN, Yang X, Miao J, Li L, Yao J, Zhou P, Xue W, Zhou GQ, Zhuang X, Ni D. AWSnet: An Auto-weighted Supervision Attention Network for Myocardial Scar and Edema Segmentation in Multi-sequence Cardiac Magnetic Resonance Images. Med Image Anal 2022; 77:102362. [DOI: 10.1016/j.media.2022.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/26/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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21
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Frøysa V, Berg GJ, Eftestøl T, Woie L, Ørn S. Texture-based probability mapping for automatic scar assessment in late gadolinium-enhanced cardiovascular magnetic resonance images. Eur J Radiol Open 2021; 8:100387. [PMID: 34926726 PMCID: PMC8649215 DOI: 10.1016/j.ejro.2021.100387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 01/18/2023] Open
Abstract
Purpose To evaluate a novel texture-based probability mapping (TPM) method for scar size estimation in LGE-CMRI. Methods This retrospective proof-of-concept study included chronic myocardial scars from 52 patients. The TPM was compared with three signal intensity-based methods: manual segmentation, full-width-half-maximum (FWHM), and 5-standard deviation (5-SD). TPM is generated using machine learning techniques, expressing the probability of scarring in pixels. The probability is derived by comparing the texture of the 3 × 3 pixel matrix surrounding each pixel with reference dictionaries from patients with established myocardial scars. The Sørensen-Dice coefficient was used to find the optimal TPM range. A non-parametric test was used to test the correlation between infarct size and remodeling parameters. Bland-Altman plots were performed to assess agreement among the methods. Results The study included 52 patients (76.9% male; median age 64.5 years (54, 72.5)). A TPM range of 0.328–1.0 was found to be the optimal probability interval to predict scar size compared to manual segmentation, median dice (25th and 75th percentiles)): 0.69(0.42–0.81). There was no significant difference in the scar size between TPM and 5-SD. However, both 5-SD and TPM yielded larger scar sizes compared with FWHM (p < 0.001 and p = 0.002). There were strong correlations between scar size measured by TPM, and left ventricular ejection fraction (LVEF, r = −0.76, p < 0.001), left ventricular end-diastolic volume index (r = 0.73, p < 0.001), and left ventricular end-systolic volume index (r = 0.75, p < 0.001). Conclusion The TPM method is comparable with current SI-based methods, both for the scar size assessment and the relationship with left ventricular remodeling when applied on LGE-CMRI. Texture based probability mapping can be used to evaluate myocardial scar size. The method can assess myocardial fibrosis independent of signal intensity. The TPM method shows strong correlations between scar size and left ventricular ejection fraction.
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Affiliation(s)
- Vidar Frøysa
- Department of Cardiology, Stavanger University Hospital, Armauer Hansens vei 20, 4011, Stavanger, Norway
| | - Gøran J Berg
- Department of Electrical and Computer Science, University of Stavanger, P.O. box 8600, 4036 Stavanger, Norway
| | - Trygve Eftestøl
- Department of Electrical and Computer Science, University of Stavanger, P.O. box 8600, 4036 Stavanger, Norway
| | - Leik Woie
- Department of Electrical and Computer Science, University of Stavanger, P.O. box 8600, 4036 Stavanger, Norway
| | - Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Armauer Hansens vei 20, 4011, Stavanger, Norway.,Department of Electrical and Computer Science, University of Stavanger, P.O. box 8600, 4036 Stavanger, Norway
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22
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Peng F, Zheng T, Tang X, Liu Q, Sun Z, Feng Z, Zhao H, Gong L. Magnetic Resonance Texture Analysis in Myocardial Infarction. Front Cardiovasc Med 2021; 8:724271. [PMID: 34778395 PMCID: PMC8581163 DOI: 10.3389/fcvm.2021.724271] [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: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Texture analysis (TA) is a newly arisen field that can detect the invisible MRI signal changes among image pixels. Myocardial infarction (MI) is cardiomyocyte necrosis caused by myocardial ischemia and hypoxia, becoming the primary cause of death and disability worldwide. In recent years, various TA studies have been performed in patients with MI and show a good clinical application prospect. This review briefly presents the main pathogenesis and pathophysiology of MI, introduces the overview and workflow of TA, and summarizes multiple magnetic resonance TA (MRTA) clinical applications in MI. We also discuss the facing challenges currently for clinical utilization and propose the prospect.
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Affiliation(s)
- Fei Peng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tian Zheng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoping Tang
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiao Liu
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zijing Sun
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaofeng Feng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Lianggeng Gong
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
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23
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Jenista ER, Jensen CJ, Wendell D, Spatz D, Darty S, Kim HW, Parker M, Klem I, Chen EL, Kim RJ, Rehwald WG. Double spectral attenuated inversion recovery (DSPAIR)-an efficient fat suppression technique for late gadolinium enhancement at 3 tesla. NMR IN BIOMEDICINE 2021; 34:e4580. [PMID: 34251717 DOI: 10.1002/nbm.4580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
Despite clinical use of late gadolinium enhancement (LGE) for two decades, an efficient, robust fat suppression (FS) technique still does not exist for this CMR mainstay. In ischemic and non-ischemic heart disease, differentiating fibrotic tissue from infiltrating and adjacent fat is crucial. Multiple groups have independently developed an FS technique for LGE, double spectral attenuated inversion recovery (DSPAIR), but no comprehensive evaluation was performed. This study aims to fill this gap. DSPAIR uses two SPAIR pulses and one non-selective IR pulse to enable FS LGE, including compatibility with phase sensitive inversion recovery (PSIR). We implemented a magnitude (MAGN) and a PSIR variant and compared them with LGE without FS (CONTROL) and with spectral presaturation with inversion recovery (SPIR) in simulations, phantoms, and patients. Fat magnetization by SPIR, MAGN DSPAIR, and PSIR DSPAIR was simulated as a function of pulse B1 , readout (RO) pulse number, and fat TI . A phantom with fat, fibrosis, and myocardium compartments was imaged using all FS methods and modifying pulse B1 , RO pulse number, and heart rate. Signal was measured in SNR units. Fat, myocardium, and fibrosis SNR and fibrosis-to-fat CNR were obtained. Patient images were acquired with all FS techniques. Fat, myocardium, and fibrosis SNR, fibrosis-to-fat CNR, and image and FS quality were assessed. In the phantom, both DSPAIR variants provided superior FS compared with SPIR, independent of heart rate and RO pulse number. MAGN DSPAIR reduced fat signal by 99% compared with CONTROL, PSIR DSPAIR by 116%, and SPIR by 67% (25 RO pulses). In patients, both DSPAIR variants substantially reduced fat signal (MAGN DSPAIR by 87.1% ± 10.0%, PSIR DSPAIR by 130.5% ± 36.3%), but SPIR did not (35.8% ± 25.5%). FS quality was good to excellent for MAGN and PSIR DSPAIR, and moderate to poor for SPIR. DSPAIR provided highly effective FS across a wide range of parameters. PSIR DSPAIR performed best.
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Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Christoph J Jensen
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - David Wendell
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Deneen Spatz
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Darty
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Han W Kim
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele Parker
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Igor Klem
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Enn-Ling Chen
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Raymond J Kim
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Wolfgang G Rehwald
- Duke Cardiovascular MR Center, Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA
- Siemens Medical Solutions North America, Malvern, Pennsylvania, USA
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24
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Fisser C, Colling S, Debl K, Hetzenecker A, Sterz U, Hamer OW, Fellner C, Maier LS, Buchner S, Arzt M. The impact of epicardial adipose tissue in patients with acute myocardial infarction. Clin Res Cardiol 2021; 110:1637-1646. [PMID: 33978815 PMCID: PMC8484200 DOI: 10.1007/s00392-021-01865-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
AIMS Epicardial adipose tissue (EAT) has been linked to impaired reperfusion success after percutaneous coronary intervention (PCI). Whether EAT predicts myocardial damage in the early phase after acute myocardial infarction (MI) is unclear. Therefore, we investigated whether EAT in patients with acute MI is associated with more microvascular obstruction (MVO), greater ST-deviation, larger infarct size and reduced myocardial salvage index (MSI). METHODS AND RESULTS This retrospective analysis of a prospective observational study including patients with acute MI (n = 54) undergoing PCI and 12 healthy matched controls. EAT, infarct size and MSI were analyzed with cardiac magnetic resonance imaging, conducted 3-5 days and 12 weeks after MI. Patients with acute MI showed higher EAT volume than healthy controls (46 [25.;75. percentile: 37;59] vs. 24 [15;29] ml, p < 0.001). The high EAT group (above median) showed significantly more MVO (2.22 [0.00;5.38] vs. 0.0 [0.00;2.18] %, p = 0.004), greater ST-deviation (0.38 [0.22;0.55] vs. 0.15 [0.03;0.20] mV×10-1, p = 0.008), larger infarct size at 12 weeks (23 [17;29] vs. 10 [4;16] %, p < 0.001) and lower MSI (40 [37;54] vs. 66 [49;88] %, p < 0.001) after PCI than the low EAT group. After accounting for demographic characteristics, body-mass index, heart volume, infarct location, TIMI-flow grade as well as apnea-hypopnea index, EAT was associated with infarct size at 12 weeks (B = 0.38 [0.11;0.64], p = 0.006), but not with MSI. CONCLUSIONS Patients with acute MI showed higher volume of EAT than healthy individuals. High EAT was linked to more MVO and greater ST-deviation. EAT was associated with infarct size, but not with MSI.
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Affiliation(s)
- Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Stefan Colling
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Ulrich Sterz
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Okka W Hamer
- Institute for Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Institute for Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Department of Internal Medicine II, Sana Clinics Cham, Cham, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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25
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Wu Y, Tang Z, Li B, Firmin D, Yang G. Recent Advances in Fibrosis and Scar Segmentation From Cardiac MRI: A State-of-the-Art Review and Future Perspectives. Front Physiol 2021; 12:709230. [PMID: 34413789 PMCID: PMC8369509 DOI: 10.3389/fphys.2021.709230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
Segmentation of cardiac fibrosis and scars is essential for clinical diagnosis and can provide invaluable guidance for the treatment of cardiac diseases. Late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been successful in guiding the clinical diagnosis and treatment reliably. For LGE CMR, many methods have demonstrated success in accurately segmenting scarring regions. Co-registration with other non-contrast-agent (non-CA) modalities [e.g., balanced steady-state free precession (bSSFP) cine magnetic resonance imaging (MRI)] can further enhance the efficacy of automated segmentation of cardiac anatomies. Many conventional methods have been proposed to provide automated or semi-automated segmentation of scars. With the development of deep learning in recent years, we can also see more advanced methods that are more efficient in providing more accurate segmentations. This paper conducts a state-of-the-art review of conventional and current state-of-the-art approaches utilizing different modalities for accurate cardiac fibrosis and scar segmentation.
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Affiliation(s)
- Yinzhe Wu
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Zeyu Tang
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Binghuan Li
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - David Firmin
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom
| | - Guang Yang
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom
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26
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Buckert D, Belal A, Seidl A, Rottbauer W, Thiele H, Rasche V, Wöhrle J. Acute phase segmental radial strain correlates with recovery and late gadolinium extent in ST-elevation myocardial infarction (STEMI): analysis of the abciximab intracoronary versus intravenously drug application in STEMI substudy. Quant Imaging Med Surg 2021; 11:3595-3603. [PMID: 34341734 DOI: 10.21037/qims-21-56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Abstract
Background The role of regional strain evaluation in patients with acute reperfused ST-elevation myocardial infarction (STEMI) is not well determined. The objective of this study was the description of regional strain characteristics in the acute and chronic phase of myocardial infarction and its correlation with symptom-to-balloon time and final extent of myocardial scar assessed by cardiac magnetic resonance imaging. Methods The study cohort has been derived from the randomized controlled Abciximab Intracoronary versus Intravenously Drug Application in STEMI (AIDA STEMI) trial enrolled at the University of Ulm. All patients received comprehensive cardiac magnetic resonance imaging examinations in the acute phase and 6 months later. Results There was a significant improvement of all global deformation indices over time (global longitudinal strain: -13.1%±5.1% to -15.5%±5.8%, P=0.001; global circumferential strain: -14.4%±3.7% to -16.8%±3.6%, P<0.0001; global radial strain: 28.1%±8.7% to 31.9%±9.2%, P=0.0002). Mean radial strain of ischemic segments significantly improved (16.6%±10.8% to 23.7%±12.8%, P<0.0001), while mean radial strain of remote segments remained unchanged (40.2%±9.4% to 39.4%±9.4%, P=0.570). There was a significant correlation between acute phase radial strain of ischemic segments and either symptom-to-balloon time (P=0.013), as well as extent of late gadolinium enhancement at follow-up (P<0.0001). Using a cut-off of ≤27%, acute phase radial strain predicted infarction of the corresponding segment with high sensitivity and specificity (74.4% and 69.0% respectively, P<0.001). Conclusions Segmental radial strain in the acute phase of infarction showed a significant correlation to either symptom-to-balloon-time and the extent of late gadolinium enhancement at follow-up, thus potentially serving as early surrogate for left ventricular remodeling and outcome in STEMI.
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Affiliation(s)
- Dominik Buckert
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Awad Belal
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Adrian Seidl
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Volker Rasche
- Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Jochen Wöhrle
- Department of Cardiology, Medical Campus Lake Constance, Friedrichshafen, Germany
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27
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Kato Y, Kizer JR, Ostovaneh MR, Lazar J, Peng Q, van der Geest RJ, Lima JAC, Ambale-Venkatesh B. Extracellular volume-guided late gadolinium enhancement analysis for non-ischemic cardiomyopathy: The Women's Interagency HIV Study. BMC Med Imaging 2021; 21:116. [PMID: 34315432 PMCID: PMC8314536 DOI: 10.1186/s12880-021-00649-6] [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: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantification of non-ischemic myocardial scar remains a challenge due to the patchy diffuse nature of fibrosis. Extracellular volume (ECV) to guide late gadolinium enhancement (LGE) analysis may achieve a robust scar assessment. METHODS Three cohorts of 80 non-ischemic-training, 20 non-ischemic-validation, and 10 ischemic-validation were prospectively enrolled and underwent 3.0 Tesla cardiac MRI. An ECV cutoff to differentiate LGE scar from non-scar was identified in the training cohort from the receiver-operating characteristic curve analysis, by comparing the ECV value against the visually-determined presence/absence of the LGE scar at the highest signal intensity (SI) area of the mid-left ventricle (LV) LGE. Based on the ECV cutoff, an LGE semi-automatic threshold of n-times of standard-deviation (n-SD) above the remote-myocardium SI was optimized in the individual cases ensuring correspondence between LGE and ECV images. The inter-method agreement of scar amount in comparison with manual (for non-ischemic) or full-width half-maximum (FWHM, for ischemic) was assessed. Intra- and inter-observer reproducibility were investigated in a randomly chosen subset of 40 non-ischemic and 10 ischemic cases. RESULTS The non-ischemic groups were all female with the HIV positive rate of 73.8% (training) and 80% (validation). The ischemic group was all male with reduced LV function. An ECV cutoff of 31.5% achieved optimum performance (sensitivity: 90%, specificity: 86.7% in training; sensitivity: 100%, specificity: 81.8% in validation dataset). The identified n-SD threshold varied widely (range 3 SD-18 SD), and was independent of scar amount (β = -0.01, p = 0.92). In the non-ischemic cohorts, results suggested that the manual LGE assessment overestimated scar (%) in comparison to ECV-guided analysis [training: 4.5 (3.2-6.4) vs. 0.92 (0.1-2.1); validation: 2.5 (1.2-3.7) vs. 0.2 (0-1.6); P < 0.01 for both]. Intra- and inter-observer analyses of global scar (%) showed higher reproducibility in ECV-guided than manual analysis with CCC = 0.94 and 0.78 versus CCC = 0.86 and 0.73, respectively (P < 0.01 for all). In ischemic validation, the ECV-guided LGE analysis showed a comparable scar amount and reproducibility with the FWHM. CONCLUSIONS ECV-guided LGE analysis is a robust scar quantification method for a non-ischemic cohort. Trial registration ClinicalTrials.gov; NCT00000797, retrospectively-registered 2 November 1999; NCT02501811, registered 15 July 2015.
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Affiliation(s)
- Yoko Kato
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Jason Lazar
- SUNY Downstate Medical Center, New York, NY, USA
| | - Qi Peng
- Albert Einstein College of Medicine, New York, NY, USA
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- Division of Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe Street MR 110, Baltimore, MD, 21287, USA.
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28
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Vesal S, Gu M, Maier A, Ravikumar N. Spatio-Temporal Multi-Task Learning for Cardiac MRI Left Ventricle Quantification. IEEE J Biomed Health Inform 2021; 25:2698-2709. [PMID: 33351771 DOI: 10.1109/jbhi.2020.3046449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Quantitative assessment of cardiac left ventricle (LV) morphology is essential to assess cardiac function and improve the diagnosis of different cardiovascular diseases. In current clinical practice, LV quantification depends on the measurement of myocardial shape indices, which is usually achieved by manual contouring of the endo- and epicardial. However, this process subjected to inter and intra-observer variability, and it is a time-consuming and tedious task. In this article, we propose a spatio-temporal multi-task learning approach to obtain a complete set of measurements quantifying cardiac LV morphology, regional-wall thickness (RWT), and additionally detecting the cardiac phase cycle (systole and diastole) for a given 3D Cine-magnetic resonance (MR) image sequence. We first segment cardiac LVs using an encoder-decoder network and then introduce a multitask framework to regress 11 LV indices and classify the cardiac phase, as parallel tasks during model optimization. The proposed deep learning model is based on the 3D spatio-temporal convolutions, which extract spatial and temporal features from MR images. We demonstrate the efficacy of the proposed method using cine-MR sequences of 145 subjects and comparing the performance with other state-of-the-art quantification methods. The proposed method obtained high prediction accuracy, with an average mean absolute error (MAE) of 129 mm 2, 1.23 mm, 1.76 mm, Pearson correlation coefficient (PCC) of 96.4%, 87.2%, and 97.5% for LV and myocardium (Myo) cavity regions, 6 RWTs, 3 LV dimensions, and an error rate of 9.0% for phase classification. The experimental results highlight the robustness of the proposed method, despite varying degrees of cardiac morphology, image appearance, and low contrast in the cardiac MR sequences.
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29
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Boyle AJ, Schultz C, Selvanayagam JB, Moir S, Kovacs R, Dib N, Zlotnick D, Al-Omary M, Sugito S, Selvarajah A, Collins N, McLachlan G. Calcium/Calmodulin-Dependent Protein Kinase II Delta Inhibition and Ventricular Remodeling After Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:762-768. [PMID: 33851966 DOI: 10.1001/jamacardio.2021.0676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance After anterior ST-segment elevation myocardial infarction (STEMI), left ventricular (LV) remodeling results in heart failure and death. Calcium/calmodulin-dependent protein kinase II delta (CaMKIId) is a key molecular mediator of adverse LV remodeling. Objective To determine whether NP202, an orally active inhibitor of CaMKIId, prevents LV remodeling in patients after anterior STEMI with early residual LV dysfunction. Design, Setting, and Participants A randomized, double-blind, placebo-controlled multicenter clinical trial of NP202 vs placebo in patients after primary percutaneous coronary intervention (PCI) for anterior STEMI was performed from November 19, 2015, to August 1, 2018. The study was performed at 32 sites across the US, Australia, and New Zealand. Patients presenting with anterior STEMI who underwent PCI within 12 hours of symptom onset and left ventricular ejection fraction (LVEF) less than 45% on screening echocardiogram 48 hours after primary PCI were included in the study. Baseline cardiovascular magnetic resonance (CMR) imaging was performed within 5 days of the STEMI and before administration of the study drug. Follow-up CMR was performed after 3 months. Data were analyzed from November 19, 2015, to August 1, 2018. Interventions Patients were randomly assigned to NP202, 1000 mg, daily for 3 months vs corresponding placebo. Main Outcomes and Measures The primary end point was change in LV end-systolic volume index (LVESVi) on CMR. Secondary end points were change in LV end-diastolic volume index, change in LVEF, change in infarct size, and change in diastolic function. Safety and tolerability were also assessed. Results A total of 147 patients (mean [SD] age, 58 [11] years; 129 men [88%]; 130 White patients [88%]) who experienced anterior STEMI treated with primary PCI were randomized to receive NP202 (73 [49.7%]) or placebo (74 [50.3%]). Baseline LVEF was similar between groups. At baseline, patients randomized to NP202 had greater LVESVi (48.2 mL/m2) than that in the placebo group (41.3 mL/m2; P = .03). However, the groups were otherwise well matched. For the primary end point of change in LVESVi from baseline to 3 months, there was no significant difference between the placebo (median [interquartile range] change, -0.60 [-9.28 to 5.99] mL/m2) and NP202 groups (-3.53 [-9.24 to 4.81] mL/m2) (P = .78). There was also no difference in the secondary efficacy end points assessed by CMR. NP202 was well tolerated and demonstrated an acceptable safety profile. Major adverse cardiac and cerebrovascular event rates were similar between groups. Two deaths occurred in each group during the follow-up period. Conclusions and Relevance Three months of treatment with NP202 after primary PCI for anterior STEMI with residual LV dysfunction did not improve LV remodeling. The drug was safe and well tolerated. Trial Registration ClinicalTrials.gov Identifier: NCT02557217.
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Affiliation(s)
- Andrew J Boyle
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Carl Schultz
- University of Western Australia School of Medicine, Perth, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Joseph B Selvanayagam
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stuart Moir
- MonashHeart, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | | | - Nabil Dib
- Dignity Healthcare, Gilbert, Arizona
| | | | - Mohammed Al-Omary
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Stuart Sugito
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Aravinda Selvarajah
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Nicholas Collins
- Department of Cardiovascular Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Vesal S, Gu M, Kosti R, Maier A, Ravikumar N. Adapt Everywhere: Unsupervised Adaptation of Point-Clouds and Entropy Minimization for Multi-Modal Cardiac Image Segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1838-1851. [PMID: 33729930 DOI: 10.1109/tmi.2021.3066683] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Deep learning models are sensitive to domain shift phenomena. A model trained on images from one domain cannot generalise well when tested on images from a different domain, despite capturing similar anatomical structures. It is mainly because the data distribution between the two domains is different. Moreover, creating annotation for every new modality is a tedious and time-consuming task, which also suffers from high inter- and intra- observer variability. Unsupervised domain adaptation (UDA) methods intend to reduce the gap between source and target domains by leveraging source domain labelled data to generate labels for the target domain. However, current state-of-the-art (SOTA) UDA methods demonstrate degraded performance when there is insufficient data in source and target domains. In this paper, we present a novel UDA method for multi-modal cardiac image segmentation. The proposed method is based on adversarial learning and adapts network features between source and target domain in different spaces. The paper introduces an end-to-end framework that integrates: a) entropy minimization, b) output feature space alignment and c) a novel point-cloud shape adaptation based on the latent features learned by the segmentation model. We validated our method on two cardiac datasets by adapting from the annotated source domain, bSSFP-MRI (balanced Steady-State Free Procession-MRI), to the unannotated target domain, LGE-MRI (Late-gadolinium enhance-MRI), for the multi-sequence dataset; and from MRI (source) to CT (target) for the cross-modality dataset. The results highlighted that by enforcing adversarial learning in different parts of the network, the proposed method delivered promising performance, compared to other SOTA methods.
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHDM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFDO, Santos ECL, Piegas LS, Soeiro ADM, Negri AJDA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLDAA, Sena JP, Peixoto JM, Souza JAD, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LADO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MTD, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RDSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VDMG, Chalela WA, Mathias Júnior W. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021. Arq Bras Cardiol 2021; 117:181-264. [PMID: 34320090 PMCID: PMC8294740 DOI: 10.36660/abc.20210180] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Gilson Soares Feitosa Filho
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Centro Universitário de Tecnologia e Ciência (UniFTC), Salvador, BA - Brasil
| | - João Luiz Petriz
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
| | | | | | - Walmor Lemke
- Clínica Cardiocare, Curitiba, PR - Brasil
- Hospital das Nações, Curitiba, PR - Brasil
| | | | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - José A Marin Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | | | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCor), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Felipe Gallego Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brasil
| | - Juliana Ascenção de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Lilia Nigro Maia
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
| | | | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luís Alberto de Oliveira Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luis Augusto Palma Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Bueno da Silva Rivas
- Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Múcio Tavares de Oliveira Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, BA - Brasil
- Universidade Salvador (UNIFACS), Salvador, BA - Brasil
- Hospital EMEC, Salvador, BA - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Otávio Rizzi Coelho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | - Paulo Rogério Soares
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Talia Falcão Dalçóquio
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - William Azem Chalela
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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Lee EM, Ibrahim ESH, Dudek N, Lu JC, Kalia V, Runge M, Srinivasan A, Stojanovska J, Agarwal PP. Improving MR Image Quality in Patients with Metallic Implants. Radiographics 2021; 41:E126-E137. [PMID: 34143712 DOI: 10.1148/rg.2021200092] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The number of implanted devices such as orthopedic hardware and cardiac implantable devices continues to increase with an increase in the age of the patient population, as well as an increase in the number of indications for specific devices. Many patients with these devices have or will develop clinical conditions that are best depicted at MRI. However, implanted devices containing paramagnetic or ferromagnetic substances can cause significant artifact, which could limit the diagnostic capability of this modality. Performing imaging with MRI when an implant is present may be challenging, and there are numerous techniques the radiologist and technologist can use to help minimize artifacts related to implants. First, knowledge of the presence of an implant before patient arrival is critical to ensure safety of the patient when the device is subjected to a strong magnetic field. Once safety is ensured, the examination should be performed with the MRI system that is expected to provide the best image quality. The selection of the MRI system includes multiple considerations such as the effects of field strength and availability of specific sequences, which can reduce metal artifact. Appropriate patient positioning, attention to MRI parameters (including bandwidth, voxel size, and echo), and appropriate selection of sequences (those with less metal artifact and advanced metal reduction sequences) are critical to improve image quality. Patients with implants can be successfully imaged with MRI with appropriate planning and understanding of how to minimize artifacts. This improves image quality and the diagnostic confidence of the radiologist. ©RSNA, 2021.
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Affiliation(s)
- Elizabeth M Lee
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - El-Sayed H Ibrahim
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Nancy Dudek
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Jimmy C Lu
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Vivek Kalia
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Mason Runge
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Ashok Srinivasan
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Jadranka Stojanovska
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Prachi P Agarwal
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
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Heidenreich JF, Gassenmaier T, Ankenbrand MJ, Bley TA, Wech T. Self-configuring nnU-net pipeline enables fully automatic infarct segmentation in late enhancement MRI after myocardial infarction. Eur J Radiol 2021; 141:109817. [PMID: 34144308 DOI: 10.1016/j.ejrad.2021.109817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To fully automatically derive quantitative parameters from late gadolinium enhancement (LGE) cardiac MR (CMR) in patients with myocardial infarction and to investigate if phase sensitive or magnitude reconstructions or a combination of both results in best segmentation accuracy. METHODS In this retrospective single center study, a convolutional neural network with a U-Net architecture with a self-configuring framework ("nnU-net") was trained for segmentation of left ventricular myocardium and infarct zone in LGE-CMR. A database of 170 examinations from 78 patients with history of myocardial infarction was assembled. Separate fitting of the model was performed, using phase sensitive inversion recovery, the magnitude reconstruction or both contrasts as input channels. Manual labelling served as ground truth. In a subset of 10 patients, the performance of the trained models was evaluated and quantitatively compared by determination of the Sørensen-Dice similarity coefficient (DSC) and volumes of the infarct zone compared with the manual ground truth using Pearson's r correlation and Bland-Altman analysis. RESULTS The model achieved high similarity coefficients for myocardium and scar tissue. No significant difference was observed between using PSIR, magnitude reconstruction or both contrasts as input (PSIR and MAG; mean DSC: 0.83 ± 0.03 for myocardium and 0.72 ± 0.08 for scars). A strong correlation for volumes of infarct zone was observed between manual and model-based approach (r = 0.96), with a significant underestimation of the volumes obtained from the neural network. CONCLUSION The self-configuring nnU-net achieves predictions with strong agreement compared to manual segmentation, proving the potential as a promising tool to provide fully automatic quantitative evaluation of LGE-CMR.
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Affiliation(s)
- Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany.
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Markus J Ankenbrand
- Department of Cellular and Molecular Imaging, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany; Center for Computational and Theoretical Biology, University of Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
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Enhancement patterns detected by multidetector computed tomography are associated with the long-term prognosis of patients with acute myocardial infarction. Heart Vessels 2021; 36:1784-1793. [PMID: 33997914 DOI: 10.1007/s00380-021-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
The present study investigated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) without iodine re-injection immediately after primary percutaneous coronary intervention (PCI) for predicting future cardiovascular events after acute myocardial infarction (AMI). We performed a prospective study in which 263 consecutive patients with first AMI successfully treated with primary PCI were enrolled. Sixty-four-slice MDCT without the re-injection of contrast medium was performed immediately after PCI. Myocardial DE was considered to be transmural when involving myocardial thickness ≥ 75% (Group A; n = 104), subendocardial (< 75%, Group B; n = 108), or normal (Group C; n = 51). A semiquantitative scale score was defined for 17 left ventricular segments to investigate the extent of the DE area assessed. We examined the relationship between the presence or absence of transmural DE and long-term cardiovascular event rates. The median follow-up period was 3.5 years. Kaplan-Meier survival curves showed that patient prognosis was poorer in the group with Group A than that in the group with Group B, which was equivalent to that with Group C. A multivariate analysis identified the presence of transmural DE as the strongest predictor for future cardiovascular events (hazard ratio: 3.7; P = 0.023). Transmural myocardial DE immediately following primary PCI without an iodine re-injection for AMI is a major risk factor for future cardiovascular events.
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Terenicheva MA, Stukalova OV, Shakhnovich RM, Ternovoy SK. The role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in defining the prognosis of patients with acute ST-segment elevation myocardial infarction. Part 1. Indications and contraindications to cardiovascular magnetic resonance. TERAPEVT ARKH 2021; 93:497-501. [DOI: 10.26442/00403660.2021.04.200687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Recently, the role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in the diagnosis of coronary artery disease and acute myocardial infarction has increased significantly. This method is defined as the gold standard for differentiation between ischemic vs non-ischemic and acute vs chronic myocardial injury. This part of the review summarizes the main methods of cardiovascular magnetic resonance, its safety, indications and contraindications.
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van Cauteren YJM, Smulders MW, Theunissen RALJ, Gerretsen SC, Adriaans BP, Bijvoet GP, Mingels AMA, van Kuijk SMJ, Schalla S, Crijns HJGM, Kim RJ, Wildberger JE, Heijman J, Bekkers SCAM. Cardiovascular magnetic resonance accurately detects obstructive coronary artery disease in suspected non-ST elevation myocardial infarction: a sub-analysis of the CARMENTA Trial. J Cardiovasc Magn Reson 2021; 23:40. [PMID: 33752696 PMCID: PMC7983380 DOI: 10.1186/s12968-021-00723-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Invasive coronary angiography (ICA) is still the reference test in suspected non-ST elevation myocardial infarction (NSTEMI), although a substantial number of patients do not have obstructive coronary artery disease (CAD). Early cardiovascular magnetic resonance (CMR) may be a useful gatekeeper for ICA in this setting. The main objective was to investigate the accuracy of CMR to detect obstructive CAD in NSTEMI. METHODS This study is a sub-analysis of a randomized controlled trial investigating whether a non-invasive imaging-first strategy safely reduced the number of ICA compared to routine clinical care in suspected NSTEMI (acute chest pain, non-diagnostic electrocardiogram, high sensitivity troponin T > 14 ng/L), and included 51 patients who underwent CMR prior to ICA. A stepwise approach was used to assess the diagnostic accuracy of CMR to detect (1) obstructive CAD (diameter stenosis ≥ 70% by ICA) and (2) an adjudicated final diagnosis of acute coronary syndrome (ACS). First, in all patients the combination of cine, T2-weighted and late gadolinium enhancement (LGE) imaging was evaluated for the presence of abnormalities consistent with a coronary etiology in any sequence. Hereafter and only when the scan was normal or equivocal, adenosine stress-perfusion CMR was added. RESULTS Of 51 patients included (63 ± 10 years, 51% male), 34 (67%) had obstructive CAD by ICA. The sensitivity, specificity and overall accuracy of the first step to diagnose obstructive CAD were 79%, 71% and 77%, respectively. Additional vasodilator stress-perfusion CMR was performed in 19 patients and combined with step one resulted in an overall sensitivity of 97%, specificity of 65% and accuracy of 86%. Of the remaining 17 patients with non-obstructive CAD, 4 (24%) had evidence for a myocardial infarction on LGE, explaining the modest specificity. The sensitivity, specificity and overall accuracy to diagnose ACS (n = 43) were 88%, 88% and 88%, respectively. CONCLUSION CMR accurately detects obstructive CAD and ACS in suspected NSTEMI. Non-obstructive CAD is common with CMR still identifying an infarction in almost one-quarter of patients. CMR should be considered as an early diagnostic approach in suspected NSTEMI. TRIAL REGISTRATION The CARMENTA trial has been registered at ClinicalTrials.gov with identifier NCT01559467.
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Affiliation(s)
- Yvonne J M van Cauteren
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Martijn W Smulders
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Suzanne C Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Alma M A Mingels
- Department of Clinical Chemistry, Maastricht UMC+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment (KEMTA), Maastricht UMC+, Maastricht, The Netherlands
| | - Simon Schalla
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jordi Heijman
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Chartsias A, Papanastasiou G, Wang C, Semple S, Newby DE, Dharmakumar R, Tsaftaris SA. Disentangle, Align and Fuse for Multimodal and Semi-Supervised Image Segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:781-792. [PMID: 33156786 PMCID: PMC8011298 DOI: 10.1109/tmi.2020.3036584] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Magnetic resonance (MR) protocols rely on several sequences to assess pathology and organ status properly. Despite advances in image analysis, we tend to treat each sequence, here termed modality, in isolation. Taking advantage of the common information shared between modalities (an organ's anatomy) is beneficial for multi-modality processing and learning. However, we must overcome inherent anatomical misregistrations and disparities in signal intensity across the modalities to obtain this benefit. We present a method that offers improved segmentation accuracy of the modality of interest (over a single input model), by learning to leverage information present in other modalities, even if few (semi-supervised) or no (unsupervised) annotations are available for this specific modality. Core to our method is learning a disentangled decomposition into anatomical and imaging factors. Shared anatomical factors from the different inputs are jointly processed and fused to extract more accurate segmentation masks. Image misregistrations are corrected with a Spatial Transformer Network, which non-linearly aligns the anatomical factors. The imaging factor captures signal intensity characteristics across different modality data and is used for image reconstruction, enabling semi-supervised learning. Temporal and slice pairing between inputs are learned dynamically. We demonstrate applications in Late Gadolinium Enhanced (LGE) and Blood Oxygenation Level Dependent (BOLD) cardiac segmentation, as well as in T2 abdominal segmentation. Code is available at https://github.com/vios-s/multimodal_segmentation.
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Shi X, Li C. Convexity preserving level set for left ventricle segmentation. Magn Reson Imaging 2021; 78:109-118. [PMID: 33592247 DOI: 10.1016/j.mri.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/14/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
In clinical applications of cardiac left ventricle (LV) segmentation, the segmented LV is desired to include the cavity, trabeculae, and papillary muscles, which form a convex shape. However, the intensities of trabeculae and papillary muscles are similar to myocardium. Consequently, segmentation algorithms may easily misclassify trabeculae and papillary muscles as myocardium. In this paper, we propose a level set method with a convexity preserving mechanism to ensure the convexity of the segmented LV. In the proposed level set method, the curvature of the level set contours is used to control their convexity, such that the level set contour is finally deformed as a convex shape. The experimental results and the comparison with other level set methods show the advantage of our method in terms of segmentation accuracy. Compared with the state-of-the-art methods using deep-learning, our method is able to achieve comparable segmentation accuracy without the need for training, while the deep-learning based method requires a large set of training data and high-quality manual segmentation. Therefore, our method can be conveniently used in situation where training data and their manual segmentation are not available.
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Affiliation(s)
- Xue Shi
- University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Chunming Li
- University of Electronic Science and Technology of China, Chengdu 611731, China.
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Pennig L, Lennartz S, Wagner A, Sokolowski M, Gajzler M, Ney S, Laukamp KR, Persigehl T, Bunck AC, Maintz D, Weiss K, Naehle CP, Doerner J. Clinical application of free-breathing 3D whole heart late gadolinium enhancement cardiovascular magnetic resonance with high isotropic spatial resolution using Compressed SENSE. J Cardiovasc Magn Reson 2020; 22:89. [PMID: 33327958 PMCID: PMC7745391 DOI: 10.1186/s12968-020-00673-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm3 acquired voxel size) compared to standard breath-hold LGE imaging. METHODS This was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February-November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic-5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis. RESULTS Global LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1-50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired. CONCLUSIONS In a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matej Gajzler
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Svenja Ney
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Philips GmbH, Röntgenstraße 22, 22335, Hamburg, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Merkler AE, Alakbarli J, Barbar T, Baradaran H, Adejumo O, Navi BB, Kamel H, Kim J, Okin PM, Gupta A, Weinsaft JW. Associations between the size and location of myocardial infarction and cerebral infarction. J Neurol Sci 2020; 419:117182. [PMID: 33099172 DOI: 10.1016/j.jns.2020.117182] [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] [Received: 06/30/2020] [Revised: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is a known cause of cerebral infarction. We assessed whether the size and location of MI is associated with the risk of cerebral infarction. METHODS AND RESULTS We performed a cross-sectional study of adults who underwent both brain MRI and delayed-enhancement cardiac MRI (DE-CMR) within 365 days of each other at Weill Cornell Medicine between 2014 and 2017 and had evidence of MI on DE-CMR. We used multiple logistic regression to evaluate associations between MI size and any cerebral infarction, apical MI location and any cerebral infarction, and MI size/location and cortical versus subcortical cerebral infarction. Models were adjusted for demographics, and the total number of vascular risk factors. Among 234 patients who underwent both DE-CMR and brain MRI within 365 days, 76 had evidence for MI on DE-CMR. Among these 76 patients, 51 (67.1%) had evidence of cerebral infarction. The size of MI (global MI burden) was not associated with any cerebral infarction (OR per 5% increase in MI size, 1.12; 95% CI, 0.85-1.47), but was associated with cortical cerebral infarction (OR per 5% increase in MI size, 1.30; 95% CI, 1.00.-1.68). Similarly, apical MI location was not associated with any cerebral infarction (OR 2.63, 95% CI, 0.78-8.87), but was associated with cortical cerebral infarction (OR, 3.67; 95% CI, 1.19-11.33). CONCLUSION Among patients with MI on cardiac MRI, both size and apical location of MI were associated with cortical cerebral infarction. Our results may help stratify cardioembolic risk and inform antithrombotic treatment algorithms among patients with MI.
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Affiliation(s)
- Alexander E Merkler
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA.
| | - Javid Alakbarli
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tarek Barbar
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Hediyeh Baradaran
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Peter M Okin
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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Lobeek M, Badings E, Lenssen M, Uijlings R, Koster K, van 't Riet E, Martens FMAC. Diagnostic value of the electrocardiogram in the assessment of prior myocardial infarction. Neth Heart J 2020; 29:142-150. [PMID: 33197002 PMCID: PMC7904994 DOI: 10.1007/s12471-020-01515-w] [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] [Accepted: 10/20/2020] [Indexed: 01/14/2023] Open
Abstract
Background The best available imaging technique for the detection of prior myocardial infarction (MI) is cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Although the electrocardiogram (ECG) still plays a major role in the diagnosis of prior MI, the diagnostic value of the ECG remains uncertain. This study evaluates the diagnostic value of the ECG in the assessment of prior MI. Methods In this retrospective study, data from electronic patient files were collected of 1033 patients who had undergone CMR with LGE between January 2014 and December 2017. After the exclusion of 59 patients, the data of 974 patients were analysed. Twelve-lead ECGs were blinded and evaluated for signs of prior MI by two cardiologists separately. Disagreement in interpretation was resolved by the judgement of a third cardiologist. Outcomes of CMR with LGE were used as the gold standard. Results The sensitivity of the ECG in the detection of MI was 38.0% with a 95% confidence interval (CI) of 31.6–44.8%. The specificity was 86.9% (95% CI 84.4–89.1%). The positive and negative predictive value were 43.6% (95% CI 36.4–50.9%) and 84.0% (95% CI 81.4–86.5%) respectively. In 170 ECGs (17.5%), the two cardiologists disagreed on the presence or absence of MI. Inter-rater variability was moderate (κ 0.51, 95% CI 0.45–0.58, p < 0.001). Conclusion The ECG has a low diagnostic value in the detection of prior MI. However, if the ECG shows no signs of prior MI, the absence of MI is likely. This study confirms that a history of MI should not be based solely on an ECG.
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Affiliation(s)
- M Lobeek
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
| | - E Badings
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - M Lenssen
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - R Uijlings
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - K Koster
- Department of Radiology, Deventer Hospital, Deventer, The Netherlands
| | - E van 't Riet
- Teaching Hospital Deventer, Deventer Hospital, Deventer, The Netherlands
| | - F M A C Martens
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
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Jenista ER, Wendell DC, Kim HW, Rehwald WG, Chen EL, Darty SN, Smith LR, Azevedo CF, Parker MA, Kim RJ. Comparison of magnetization transfer-preparation and T2-preparation for dark-blood delayed-enhancement imaging. NMR IN BIOMEDICINE 2020; 33:e4396. [PMID: 32875674 DOI: 10.1002/nbm.4396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/03/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Recently developed dark-blood techniques such as Flow-Independent Dark-blood DeLayed Enhancement (FIDDLE) allow simultaneous visualization of tissue contrast-enhancement and blood-pool suppression. Critical to FIDDLE is the magnetization preparation, which accentuates differences between myocardium and blood-pool. Here, we compared magnetization transfer (MT)-preparation and T2-preparation for use with FIDDLE. Variants of FIDDLE were developed with MT- or T2-preparation modules and tested in 35 patients (11 at 1.5 T, 24 at 3 T). Images were acquired with each FIDDLE variant in an interleaved fashion 10 minutes after gadolinium administration with otherwise identical acquisition parameters. Images were visually and quantitatively assessed for artifacts and differences in right ventricle to left ventricle (RV-to-LV) blood-pool suppression. Bright artifacts, reflecting incomplete blood-pool suppression, were frequently observed in the left atrium with T2-preparation FIDDLE at 1.5 and 3 T (82% and up to 100% of patients, respectively). MT-preparation FIDDLE resulted in fewer patients with artifacts (0% at 1.5 T, 22% at 3 T; P < .01). Left atrial blood-pool signal was significantly more homogeneous with MT-preparation than with T2-preparation at 1.5 and 3 T (P < .001 for all comparisons). Visibly different RV-to-LV blood-pool suppression was observed with T2-preparation in 36% of patients at 1.5 T and up to 94% at 3 T. In these patients, RV blood-pool signal was elevated, reducing the conspicuity of the myocardial-RV blood-pool border. Conversely, there were no visible differences in RV-to-LV blood-pool suppression with MT-preparation. Quantitative assessment of differences in blood-pool suppression and blood-pool artifacts was consistent with visual analyses. We conclude that for dark blood-blood delayed-enhancement imaging of the heart, MT-preparation results in fewer bright blood-pool artifacts and more uniform blood-pool suppression than T2-preparation.
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Affiliation(s)
- Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - David C Wendell
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Enn-Ling Chen
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Stephen N Darty
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Logan R Smith
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Clerio F Azevedo
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michele A Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Modaragamage Dona AC, Abuelgasim E, Abuelgasim B, Kermali M, Zahra SA, Hewage S, Harky A. Dissection of coronary artery: A clinical overview. J Cardiol 2020; 77:353-360. [PMID: 32994072 DOI: 10.1016/j.jjcc.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening disorder. SCAD is gaining importance as an emerging cause of acute coronary syndrome (ACS), especially in otherwise healthy young women. While SCAD and ACS show similarity in presentation, the management of SCAD differs to that of ACS. If not managed properly SCAD can lead to sudden death. This review examines the pathophysiology, clinical presentation, diagnostic algorithms, and the current and future management of SCAD.
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Affiliation(s)
| | - Eyad Abuelgasim
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Muhammed Kermali
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Syeda Anum Zahra
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Savini Hewage
- Faculty of Medicine, St George's, University of London, London, United Kingdom
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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[Troponin elevation in acute ischemic stroke-unspecific or acute myocardial infarction? : Diagnostics and clinical implications]. Herz 2020; 46:342-351. [PMID: 32632550 DOI: 10.1007/s00059-020-04967-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 01/01/2023]
Abstract
Routine determination of troponin levels is recommended for all patients with acute ischemic stroke. In 20-55% of these patients the troponin levels are elevated, which may be caused by ischemic as well as non-ischemic myocardial damage and particularly neurocardiogenic myocardial damage. In patients with acute ischemic stroke, the prevalence of previously unknown coronary heart disease is reported to be up to 27% and is prognostically relevant for these patients; however, relevant coronary stenoses are less frequently detected in stroke patients with troponin elevation compared to patients with non-ST elevation myocardial infarction. The risk of secondary intracerebral hemorrhage due to the necessity for dual platelet aggregation inhibition illustrates the challenging indication for invasive coronary diagnostics and revascularization. Therefore, a diagnostic work-up and interdisciplinary risk evaluation appropriate to the urgency are necessary in order to be able to determine a reasonable treatment approach with timing of the intervention, type and duration of blood thinning. In addition to conventional examination methods, multimodal cardiac imaging is increasingly used for this purpose. This review article aims to provide a pragmatic and clinically oriented approach to diagnostic and therapeutic procedures, taking into account the available evidence.
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Initial Imaging-Guided Strategy Versus Routine Care in Patients With Non-ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2020; 74:2466-2477. [PMID: 31727284 DOI: 10.1016/j.jacc.2019.09.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with non-ST-segment elevation myocardial infarction and elevated high-sensitivity cardiac troponin levels often routinely undergo invasive coronary angiography (ICA), but many do not have obstructive coronary artery disease. OBJECTIVES This study investigated whether cardiovascular magnetic resonance imaging (CMR) or computed tomographic angiography (CTA) may serve as a safe gatekeeper for ICA. METHODS This randomized controlled trial (NCT01559467) in 207 patients (age 64 years; 62% male patients) with acute chest pain, elevated high-sensitivity cardiac troponin T levels (>14 ng/l), and inconclusive electrocardiogram compared a CMR- or CTA-first strategy with a control strategy of routine clinical care. Follow-up ICA was recommended when initial CMR or CTA suggested myocardial ischemia, infarction, or obstructive coronary artery disease (≥70% stenosis). Primary efficacy and secondary safety endpoints were referral to ICA during hospitalization and 1-year outcomes (major adverse cardiac events and complications), respectively. RESULTS The CMR- and CTA-first strategies reduced ICA compared with routine clinical care (87% [p = 0.001], 66% [p < 0.001], and 100%, respectively), with similar outcome (hazard ratio: CMR vs. routine, 0.78 [95% confidence interval: 0.37 to 1.61]; CTA vs. routine, 0.66 [95% confidence interval: 0.31 to 1.42]; and CMR vs. CTA, 1.19 [95% confidence interval: 0.53 to 2.66]). Obstructive coronary artery disease after ICA was found in 61% of patients in the routine clinical care arm, in 69% in the CMR-first arm (p = 0.308 vs. routine), and in 85% in the CTA-first arm (p = 0.006 vs. routine). In the non-CMR and non-CTA arms, follow-up CMR and CTA were performed in 67% and 13% of patients and led to a new diagnosis in 33% and 3%, respectively (p < 0.001). CONCLUSIONS A novel strategy of implementing CMR or CTA first in the diagnostic process in non-ST-segment elevation myocardial infarction is a safe gatekeeper for ICA.
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Farzaneh-Far A, Romano S. Measuring longitudinal left ventricular function and strain using cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2020; 20:1259-1261. [PMID: 31157364 DOI: 10.1093/ehjci/jez097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
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Abstract
OBJECTIVE. Patients with cardiac implantable electronic devices (CIEDs) require cardiac MRI (CMRI) for a variety of reasons. The purpose of this study is to review and evaluate the value and safety of CMRI for patients with in situ CIEDs. CONCLUSION. Late gadolinium enhancement CMRI is the reference standard for assessing myocardial viability in patients with ventricular tachycardia before ablation of arrhythmogenic substrates. The use of late gadolinium enhancement CMRI for patients with CIEDs is safe as long as an imaging protocol is in place and precaution measures are taken.
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Batlle JC, Kirsch J, Bolen MA, Bandettini WP, Brown RKJ, Francois CJ, Galizia MS, Hanneman K, Inacio JR, Johnson TV, Khosa F, Krishnamurthy R, Rajiah P, Singh SP, Tomaszewski CA, Villines TC, Wann S, Young PM, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome. J Am Coll Radiol 2020; 17:S55-S69. [PMID: 32370978 DOI: 10.1016/j.jacr.2020.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/17/2022]
Abstract
Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Juan C Batlle
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida.
| | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | | | - W Patricia Bandettini
- National Institutes of Health, Bethesda, Maryland; Society for Cardiovascular Magnetic Resonance
| | | | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joao R Inacio
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas V Johnson
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Cardiology Expert
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin; Nuclear Cardiology Expert
| | | | | | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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49
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Carvalho FPD, Azevedo CFD. Coronary Slow Flow Phenomenon - Adding Myocardial Fibrosis to the Equation. Arq Bras Cardiol 2020; 114:552-553. [PMID: 32267329 PMCID: PMC7792736 DOI: 10.36660/abc.20200187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Filipe Penna de Carvalho
- Diagnósticos da América SA, Rio de Janeiro, RJ - Brasil
- Américas Serviços Médicos, Rio de Janeiro, RJ - Brasil
| | - Clério Francisco de Azevedo
- Diagnósticos da América SA, Rio de Janeiro, RJ - Brasil
- Duke University Hospital - Medicine/Cardiology, Durham, North Carolina - EUA
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50
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Comparison of direct stenting with conventional strategy on myocardial impairments in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging 2020; 36:1167-1175. [PMID: 32166507 DOI: 10.1007/s10554-020-01812-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
Direct stenting (DS) without pre-dilatation of the culprit lesion might improve myocardial perfusion and prognosis in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI); however, some studies report conflicting results. We investigated whether DS provides incremental myocardial benefits over conventional stenting (CS) in STEMI patients based on cardiac magnetic resonance imaging (CMR) measures. Reperfused patients who underwent CMR examinations within 1 week of STEMI onset were selected from a multicenter CMR registry of STEMI (NCT: 03768453). Patients were stratified into either a DS or CS group. Each group comprised 137 patients after 1:1 propensity score matching. Major adverse events (MACEs), including death, myocardial re-infarction, re-admission for heart failure, and stroke were noted during a median period of 44 months (interquartile range 32-58 months). DS was associated with larger (p = 0.007) and shorter (p = 0.005) stent sizes than CS. DS and CS achieved comparable angiographic TIMI-3 flow grades (p = 0.86) and myocardial blush grades (p = 0.70). There were no group differences regarding the incidence of CMR manifestations of microvascular dysfunction, including microvascular obstruction (MVO) (p = 0.89) and intramyocardial hemorrhage (p = 0.47), the extent of MVO (p = 0.21), infarction size (p = 0.83), or left ventricular ejection fraction (p = 0.57). Kaplan-Meier analysis revealed similar risks of MACEs (log rank p = 0.909), which occurred in 23.4% of DS and 26.3% of CS patients (p = 0.576). DS did not show any incremental benefits over CS on myocardial impairments as evaluated using CMR.Clinical Trial Registration: Clinicaltrials.gov, NCT: 03768453.
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