1
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Haney AC, Salatzki J, Hund H, Friedrich MG, Giannitsis E, Frey N, Steen H, Loßnitzer D, Riffel J, André F. Prognostic value of negative stress cardiac magnetic resonance imaging in patients with moderate-severe coronary artery stenosis. Front Cardiovasc Med 2023; 10:1264374. [PMID: 37868771 PMCID: PMC10588178 DOI: 10.3389/fcvm.2023.1264374] [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: 07/20/2023] [Accepted: 09/08/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aims to evaluate the prognostic value of stress cardiac magnetic resonance (CMR) without inducible ischemia in a real-world cohort of patients with known severe coronary artery stenosis. Background The prognosis of patients with severe coronary artery stenosis and without inducible ischemia using stress CMR remains uncertain, even though its identification of functionally significant coronary artery disease (CAD) is excellent. Materials and methods Patients without inducible ischemia and known CAD who underwent stress CMR between February 2015 and December 2016 were included in this retrospective study. These patients were divided into two groups: group 1 with stenosis of 50%-75% and group 2 with stenosis of >75%. The primary endpoint was defined as the occurrence of a major adverse cardiovascular event (MACE) [cardiac death, non-fatal myocardial infarction (MI), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG)]. Results Real-world data collected from 169 patients with a median age of 69 (60-75) years were included. The median follow-up was 5.5 (IQR 4.1-6.6) years. Events occurred after a mean time of 3.0 ± 2.2 years in group 1 and 3.7 ± 2.0 years in group 2 (p = 0.35). Sixteen (18.8%) patients in group 1 and 23 (27.4%) patients in group 2 suffered from MACE without a significant difference between the two groups (p = 0.33). In group 2, one cardiac death (1.2%), seven non-fatal MI (8.3%), 15 PCI (17.9%), and one CABG (1.2%) occurred. Conclusion The findings of this pilot study suggest that long-term outcomes in a real-world patient cohort with known severe and moderate coronary artery stenosis but without inducible ischemia were similar. Stress CMR may provide valuable risk stratification in patients with angiographically significant but hemodynamically non-obstructive coronary lesions.
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Affiliation(s)
- Ailís Ceara Haney
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hauke Hund
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Matthias G. Friedrich
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, QC, Canada
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Henning Steen
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dirk Loßnitzer
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- First Department of Medicine-Cardiology, University Medical Centre MannheimMannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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2
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Salatzki J, Ochs A, Kirchgäßner N, Heins J, Seitz S, Hund H, Mereles D, Friedrich MG, Katus HA, Frey N, André F, Ochs MM. Safety of Stress Cardiac Magnetic Resonance in Patients With Moderate to Severe Aortic Valve Stenosis. J Cardiovasc Imaging 2023; 31:26-38. [PMID: 36693342 PMCID: PMC9880345 DOI: 10.4250/jcvi.2022.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dobutamine and adenosine stress cardiac magnetic resonance (CMR) imaging is relatively contraindicated in patients with moderate to severe aortic valve stenosis (AS). We aimed to determine the safety of dobutamine and adenosine stress CMR in patients with moderate to severe AS. METHODS In this retrospective study patients with AS who underwent either dobutamine or adenosine stress CMR for exclusion of obstructive coronary artery disease were enrolled. We recorded clinical data, CMR and echocardiography findings, and complications as well as minor symptoms. Patients with AS were compared to matched individuals without AS. RESULTS A total of 187 patients with AS were identified and compared to age-, gender- and body mass index-matched 187 patients without AS. No severe complications were reported in the study nor the control group. The reported frequency of non-severe complications and minor symptoms were similar between the study and the control groups. Nineteen patients with AS experienced non-severe complications or minor symptoms during dobutamine stress CMR compared to eighteen patients without AS (p = 0.855). One patient with AS and two patients without AS undergoing adenosine stress CMR experienced minor symptoms (p = 0.562). Four examinations were aborted because of chest pain, paroxysmal atrial fibrillation and third-degree atrioventricular block. Inducible ischaemia, prior coronary artery bypass grafting, prior stroke and age were associated with a higher incidence of complications and minor symptoms. CONCLUSIONS Moderate to severe AS was not associated with complications during CMR stress test. The incidence of non-severe complications and minor symptoms was greater with dobutamine.
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Affiliation(s)
- Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Nadja Kirchgäßner
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jannick Heins
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Seitz
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hauke Hund
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Derliz Mereles
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Matthias G. Friedrich
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, Canada
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco M. Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
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3
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Minhas AS, Goerlich E, Corretti MC, Arbab-Zadeh A, Kelle S, Leucker T, Lerman A, Hays AG. Imaging Assessment of Endothelial Function: An Index of Cardiovascular Health. Front Cardiovasc Med 2022; 9:778762. [PMID: 35498006 PMCID: PMC9051238 DOI: 10.3389/fcvm.2022.778762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Endothelial dysfunction is a key early mechanism in a variety of cardiovascular diseases and can be observed in larger conduit arteries as well as smaller resistance vessels (microvascular dysfunction). The presence of endothelial dysfunction is a strong prognosticator for cardiovascular events and mortality, and assessment of endothelial function can aid in selecting therapies and testing their response. While the gold standard method of measuring coronary endothelial function remains invasive angiography, several non-invasive imaging techniques have emerged for investigating both coronary and peripheral endothelial function. In this review, we will explore and summarize the current invasive and non-invasive modalities available for endothelial function assessment for clinical and research use, and discuss the strengths, limitations and future applications of each technique.
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Affiliation(s)
- Anum S. Minhas
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Erin Goerlich
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Armin Arbab-Zadeh
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Thorsten Leucker
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amir Lerman
- Division of Ischemic Heart Disease and Critical Care, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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4
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Pezel T, Sanguineti F, Kinnel M, Hovasse T, Garot P, Unterseeh T, Champagne S, Louvard Y, Morice MC, Garot J. Prognostic value of dipyridamole stress perfusion cardiovascular magnetic resonance in elderly patients >75 years with suspected coronary artery disease. Eur Heart J Cardiovasc Imaging 2021; 22:904-911. [PMID: 32756995 DOI: 10.1093/ehjci/jeaa193] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/14/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS There are only very few data on the prognostic value of stress cardiovascular magnetic resonance (CMR) in elderly people, while life expectancy of the general population is steadily increasing. Therefore, this study aims to assess the prognostic value of vasodilator stress perfusion CMR in elderly >75 years. METHODS AND RESULTS Between 2008 and 2017, we included consecutive elderly >75 years without known coronary artery disease (CAD) referred for dipyridamole stress CMR. They were followed for the occurrence of major adverse cardiovascular events (MACE) including cardiac death or non-fatal myocardial infarction. Univariate and multivariate analyses were performed to determine the prognostic value of ischaemia or late gadolinium enhancement. Of 754 elderly individuals (82.0 ± 3.9 years, 48.4% men), 659 (87.4%) completed the follow-up with median follow-up of 4.7 years. Using Kaplan-Meier analysis, the presence of myocardial ischaemia was associated with the occurrence of MACE [hazard ratio (HR) 5.38, 95% confidence interval (CI): 3.56-9.56; P < 0.001]. In a multivariable Cox regression including clinical characteristics and CMR indexes, inducible ischaemia was an independent predictor of a higher incidence of MACE (HR 4.44, 95% CI: 2.51-7.86; P < 0.001). In patients without ischaemia, the occurrence of MACE was lower in women when compared with men (P < 0.01). CONCLUSION Stress CMR is safe and has discriminative prognostic value in elderly, with a significantly lower event rate of future cardiovascular event or death in subjects without ischaemia or infarction.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Marine Kinnel
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thomas Hovasse
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Philippe Garot
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Stéphane Champagne
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Yves Louvard
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Marie Claude Morice
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Jérôme Garot
- Department of Cardiology Cardiovascular Magnetic Resonance Laboratory, The Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
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5
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Buckert D, Witzel S, Steinacker JM, Rottbauer W, Bernhardt P. Comparing Cardiac Magnetic Resonance-Guided Versus Angiography-Guided Treatment of Patients With Stable Coronary Artery Disease: Results From a Prospective Randomized Controlled Trial. JACC Cardiovasc Imaging 2019; 11:987-996. [PMID: 29976305 DOI: 10.1016/j.jcmg.2018.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was the prospective and randomized evaluation of cardiovascular endpoints and quality of life in patients with stable coronary artery disease comparing a cardiac magnetic resonance (CMR)-based management strategy with a coronary angiography-based approach. BACKGROUND Evidence from trials prospectively evaluating the role of CMR in clinical pathways and decision processes is limited. METHODS Patients with symptomatic CAD were randomized to diagnostic coronary angiography (group 1) or adenosine stress CMR (group 2). The primary endpoint was the composite of cardiac death and nonfatal myocardial infarction. Quality of life was assessed using the Seattle Angina Questionnaire at baseline and during follow-up. RESULTS Two hundred patients were enrolled. In group 1, 45 revascularizations (45.9%) were performed. In group 2, 27 patients (28.1%) were referred to revascularization because of ischemia on CMR. At 12-month follow-up, 7 primary events occurred: 3 in group 1 (event rate 3.1%) and 4 in group 2 (event rate 4.2%), with no statistically significant difference (p = 0.72). Within the next 2 years, 6 additional events could be observed, giving 4 events in group 1 and 9 events in group 2 (event rate 4.1% vs. 9.4%; p = 0.25). Group 2 showed significant quality-of-life improvement after 1 year in comparison to group 1. CONCLUSIONS A CMR-based management strategy for patients with stable coronary artery disease was safe, reduced revascularization procedures, and resulted in better quality of life at 12-month follow-up, though noninferiority could not be proved. Optimal timing for reassessment remains to be investigated. (Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary Intervention [MAGnet]; NCT02580851).
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Affiliation(s)
- Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.
| | - Simon Witzel
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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6
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Abstract
Heart disease is the leading cause of death among women in the industrialized world. However, women after myocardial infarctions (MIs) are less likely to receive preventive medications or revascularization and as many as 47% experience heart failure, stroke or die within 5 years. Premenopausal women with MIs frequently have coronary plaque erosions or dissections. Women under 50 years with angina and nonobstructive epicardial coronary artery disease often have coronary microvascular dysfunction (CMD) with reductions in coronary flow reserve that may require nontraditional therapies. In women with coronary artery disease treated with stents, the 3-year incidence of recurrent MI or death is 9.2%. Coronary bypass surgery operative mortality averages 4.6% for women compared with 2.4% in men. Addition of internal mammary artery and radial artery coronary grafts in women does not increase operative survival but improves 5-year outcome to greater than 80%.
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7
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Stoiber L, Schnackenburg B, Gebker R, Hireche-Chikaoui H, Pieske B, Kelle S. CMR stress testing in a patient with morbid obesity (BMI 58 kg/m 2) and suspected coronary artery disease. BMC Cardiovasc Disord 2018; 18:47. [PMID: 29506495 PMCID: PMC5838924 DOI: 10.1186/s12872-018-0779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Severe obesity is asscociated with an increased risk of coronary artery disease (CAD) but non-invasive cardiac imaging modalities have important technical limits. Case presentation We report a case of a 58-year old patient with suspected CAD and severely elevated BMI of 58 kg/m2. Conclusions Stress-CMR was able to non-invasively stratify risk with good imaging quality despite the body dimensions of the patient.
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Affiliation(s)
- Lukas Stoiber
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
| | | | - Rolf Gebker
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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8
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Peterzan MA, Rider OJ, Anderson LJ. The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure. Card Fail Rev 2016; 2:115-122. [PMID: 28785465 PMCID: PMC5490982 DOI: 10.15420/cfr.2016.2.2.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/24/2016] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular imaging is key for the assessment of patients with heart failure. Today, cardiovascular magnetic resonance imaging plays an established role in the assessment of patients with suspected and confirmed heart failure syndromes, in particular identifying aetiology. Its role in informing prognosis and guiding decisions around therapy are evolving. Key strengths include its accuracy; reproducibility; unrestricted field of view; lack of radiation; multiple abilities to characterise myocardial tissue, thrombus and scar; as well as unparalleled assessment of left and right ventricular volumes. T2* has an established role in the assessment and follow-up of iron overload cardiomyopathy and a role for T1 in specific therapies for cardiac amyloid and Anderson-Fabry disease is emerging.
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Affiliation(s)
- Mark A Peterzan
- Cardiology Clinical Academic GroupSt George’s Hospital, London, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Lisa J Anderson
- Cardiology Clinical Academic GroupSt George’s Hospital, London, UK
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9
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Giusca S, Kelle S, Nagel E, Buss S, Voss A, Puntmann V, Fleck E, Katus H, Korosoglou G. Differences in the prognostic relevance of myocardial ischaemia and scar by cardiac magnetic resonance in patients with and without diabetes mellitus. Eur Heart J Cardiovasc Imaging 2016; 17:812-820. [DOI: 10.1093/ehjci/jev220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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10
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Guaricci AI, Brunetti ND, Marra MP, Tarantini G, di Biase M, Pontone G. Diagnosis and prognosis of ischemic heart disease. J Cardiovasc Med (Hagerstown) 2015; 16:653-62. [DOI: 10.2459/jcm.0000000000000267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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11
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Comparison of coronary magnetic resonance and computed tomography angiography for prediction of cardiovascular events. JACC Cardiovasc Imaging 2015; 7:1063-5. [PMID: 25323169 DOI: 10.1016/j.jcmg.2014.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 11/24/2022]
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12
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Kato S, Saito N, Kirigaya H, Gyotoku D, Iinuma N, Kusakawa Y, Iguchi K, Nakachi T, Fukui K, Futaki M, Iwasawa T, Taguri M, Kimura K, Umemura S. Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease. Heart Vessels 2015; 31:871-80. [DOI: 10.1007/s00380-015-0685-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
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13
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Buss SJ, Krautz B, Hofmann N, Sander Y, Rust L, Giusca S, Galuschky C, Seitz S, Giannitsis E, Pleger S, Raake P, Most P, Katus HA, Korosoglou G. Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement. Int J Cardiol 2015; 183:162-70. [PMID: 25675901 DOI: 10.1016/j.ijcard.2015.01.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/23/2014] [Accepted: 01/04/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate whether myocardial deformation imaging, assessed by feature tracking cardiac magnetic resonance (FTI-CMR), would allow objective quantification of myocardial strain and estimation of functional recovery in patients with first time ST-elevation myocardial infarction (STEMI). METHODS Cardiac magnetic resonance (CMR) imaging was performed in 74 consecutive patients 2-4 days after successfully reperfused STEMI, using a 1.5T CMR scanner (Philips Achieva). Peak systolic circumferential and longitudinal strains were measured using the FTI applied to SSFP cine sequences and were compared to infarct size, determined by late gadolinium enhancement (LGE). Follow-up CMR at 6 months was performed in order to assess residual ejection fraction, which deemed as the reference standard for the estimation of functional recovery. RESULTS During the follow-up period 53 of 74 (72%) patients exhibited preserved residual ejection fraction ≥50%. A cut-off value of -19.3% for global circumferential strain identified patients with preserved ejection fraction ≥50% at follow-up with sensitivity of 76% and specificity of 85% (AUC=0.86, 95% CI=0.75-0.93, p<0.001), which was superior to that provided by longitudinal strain (ΔAUC=0.13, SE=0.05, z-statistic=2.5, p=0.01), and non-inferior to that provided by LGE (ΔAUC=0.07, p=NS). Multivariate analysis showed that global circumferential strain and LGE exhibited independent value for the prediction of preserved LV-function, surpassing that provided by age, diabetes and baseline ejection fraction (HR=1.4, 95% CI=1.0-1.9 and HR=1.4, 95% CI=1.1-1.7, respectively, p<0.05 for both). CONCLUSIONS Estimation of circumferential strain by FTI provides objective assessment of infarct size without the need for contrast agent administration and estimation of functional recovery with non-inferior accuracy compared to that provided by LGE.
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Affiliation(s)
- Sebastian J Buss
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Birgit Krautz
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Nina Hofmann
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Yannick Sander
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Lukas Rust
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Sorin Giusca
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | | | - Sebastian Seitz
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Sven Pleger
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Philip Raake
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Patrick Most
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, University of Heidelberg, INF 410, 69120 Heidelberg, Germany.
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14
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Kelle S, Giusca S, Buss SJ, Fleck E, Katus HA, Korosoglou G. BMI does not influence the prediction of cardiac events using stress CMR. Int J Cardiol 2015; 179:31-3. [DOI: 10.1016/j.ijcard.2014.10.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 12/21/2022]
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Giusca S, Kelle S, Nagel E, Buss SJ, Puntmann V, Wellnhofer E, Fleck E, Katus HA, Korosoglou G. Ischemic burden and clinical outcome: is one 'culprit' ischemic segment by dobutamine stress magnetic resonance predictive? PLoS One 2014; 9:e115182. [PMID: 25517506 PMCID: PMC4269427 DOI: 10.1371/journal.pone.0115182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/19/2014] [Indexed: 01/17/2023] Open
Abstract
AIMS We sought to evaluate the impact of ischemic burden for the prediction of hard cardiac events (cardiac death or nonfatal myocardial infarction) in patients with known or suspected CAD who undergo dobutamine stress cardiac magnetic resonance imaging (DCMR). METHODS We included 3166 patients (pts.), mean age 63 ± 12 years, 27% female, who underwent DCMR in 3 tertiary cardiac centres (University Hospital Heildelberg, German Heart Institute and Kings College London). Pts. were separated in groups based on the number of ischemic segments by wall motion abnormalities (WMA) as follows: 1. no ischemic segment, 2. one ischemic segment, 3. two ischemic segments and 4. ≥ three ischemic segments. Cardiac death and nonfatal myocardial infarction were registered as hard cardiac events. Pts. with an "early" revascularization procedure (in the first three months after DCMR) were not included in the final survival analysis. RESULTS Pts. were followed for a median of 3.1 years (iqr 2-4.5 years). 187 (5.9%) pts. experienced hard cardiac events. 2349 (74.2%) had no inducible ischemia, 189 (6%) had ischemia in 1 segment, 292 (9.2%) in 2 segments and 336 (10.6%) ≥ 3 segments. Patients with only 1 ischemic segment showed a high rate of hard cardiac events of ∼ 6% annually, which was 10-fold higher compared to those without ischemia (0.6% annually, p < 0.001) but similar to those with 2 and ≥ 3 ischemic segments (∼ 5.5% and ∼ 7%, p = NS). CONCLUSIONS The presence of inducible ischemia even in a single 'culprit' myocardial segment during DCMR is enough to predict hard cardiac events in patients with known or suspected CAD.
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Affiliation(s)
- Sorin Giusca
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - Sebastian Kelle
- German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Eike Nagel
- King's College London, Division of Imaging Sciences, London, United Kingdom
| | | | - Valentina Puntmann
- King's College London, Division of Imaging Sciences, London, United Kingdom
| | - Ernst Wellnhofer
- German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Eckart Fleck
- German Heart Institute Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Hugo Albert Katus
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
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Petrov G, Kelle S, Fleck E, Wellnhofer E. Incremental cost-effectiveness of dobutamine stress cardiac magnetic resonance imaging in patients at intermediate risk for coronary artery disease. Clin Res Cardiol 2014; 104:401-9. [PMID: 25395355 PMCID: PMC4544498 DOI: 10.1007/s00392-014-0793-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/10/2014] [Indexed: 01/12/2023]
Abstract
Aims The effectiveness of stress cardiac magnetic resonance (CMR) as a gatekeeper for coronary angiography (CA) has been established. Level five HTA studies according to the hierarchical model of diagnostic test evaluation are not available. Methods This cohort study included 1,158 consecutive patients (mean age 63 ± 11 years, 42 % women) presenting at our institution between January 1, 2003 and December 31, 2004 with suspected coronary artery disease (CAD) for an elective CA. The patients were assessed for eligibility and propensity score matching was applied to address selection bias regarding the patients’ allocation to CMR or direct CA. Median patient follow-up was 7.9 years (95 % CI 7.8–8.0 years). The primary effect was calculated as relative survival difference. The cost unit calculation (per patient) at our institute was the source of costs. Results Survival was similar in CMR and CA (p = 0.139). Catheterizations ruling out CAD were significantly reduced by the CMR gate-keeper strategy. Patients with prior CMR had significantly lower costs at the initial hospital stay and at follow-up (CMR vs. CA, initial: 2,904€ vs. 3,421€, p = 0.018; follow-up: 2,045€ vs. 3,318€, p = 0.037). CMR was cost-effective in terms of a contribution of 12,466€ per life year to cover a part of the CMR costs. Conclusion Stress CMR prior to CA was saving 12,466€ of hospital costs per life year. Lower costs at follow-up suggest sustained cost-effectiveness of the CMR-guided strategy. Electronic supplementary material The online version of this article (doi:10.1007/s00392-014-0793-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- George Petrov
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Eckart Fleck
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ernst Wellnhofer
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Korosoglou G, Giusca S, Gitsioudis G, Erbel C, Katus HA. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification. Front Physiol 2014; 5:291. [PMID: 25147526 PMCID: PMC4123729 DOI: 10.3389/fphys.2014.00291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/18/2014] [Indexed: 12/18/2022] Open
Abstract
Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.
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18
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Doltra A, Skorin A, Hamdan A, Schnackenburg B, Gebker R, Klein C, Nagel E, Fleck E, Kelle S. Comparison of acquisition time and dose for late gadolinium enhancement imaging at 3.0 T in patients with chronic myocardial infarction using Gd-BOPTA. Eur Radiol 2014; 24:2192-200. [DOI: 10.1007/s00330-014-3213-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/13/2014] [Accepted: 04/30/2014] [Indexed: 01/15/2023]
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Shah RV, Heydari B, Coelho-Filho O, Abbasi SA, Feng JH, Neilan TG, Francis S, Blankstein R, Steigner M, Jerosch-Herold M, Kwong RY. Vasodilator stress perfusion CMR imaging is feasible and prognostic in obese patients. JACC Cardiovasc Imaging 2014; 7:462-72. [PMID: 24726254 PMCID: PMC4110212 DOI: 10.1016/j.jcmg.2013.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 11/14/2013] [Accepted: 11/22/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to determine feasibility and prognostic performance of stress cardiac magnetic resonance (CMR) in obese patients (body mass index [BMI] ≥30 kg/m(2)). BACKGROUND Current stress imaging methods remain limited in obese patients. Given the impact of the obesity epidemic on cardiovascular disease, alternative methods to effectively risk stratify obese patients are needed. METHODS Consecutive patients with a BMI ≥30 kg/m(2) referred for vasodilating stress CMR were followed for major adverse cardiovascular events (MACE), defined as cardiac death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR beyond traditional clinical risk indexes. RESULTS Of 285 obese patients, 272 (95%) completed the CMR protocol, and among these, 255 (94%) achieved diagnostic imaging quality. Mean BMI was 35.4 ± 4.8 kg/m(2), with a maximum weight of 200 kg. Reasons for failure to complete CMR included claustrophobia (n = 4), intolerance to stress agent (n = 4), poor gating (n = 4), and declining participation (n = 1). Sedation was required in 19 patients (7%; 2 patients with intravenous sedation). Sixteen patients required scanning by a 70-cm-bore system (6%). Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (0.3% vs. 6.3% for those with ischemia and 6.7% for those with ischemia and LGE). Median follow-up of the cohort was 2.1 years. In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, inducible ischemia (hazard ratio 7.5; 95% confidence interval: 2.0 to 28.0; p = 0.002) remained independently associated with MACE. When patients with early coronary revascularization (within 90 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong association with MACE. CONCLUSIONS Stress CMR is feasible and effective in prognosticating obese patients, with a very low negative event rate in patients without ischemia or infarction.
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Affiliation(s)
- Ravi V Shah
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bobak Heydari
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Otavio Coelho-Filho
- Cardiology Division, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Siddique A Abbasi
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jiazhuo H Feng
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tomas G Neilan
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjeev Francis
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Steigner
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Doltra A, Schneeweis C, Fleck E, Kelle S. Cardiac magnetic resonance for prognostic assessment: present applications and future directions. Expert Rev Cardiovasc Ther 2014; 12:771-82. [PMID: 24754461 DOI: 10.1586/14779072.2014.910117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiac magnetic resonance is increasingly used in clinical practice for both diagnostic and prognostic purposes. In the field of ischemic heart disease, perfusion imaging permits the assessment of ischemia, which is strongly related to future cardiac events and mortality. Late gadolinium enhancement is also associated with the prognosis and can be used as a marker of functional recovery. Cardiac magnetic resonance also permits the detection of microvascular obstruction and infarct hemorrhage, both related to an adverse outcome. In non-ischemic heart disease, the presence of late gadolinium enhancement is linked to mortality and hard events. Finally, coronary angiography, as well as new techniques, such as T1 mapping, may also have a prognostic role.
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Affiliation(s)
- Adelina Doltra
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1,13353 Berlin, Germany
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21
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Nagel E, Shaw LJ. The assessment of ischaemic burden: thoughts on definition and quantification. Eur Heart J Cardiovasc Imaging 2014; 15:610-1. [DOI: 10.1093/ehjci/jeu029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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22
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Mahfoud F, Urban D, Teller D, Linz D, Stawowy P, Hassel JH, Fries P, Dreysse S, Wellnhofer E, Schneider G, Buecker A, Schneeweis C, Doltra A, Schlaich MP, Esler MD, Fleck E, Böhm M, Kelle S. Effect of renal denervation on left ventricular mass and function in patients with resistant hypertension: data from a multi-centre cardiovascular magnetic resonance imaging trial. Eur Heart J 2014; 35:2224-31b. [PMID: 24603307 DOI: 10.1093/eurheartj/ehu093] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS Sympathetic stimulation induces left ventricular hypertrophy and is associated with increased cardiovascular risk. Catheter-based renal denervation (RDN) has been shown to reduce sympathetic outflow and blood pressure (BP). The present multi-centre study aimed to investigate the effect of RDN on anatomic and functional myocardial parameters, assessed by cardiac magnetic resonance (CMR), in patients with resistant hypertension. METHODS AND RESULTS Cardiac magnetic resonance was performed in 72 patients (mean age 66 ± 10 years) with resistant hypertension (55 patients underwent RDN, 17 served as controls) at baseline and after 6 months. Clinical data and CMR results were analysed blindly. Renal denervation significantly reduced systolic and diastolic BP by 22/8 mm Hg and left ventricular mass index (LVMI) by 7.1% (46.3 ± 13.6 g/m(1.7) vs. 43.0 ± 12.6 g/m(1.7), P < 0.001) without changes in the control group (41.9 ± 10.8 g/m(1.7) vs. 42.0 ± 9.7 g/m(1.7), P = 0.653). Ejection fraction (LVEF) in patients with impaired LVEF at baseline (<50%) significantly increased after RDN (43% vs. 50%, P < 0.001). Left ventricular circumferential strain as a surrogate of diastolic function in the subgroup of patients with reduced strain at baseline increased by 21% only in the RDN group (-14.8 vs. -17.9; P = 0.001) and not in control patients (-15.5 vs. -16.4, P = 0.508). CONCLUSIONS Catheter-based RDN significantly reduced BP and LVMI and improved EF and circumferential strain in patients with resistant hypertension, occurring partly BP independently.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Daniel Urban
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Desiree Teller
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Philipp Stawowy
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Jan-Hendrik Hassel
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Peter Fries
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan Dreysse
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Ernst Wellnhofer
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Günther Schneider
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Arno Buecker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Adelina Doltra
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Murray D Esler
- Baker IDI Heart & Diabetes Institute, Melbourne, Australia
| | - Eckart Fleck
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Kelle
- Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Berlin, Germany
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Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN RADIOLOGY 2014; 2014:365404. [PMID: 24967294 PMCID: PMC4045555 DOI: 10.1155/2014/365404] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient's prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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Bikiri E, Mereles D, Voss A, Greiner S, Hess A, Buss SJ, Hofmann NP, Giannitsis E, Katus HA, Korosoglou G. Dobutamine stress cardiac magnetic resonance versus echocardiography for the assessment of outcome in patients with suspected or known coronary artery disease. Are the two imaging modalities comparable? Int J Cardiol 2014; 171:153-60. [DOI: 10.1016/j.ijcard.2013.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/12/2013] [Accepted: 11/17/2013] [Indexed: 12/01/2022]
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Palios J, Karangelis D, Roubelakis A, Lerakis S. The prominent role of cardiac magnetic resonance imaging in coronary artery disease. Expert Rev Cardiovasc Ther 2014; 12:167-74. [DOI: 10.1586/14779072.2014.877344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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26
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[Cardiac magnetic resonance imaging: from imaging to diagnosis]. Radiologe 2013; 53:1033-52. [PMID: 24231826 DOI: 10.1007/s00117-013-2533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) has evolved over the past 20 years from a research-based imaging modality to an indispensable routine procedure in cardiac diagnostics. In addition to the morphological representation of cardiac anatomy, whereby only noninvasive multidetector computed tomography (MDCT) is superior, another strength of CMR is the assessment of cardiac function and tissue differentiation. This requires that the radiologist performing the examination and analyzing the results has good knowledge of cardiac and thoracic anatomy and a detailed knowledge of the various cardiovascular diseases, hemodynamics, and pathophysiology. CMR reliably allows determination of a range of easy to determine quantitative parameters such as ventricular ejection fraction and also the valvular regurgitation fraction, which allows objective assessment of cardiac function. Especially the possibility to differentiate inflamed, viable, and ischemic tissue using adenosine stress MRI in the last 10 years has led to routine use of CMR. Even compared to competing nuclear medicine procedures, CMR is important for treatment decision-making and for prognosis estimation, thus, making it an indispensable component of cardiovascular diagnostics.
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Magnetic resonance imaging of cardiovascular fibrosis and inflammation: from clinical practice to animal studies and back. BIOMED RESEARCH INTERNATIONAL 2013; 2013:676489. [PMID: 24058912 PMCID: PMC3766566 DOI: 10.1155/2013/676489] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/13/2013] [Accepted: 07/21/2013] [Indexed: 01/29/2023]
Abstract
Late gadolinium enhancement is the technique of choice for detecting myocardial fibrosis. Although this technique is used in a wide range of cardiovascular pathologies, ischemic cardiomyopathy and the workup for myocarditis and other cardiomyopathies make up a significant proportion of the total indications. Multiple studies during the last decade have demonstrated its utility to adequately characterize myocardial tissue and offer diagnostic and prognostic information. Recent T1 mapping techniques aim to overcome the limitations of late gadolinium enhancement to assess diffuse fibrosis. 19F magnetic resonance has recently emerged as a promising technique for the assessment of inflammation. In the following review we will discuss the basic aspects of fibrosis assessment with MR and its utility for diagnostic and prognostic evaluation. We will also address the topic of cardiovascular inflammation imaging with 19F as a potential new development that may broaden the indications for MR in the future.
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