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Schmitt R, Staats C, Kaier K, Ahlgrim C, Hein M, Brado J, Steinhoff P, Billig H, Soschynski M, Krauss T, Schlett CL, Westermann D, Neumann FJ, Ruile P, Breitbart P. Correlation of greyzone fibrosis compared to troponin T and late gadolinium enhancement with survival and ejection fraction in patients after acute myocardial infarction. Clin Res Cardiol 2024:10.1007/s00392-024-02536-w. [PMID: 39230714 DOI: 10.1007/s00392-024-02536-w] [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: 04/17/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024]
Abstract
AIMS To quantify greyzone fibrosis (GZF) in patients after acute myocardial infarction (MI) and to evaluate its correlation with MI-free survival and improvements in left ventricular ejection fraction (LVEF) compared with the established risk factors high-sensitivity cardiac troponin T (hs-cTnT) and Late Gadolinium Enhancement (LGE). METHODS AND RESULTS The study involved 176 patients who experienced acute MI and underwent cardiac magnetic resonance (CMR) prior to hospital discharge, followed by a second CMR on average six months later. LGE was quantified in both examinations, a separate analysis of the GZF was conducted only in the follow-up CMR after resolution of the initial infarct edema. LVEF was measured in both CMR. hs-cTnT levels were assessed at hospital admission, as well as 8, 16, 24, 48 and 72 h after coronary intervention. Telephone follow-ups were conducted annually for up to 8 years. LGE measurements showed better correlation with MI-free survival (Harrell's C of 0.711 of LGE mass) compared to GZF (0.579 of GZF mass). Additionally, hs-cTnT outperformed GZF (Harrell's C of 0.645). As an univariable predictor for MI-free survival, only hs-cTnT reached significance (p < 0.05). With regard to improvements in ejection fraction, both hs-cTnT and LGE measurements showed acceptable correlation with improvement in ejection fraction (p < 0.05), while GZF measurements showed no correlation (p > 0.5). CONCLUSIONS In CMR, the assessment of GZF demonstrated inferior p correlation compared to hs-cTnT and LGE in patients after acute MI with respect to the endpoint of MI-free survival. Furthermore, GZF showed no correlation with the improvement of LVEF.
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Affiliation(s)
- Ramona Schmitt
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.
| | - Clara Staats
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Ahlgrim
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Johannes Brado
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Steinhoff
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Hannah Billig
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
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Pantos CI, Grigoriou KP, Trikas AG, Alexopoulos NA, Mourouzis IS. Translating thyroid hormone into clinical practice: lessons learned from the post-hoc analysis on data available from the ThyRepair study. Front Endocrinol (Lausanne) 2024; 15:1405251. [PMID: 39129922 PMCID: PMC11310054 DOI: 10.3389/fendo.2024.1405251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Background Thyroid hormone (TH) appears to have a reparative action on the postinfarcted myocardium. This novel action was recently tested in a pilot, randomized, double-blind, placebo-controlled trial (ThyRepair). The present study performed a post-hoc analysis of data from the ThyRepair study to provide further insights into the novel actions of TH on the human postischemic myocardium. Methods Data from 41 patients participating in the ThyRepair study (n = 20 placebo and n = 21 LT3) were included in the analysis. LT3 treatment started after stenting and continued intravenously for 48 h. All patients had cardiac magnetic resonance (CMR) at hospital discharge; left ventricular (LV) ejection fraction (LVEF%), LV end-diastolic volume index (LVEDVi; mL/m2), LV end-systolic volume index (LVESVi; mL/m2), infarct volume (IV), left ventricular mass index (LVMi) as edema index, and microvascular obstruction (MVO) were assessed. Patients were divided into two groups based on the median value of the IV: patients with IV ≤ 20% of the LV (group A) and patients with IV > 20% (group B). CMR measurements at discharge are expressed as mean ± SD. Results In group A, the placebo and T3-treated groups had similar LVEF% (56.8 ± 10.2 vs. 52.2 ± 10.5), LVEDVi (90.9 ± 19.8 vs. 92.8 ± 14.5), and LVESVi (40.8 ± 18.2 vs. 44.9 ± 14.1) at discharge. In group B, LVEDVi and LVESVi were 112 ± 23.8 and 68.3 ± 21.5 for placebo vs. 91.8 ± 18.6 and 49.0 ± 14.0 for the T3-treated group, respectively, p < 0.05. LVEF% was significantly increased in the T3-treated group vs. placebo, 47.3 ± 6.5 vs. 39.9 ± 8.7, p < 0.05. In group B, CMR LVMi was lower in T3-treated patients vs. placebo but did not reach statistical significance (p = 0.1). MVO was 1.95 ± 2.2 in placebo vs. 0.84 ± 0.9 in the LT3-treated group, p = 0.15. Conclusion The present study suggests that acute LT3 treatment may exert more favorable effects on the recovery of cardiac function in patients with large infarct size. Furthermore, it signals a potential effect of LT3 on myocardial edema and microvascular obstruction. These novel findings merit further investigation in large trials.
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Affiliation(s)
- Constantinos I. Pantos
- Department of Pharmacology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Nikolaos A. Alexopoulos
- Department of Radiology, IASO Hospital of Athens, Athens, Greece
- Cardiovascular Imaging Unit, Department of Radiology Athens Euroclinic, Athens, Greece
| | - Iordanis S. Mourouzis
- Department of Pharmacology, National and Kapodistrian University of Athens, Athens, Greece
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Eggers KM, Lindhagen L, Lindahl B. Cardiovascular medications, high-sensitivity cardiac troponin T concentrations, and long-term outcome in non-ST segment elevation acute coronary syndrome. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:559-562. [PMID: 38842355 PMCID: PMC11265804 DOI: 10.1093/ehjacc/zuae069] [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: 02/06/2024] [Revised: 04/03/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
AIMS Cardiac troponin plays an essential role in the management of non-ST segment elevation acute coronary syndrome (NSTE-ACS). However, it is not clear whether troponin concentrations provide guidance regarding the initiation of prognostically beneficial cardiovascular medications [i.e. betablockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, and statins] in NSTE-ACS. METHODS AND RESULTS Registry-based study investigating three NSTE-ACS cohorts (n = 43 075, 40 162, and 46 698) with elevated high-sensitivity cardiac troponin concentrations >14 ng/L. Cox proportional regression models with the addition of interaction terms were used to analyse the interrelations of high-sensitivity cardiac troponin T (hs-cTnT) concentrations, new initiated medications with the respective three drug classes, and long-term risk of all-cause mortality and major adverse events (MAE). Betablockers were associated with risk reductions of 8 and 5% regarding all-cause mortality and MAE, respectively. There was no evidence of an interaction with hs-cTnT concentrations. RAAS inhibitors were associated with 13 and 8% risk reductions, respectively, with a weak interaction between hs-cTnT and MAE (Pinteraction = 0.016). However, no increasing prognostic benefit was noted at hs-cTnT concentrations >100 ng/L. Statins were associated with 38 and 32% risk reductions, respectively, with prognostic benefit across the entire range of hs-cTnT concentrations, and with a weak interaction regarding MAE (Pinteraction = 0.011). CONCLUSION Cardiovascular medications provide different prognostic benefit in patients with NSTE-ACS with elevated hs-cTnT, and there was some evidence of greater treatment effects regarding MAE along with higher hs-cTnT concentrations. However, hs-cTnT appears only to have limited value overall for customizing such treatments.
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Affiliation(s)
- Kai M Eggers
- Cardiology, Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lars Lindhagen
- Cardiology, Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Cardiology, Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Wang D, Li X, Feng W, Zhou H, Peng W, Wang X. Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1360648. [PMID: 38685980 PMCID: PMC11057370 DOI: 10.3389/fcvm.2024.1360648] [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: 01/10/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Background The angiography-derived index of microvascular resistance (A-IMR) is a novel tool for diagnosing coronary microvascular dysfunction (CMD) addressing limitation of unavailability. However, the clinical value of A-IMR remains controversial. Methods A systematic review and meta-analysis was conducted. PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies. Studies that reported estimates of A-IMR's diagnostic accuracy (with thermodilution-based IMR as the reference test) and/or predictions of adverse cardiovascular events were selected. Pooled sensitivity, specificity, area under the summary receiver operating characteristic curve (sROC) were calculated to measure diagnostic performance; pooled hazard/risk ratio (HR/RR) and 95% confidence interval (95% CI) of major adverse cardiovascular events (MACE) or other independent adverse events were calculated to measure prognostic effect. This study was registered with PROSPERO (CRD42023451884). Results A total of 12 diagnostic studies pooling 1,642 vessels and 12 prognostic studies pooling 2,790 individuals were included. A-IMR yielded an area under sROC of 0.93 (95% CI: 0.91, 0.95), a pooled sensitivity of 0.85 (95% CI: 0.79, 0.89) and a pooled specificity of 0.89 (95% CI: 0.83, 0.93) for the diagnosis of CMD. CMD diagnosed using A-IMR was associated with higher risks of MACE (HR, 2.73, 95% CI: 2.16, 3.45), CV death (RR, 2.39, 95% CI: 1.49, 3.82) and heart failure hospitalization (HR, 2.30, 95% CI: 1.53, 3.45). Conclusion A-IMR demonstrated high diagnostic accuracy for CMD and showed a strong prognostic capability in predicting the risk of adverse CV outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451884, PROSPERO (CRD42023451884).
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Affiliation(s)
- Dayang Wang
- Cardiovascular Institute, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoming Li
- Center of Intervention, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Feng
- Cardiovascular Institute, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hufang Zhou
- Cardiovascular Institute, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenhua Peng
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Pei Z, Qiu J, Zhao Y, Song S, Wang R, Luo W, Cai X, Liu B, Chen H, Yin J, Weng X, Wu Y, Li C, Shen L, Ge J. A novel intracoronary hypothermia device reduces myocardial reperfusion injury in pigs. Chin Med J (Engl) 2024:00029330-990000000-00988. [PMID: 38445387 DOI: 10.1097/cm9.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury. METHODS This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (5 and 42 days post-MI) and a series of biomarkers/histological studies were performed. RESULTS The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH. CONCLUSIONS The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.
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Affiliation(s)
- Zhiqiang Pei
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Jin Qiu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Yongchao Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Shuai Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Rui Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Wei Luo
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xingxing Cai
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 201322, China
| | - Bin Liu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Han Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xinyu Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Li Shen
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
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van de Veerdonk MC, Roosma L, Trip P, Gopalan D, Vonk Noordegraaf A, Dorfmüller P, Nossent EJ. Clinical-imaging-pathological correlation in pulmonary hypertension associated with left heart disease. Eur Respir Rev 2024; 33:230144. [PMID: 38417969 PMCID: PMC10900069 DOI: 10.1183/16000617.0144-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 03/01/2024] Open
Abstract
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.
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Affiliation(s)
- Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lize Roosma
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Pia Trip
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany
| | - Esther J Nossent
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Carmo HRP, Bonilha I, Barreto J, Tognolini M, Zanotti I, Sposito AC. High-Density Lipoproteins at the Interface between the NLRP3 Inflammasome and Myocardial Infarction. Int J Mol Sci 2024; 25:1290. [PMID: 38279290 PMCID: PMC10816227 DOI: 10.3390/ijms25021290] [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: 12/30/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Despite significant therapeutic advancements, morbidity and mortality following myocardial infarction (MI) remain unacceptably high. This clinical challenge is primarily attributed to two significant factors: delayed reperfusion and the myocardial injury resulting from coronary reperfusion. Following reperfusion, there is a rapid intracellular pH shift, disruption of ionic balance, heightened oxidative stress, increased activity of proteolytic enzymes, initiation of inflammatory responses, and activation of several cell death pathways, encompassing apoptosis, necroptosis, and pyroptosis. The inflammatory cell death or pyroptosis encompasses the activation of the intracellular multiprotein complex known as the NLRP3 inflammasome. High-density lipoproteins (HDL) are endogenous particles whose components can either promote or mitigate the activation of the NLRP3 inflammasome. In this comprehensive review, we explore the role of inflammasome activation in the context of MI and provide a detailed analysis of how HDL can modulate this process.
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Affiliation(s)
- Helison R. P. Carmo
- Atherosclerosis and Vascular Biology Laboratory (Aterolab), Division of Cardiology, State University of Campinas (UNICAMP), Campinas 13084-971, SP, Brazil; (H.R.P.C.); (I.B.); (J.B.); (A.C.S.)
| | - Isabella Bonilha
- Atherosclerosis and Vascular Biology Laboratory (Aterolab), Division of Cardiology, State University of Campinas (UNICAMP), Campinas 13084-971, SP, Brazil; (H.R.P.C.); (I.B.); (J.B.); (A.C.S.)
| | - Joaquim Barreto
- Atherosclerosis and Vascular Biology Laboratory (Aterolab), Division of Cardiology, State University of Campinas (UNICAMP), Campinas 13084-971, SP, Brazil; (H.R.P.C.); (I.B.); (J.B.); (A.C.S.)
| | | | - Ilaria Zanotti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy;
| | - Andrei C. Sposito
- Atherosclerosis and Vascular Biology Laboratory (Aterolab), Division of Cardiology, State University of Campinas (UNICAMP), Campinas 13084-971, SP, Brazil; (H.R.P.C.); (I.B.); (J.B.); (A.C.S.)
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8
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Soulat G, Mousseaux E, Puymirat E. Editorial for "MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure". J Magn Reson Imaging 2023; 58:1519-1520. [PMID: 36744554 DOI: 10.1002/jmri.28636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gilles Soulat
- Université Paris cité, PARCC, INSERM, Paris, France
- Department of Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Elie Mousseaux
- Université Paris cité, PARCC, INSERM, Paris, France
- Department of Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Etienne Puymirat
- Université Paris cité, PARCC, INSERM, Paris, France
- Department of Cardiology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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9
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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - 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
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10
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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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11
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Bo K, Gao Y, Zhou Z, Gao X, Liu T, Zhang H, Li Q, Wang H, Xu L. Incremental prognostic value of left atrial strain in patients with heart failure. ESC Heart Fail 2022; 9:3942-3953. [PMID: 35950517 PMCID: PMC9773762 DOI: 10.1002/ehf2.14106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The present study aimed to evaluate the prognostic value of atrial strain and strain rate (SR) parameters derived from cardiac magnetic resonance (CMR) feature tracking (FT) in patients with ischaemic and non-ischaemic dilated cardiomyopathy with heart failure with reduced ejection fraction (HFrEF) but without atrial fibrillation. METHODS AND RESULTS A total of 300 patients who underwent CMR with left ventricular ejection fraction (LVEF) ≤ 40% and ischaemic or non-ischaemic dilated cardiomyopathy were analysed in this retrospective study. Major adverse cardiac events (MACEs) include cardiovascular death, heart transplantation, and rehospitalization for worsening HF. Ninety-four patients had MACEs during median follow-up of 3.84 years. Multivariate Cox regression models adjusted for common clinical and CMR risk factors detected a significant association between LA-εs and MACE in ischaemic (HR = 0.94/%; P = 0.002), non-ischaemic dilated cardiomyopathy (HR = 0.88/%; P = 0.001), or all included patients (HR = 0.87; P < 0.001). LA-εs provided incremental prognostic value over conventional outcome predictors (Uno C statistical comparison model: from 0.776 to 0.801, P < 0.0001; net reclassification improvement: 0.075, 95% CI: 0.0262-0.1301). Kaplan-Meier analysis revealed that the risk of MACE occurrence increased significantly with lower tertiles of left atrial reservoir strain (LA-εs) (log-rank P < 0.0001). Patients in the worst LA-εs tertile faced a significantly increased risk of MACEs irrespective of late gadolinium enhancement (LGE) (log-rank P < 0.0001). CONCLUSIONS LA-εs derived from CMR FT has a significant prognostic impact on patients with ischaemic or non-ischaemic dilated cardiomyopathy, incremental to common clinical and CMR risk-factors.
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Affiliation(s)
- Kairui Bo
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Xuelian Gao
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Tong Liu
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Qing Li
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Hui Wang
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Lei Xu
- Department of Radiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
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12
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Assadi H, Alabed S, Maiter A, Salehi M, Li R, Ripley DP, Van der Geest RJ, Zhong Y, Zhong L, Swift AJ, Garg P. The Role of Artificial Intelligence in Predicting Outcomes by Cardiovascular Magnetic Resonance: A Comprehensive Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1087. [PMID: 36013554 PMCID: PMC9412853 DOI: 10.3390/medicina58081087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Interest in artificial intelligence (AI) for outcome prediction has grown substantially in recent years. However, the prognostic role of AI using advanced cardiac magnetic resonance imaging (CMR) remains unclear. This systematic review assesses the existing literature on AI in CMR to predict outcomes in patients with cardiovascular disease. Materials and Methods: Medline and Embase were searched for studies published up to November 2021. Any study assessing outcome prediction using AI in CMR in patients with cardiovascular disease was eligible for inclusion. All studies were assessed for compliance with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM). Results: A total of 5 studies were included, with a total of 3679 patients, with 225 deaths and 265 major adverse cardiovascular events. Three methods demonstrated high prognostic accuracy: (1) three-dimensional motion assessment model in pulmonary hypertension (hazard ratio (HR) 2.74, 95%CI 1.73−4.34, p < 0.001), (2) automated perfusion quantification in patients with coronary artery disease (HR 2.14, 95%CI 1.58−2.90, p < 0.001), and (3) automated volumetric, functional, and area assessment in patients with myocardial infarction (HR 0.94, 95%CI 0.92−0.96, p < 0.001). Conclusion: There is emerging evidence of the prognostic role of AI in predicting outcomes for three-dimensional motion assessment in pulmonary hypertension, ischaemia assessment by automated perfusion quantification, and automated functional assessment in myocardial infarction.
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Affiliation(s)
- Hosamadin Assadi
- Department of Medicine, Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Samer Alabed
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Ahmed Maiter
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Mahan Salehi
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Rui Li
- Department of Medicine, Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - David P. Ripley
- Northumbria Healthcare Foundation Trust, Northumbria Specialist Care Emergency Hospital, Northumbria Way, Northumberland NE23 6NZ, UK
| | - Rob J. Van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Yumin Zhong
- Department of Radiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd., Shanghai 200127, China
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Cardiovascular Sciences, Duke-NUS Medical School, 8 College Road, Singapore 169856, Singapore
| | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Pankaj Garg
- Department of Medicine, Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
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13
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 710] [Impact Index Per Article: 355.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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14
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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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15
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 891] [Impact Index Per Article: 445.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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16
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Keenan KE, Delfino JG, Jordanova KV, Poorman ME, Chirra P, Chaudhari AS, Baessler B, Winfield J, Viswanath SE, deSouza NM. Challenges in ensuring the generalizability of image quantitation methods for MRI. Med Phys 2022; 49:2820-2835. [PMID: 34455593 PMCID: PMC8882689 DOI: 10.1002/mp.15195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 01/31/2023] Open
Abstract
Image quantitation methods including quantitative MRI, multiparametric MRI, and radiomics offer great promise for clinical use. However, many of these methods have limited clinical adoption, in part due to issues of generalizability, that is, the ability to translate methods and models across institutions. Researchers can assess generalizability through measurement of repeatability and reproducibility, thus quantifying different aspects of measurement variance. In this article, we review the challenges to ensuring repeatability and reproducibility of image quantitation methods as well as present strategies to minimize their variance to enable wider clinical implementation. We present possible solutions for achieving clinically acceptable performance of image quantitation methods and briefly discuss the impact of minimizing variance and achieving generalizability towards clinical implementation and adoption.
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Affiliation(s)
- Kathryn E. Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Jana G. Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, 10993 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Kalina V. Jordanova
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Megan E. Poorman
- Physical Measurement Laboratory, National Institute of Standards and Technology, 325 Broadway, Boulder, CO 80305, USA
| | - Prathyush Chirra
- Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Akshay S. Chaudhari
- Department of Radiology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
- Department of Biomedical Data Science, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Bettina Baessler
- University Hospital of Zurich and University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jessica Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Satish E. Viswanath
- Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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17
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Krittayaphong R, Zhang S, Tanapibunpon P, Kaolawanich Y, Nakyen S. Dark-blood late gadolinium-enhancement cardiac magnetic resonance imaging for myocardial scar detection based on simplified timing scheme: single-center experience in patients with suspected coronary artery disease. Quant Imaging Med Surg 2022; 12:1037-1050. [PMID: 35111603 DOI: 10.21037/qims-21-704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to examine scar detectability using dark-blood late gadolinium enhancement (LGE) with simplified timing scheme and fixed parameters comparing to two conventional bright-blood approaches in patients with known or suspected coronary artery disease. Methods Three LGE techniques were performed in all patients with known or suspected coronary artery disease at 3 T: dark blood two-dimensional (2D) phase-sensitive inversion recovery (PSIR) preceded with a T2-preparation pulse (DB-LGE), conventional three-dimensional (3D) gradient-echo inversion recovery (3D-IR) and conventional 2D PSIR. Timing parameters in DB-LGE were tested in five clinically confirmed coronary artery disease patients with scars and fixed for the rest of the study. Two independent readers evaluated images at both patient and segment levels. Image quality and contrast ratio between scar and adjacent tissues were assessed. Concordance between the three techniques and detection rate based on expert consensus were reported. Results Forty-six patients were recruited in the study (average age 66.8 years, 69.6% male). DB-LGE demonstrated superior image quality (P=0.001 vs. 3D-IR) and scar-to-blood contrast ratio (P<0.001 vs. 3D-IR and PSIR). Among 41 patients with suspected coronary artery disease, myocardial scar was present in 30 patients (73.2%), all detected by DB-LGE, yielding a detection rate of 100% compared to 93.3% and 96.7% for bright-blood 3D-IR and PSIR. For subendocardial scar detection among 656 segments, DB-LGE had a detection rate of 99.4% compared to 57.8% for 3D-IR and 61.0% for PSIR (both P<0.001). Conclusions DB-LGE improves detection of myocardial scar compared with conventional bright-blood LGE techniques, particularly of subendocardial scar.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shuo Zhang
- Philips Healthcare, Singapore.,Philips Healthcare, Hamburg, Germany
| | - Prajak Tanapibunpon
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Nakyen
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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18
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de Koning MSLY, van Dorp P, Assa S, Hartman MHT, Voskuil M, Anthonio RL, Veen D, Pundziute-Do Prado G, Leiner T, van Goor H, van der Meer P, van Veldhuisen DJ, Nijveldt R, Lipsic E, van der Harst P. Rationale and Design of the Groningen Intervention Study for the Preservation of Cardiac Function with Sodium Thiosulfate after St-segment Elevation Myocardial Infarction (GIPS-IV) trial. Am Heart J 2022; 243:167-176. [PMID: 34534493 DOI: 10.1016/j.ahj.2021.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ischemia and subsequent reperfusion cause myocardial injury in patients presenting with ST-segment elevation myocardial infarction (STEMI). Hydrogen sulfide (H2S) reduces "ischemia-reperfusion injury" in various experimental animal models, but has not been evaluated in humans. This trial will examine the efficacy and safety of the H2S-donor sodium thiosulfate (STS) in patients presenting with a STEMI. STUDY DESIGN The Groningen Intervention study for the Preservation of cardiac function with STS after STEMI (GIPS-IV) trial (NCT02899364) is a double-blind, randomized, placebo-controlled, multicenter trial, which will enroll 380 patients with a first STEMI. Patients receive STS 12.5 grams intravenously or matching placebo in addition to standard care immediately at arrival at the catheterization laboratory after providing consent. A second dose is administered 6 hours later at the coronary care unit. The primary endpoint is myocardial infarct size as quantified by cardiac magnetic resonance imaging 4 months after randomization. Secondary endpoints include the effect of STS on peak CK-MB during admission and left ventricular ejection fraction and NT-proBNP levels at 4 months follow-up. Patients will be followed-up for 2 years to assess clinical endpoints. CONCLUSIONS The GIPS-IV trial is the first study to determine the effect of a H2S-donor on myocardial infarct size in patients presenting with STEMI.
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19
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Infante T, Cavaliere C, Punzo B, Grimaldi V, Salvatore M, Napoli C. Radiogenomics and Artificial Intelligence Approaches Applied to Cardiac Computed Tomography Angiography and Cardiac Magnetic Resonance for Precision Medicine in Coronary Heart Disease: A Systematic Review. Circ Cardiovasc Imaging 2021; 14:1133-1146. [PMID: 34915726 DOI: 10.1161/circimaging.121.013025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The risk of coronary heart disease (CHD) clinical manifestations and patient management is estimated according to risk scores accounting multifactorial risk factors, thus failing to cover the individual cardiovascular risk. Technological improvements in the field of medical imaging, in particular, in cardiac computed tomography angiography and cardiac magnetic resonance protocols, laid the development of radiogenomics. Radiogenomics aims to integrate a huge number of imaging features and molecular profiles to identify optimal radiomic/biomarker signatures. In addition, supervised and unsupervised artificial intelligence algorithms have the potential to combine different layers of data (imaging parameters and features, clinical variables and biomarkers) and elaborate complex and specific CHD risk models allowing more accurate diagnosis and reliable prognosis prediction. Literature from the past 5 years was systematically collected from PubMed and Scopus databases, and 60 studies were selected. We speculated the applicability of radiogenomics and artificial intelligence through the application of machine learning algorithms to identify CHD and characterize atherosclerotic lesions and myocardial abnormalities. Radiomic features extracted by cardiac computed tomography angiography and cardiac magnetic resonance showed good diagnostic accuracy for the identification of coronary plaques and myocardium structure; on the other hand, few studies exploited radiogenomics integration, thus suggesting further research efforts in this field. Cardiac computed tomography angiography resulted the most used noninvasive imaging modality for artificial intelligence applications. Several studies provided high performance for CHD diagnosis, classification, and prognostic assessment even though several efforts are still needed to validate and standardize algorithms for CHD patient routine according to good medical practice.
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Affiliation(s)
- Teresa Infante
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy (T.I., C.N.)
| | | | - Bruna Punzo
- IRCCS SDN, Naples, Italy (C.C., B.P., V.G., M.S., C.N.)
| | | | | | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy (T.I., C.N.).,IRCCS SDN, Naples, Italy (C.C., B.P., V.G., M.S., C.N.)
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20
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Nguyen TD, Weinsaft JW, Kim J. Editorial for "Magnetic Resonance Assessment of Left Ventricular Ejection Fraction at Any Time Post-Infarction for Prediction of Subsequent Events in a Large Multicenter STEMI Registry". J Magn Reson Imaging 2021; 56:488-489. [PMID: 34738681 DOI: 10.1002/jmri.27982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Jiwon Kim
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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21
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Stress Cardiac Magnetic Resonance Myocardial Perfusion Imaging: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1655-1668. [PMID: 34649703 DOI: 10.1016/j.jacc.2021.08.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022]
Abstract
Stress cardiovascular magnetic resonance imaging (CMR) is a cost-effective, noninvasive test that accurately assesses myocardial ischemia, myocardial viability, and cardiac function without the need for ionizing radiation. There is a large body of literature, including randomized controlled trials, validating its diagnostic performance, risk stratification capabilities, and ability to guide appropriate use of coronary intervention. Specifically, stress CMR has shown higher diagnostic sensitivity than single-photon emission computed tomography imaging in detecting angiographically significant coronary artery disease. Stress CMR is particularly valuable for the evaluation of patients with moderate to high pretest probability of having stable ischemic heart disease and for patients known to have challenging imaging characteristics, including women, individuals with prior revascularization, and those with left ventricular dysfunction. This paper reviews the basics principles of stress CMR, the data supporting its clinical use, the added-value of myocardial blood flow quantification, and the assessment of myocardial function and viability routinely obtained during a stress CMR study.
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22
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Speers C, Murthy VL, Walker EM, Glide-Hurst CK, Marsh R, Tang M, Morris EL, Schipper MJ, Weinberg RL, Gits HC, Hayman J, Feng M, Balter J, Moran J, Jagsi R, Pierce LJ. Cardiac Magnetic Resonance Imaging and Blood Biomarkers for Evaluation of Radiation-Induced Cardiotoxicity in Patients With Breast Cancer: Results of a Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2021; 112:417-425. [PMID: 34509552 DOI: 10.1016/j.ijrobp.2021.08.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation therapy (RT) can increase the risk of cardiac events in patients with breast cancer (BC), but biomarkers predicting risk for developing RT-induced cardiac disease are currently lacking. We report results from a prospective clinical trial evaluating early magnetic resonance imaging (MRI) and serum biomarker changes as predictors of cardiac injury and risk of subsequent cardiac events after RT for left-sided disease. METHODS Women with node-negative and node-positive (N-/+) left-sided BC were enrolled on 2 institutional review board (IRB)-approved protocols at 2 institutions. MRI was conducted pretreatment (within 1 week of starting radiation), at the end of treatment (last day of treatment ±1 week), and 3 months after the last day of treatment (±2 weeks) to quantify left and right ventricular volumes and function, myocardial fibrosis, and edema. Perfusion changes during regadenoson stress perfusion were also assessed on a subset of patients (n = 28). Serum was collected at the same time points. Whole heart and cardiac substructures were contoured using CT and MRI. Models were constructed using baseline cardiac and clinical risk factors. Associations between MRI-measured changes and dose were evaluated. RESULTS Among 51 women enrolled, mean heart dose ranged from 0.80 to 4.7 Gy and mean left ventricular (LV) dose from 1.1 to 8.2 Gy, with mean heart dose 2.0 Gy. T1 time, a marker of fibrosis, and right ventricular (RV) ejection fraction (EF) significantly changed with treatment; these were not dose dependent. T2 (marker of edema) and LV EF did not significantly change. No risk factors were associated with baseline global perfusion. Prior receipt of doxorubicin was marginally associated with decreased myocardial perfusion after RT (P = .059), and mean MHD was not associated with perfusion changes. A significant correlation between baseline IL-6 and mean heart dose (MHD) at the end of RT (ρ 0.44, P = .007) and a strong trend between troponin I and MHD at 3 months post-treatment (ρ 0.33, P = .07) were observed. No other significant correlations were identified. CONCLUSIONS In this prospective study of women with left-sided breast cancer treated with contemporary treatment planning, cardiac radiation doses were very low relative to historical doses reported by Darby et al. Although we observed significant changes in T1 and RV EF shortly after RT, these changes were not correlated with whole heart or substructure doses. Serum biomarker analysis of cardiac injury demonstrates an interesting trend between markers and MHD that warrants further investigation.
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Affiliation(s)
- Corey Speers
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Carri K Glide-Hurst
- Department of Human Oncology, School of Medicine and Public Heath, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Ming Tang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Emily L Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Hunter C Gits
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - James Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - James Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jean Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan.
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23
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Gómez-Talavera S, Fernandez-Jimenez R, Fuster V, Nothnagel ND, Kouwenhoven M, Clemence M, García-Lunar I, Gómez-Rubín MC, Navarro F, Pérez-Asenjo B, Fernández-Friera L, Calero MJ, Orejas M, Cabrera JA, Desco M, Pizarro G, Ibáñez B, Sánchez-González J. Clinical Validation of a 3-Dimensional Ultrafast Cardiac Magnetic Resonance Protocol Including Single Breath-Hold 3-Dimensional Sequences. JACC Cardiovasc Imaging 2021; 14:1742-1754. [PMID: 33865783 PMCID: PMC8421247 DOI: 10.1016/j.jcmg.2021.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/05/2021] [Accepted: 02/05/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVES This study sought to clinically validate a novel 3-dimensional (3D) ultrafast cardiac magnetic resonance (CMR) protocol including cine (anatomy and function) and late gadolinium enhancement (LGE), each in a single breath-hold. BACKGROUND CMR is the reference tool for cardiac imaging but is time-consuming. METHODS A protocol comprising isotropic 3D cine (Enhanced sensitivity encoding [SENSE] by Static Outer volume Subtraction [ESSOS]) and isotropic 3D LGE sequences was compared with a standard cine+LGE protocol in a prospective study of 107 patients (age 58 ± 11 years; 24% female). Left ventricular (LV) mass, volumes, and LV and right ventricular (RV) ejection fraction (LVEF, RVEF) were assessed by 3D ESSOS and 2D cine CMR. LGE (% LV) was assessed using 3D and 2D sequences. RESULTS Three-dimensional and LGE acquisitions lasted 24 and 22 s, respectively. Three-dimensional and LGE images were of good quality and allowed quantification in all cases. Mean LVEF by 3D and 2D CMR were 51 ± 12% and 52 ± 12%, respectively, with excellent intermethod agreement (intraclass correlation coefficient [ICC]: 0.96; 95% confidence interval [CI]: 0.94 to 0.97) and insignificant bias. Mean RVEF 3D and 2D CMR were 60.4 ± 5.4% and 59.7 ± 5.2%, respectively, with acceptable intermethod agreement (ICC: 0.73; 95% CI: 0.63 to 0.81) and insignificant bias. Both 2D and 3D LGE showed excellent agreement, and intraobserver and interobserver agreement were excellent for 3D LGE. CONCLUSIONS ESSOS single breath-hold 3D CMR allows accurate assessment of heart anatomy and function. Combining ESSOS with 3D LGE allows complete cardiac examination in <1 min of acquisition time. This protocol expands the indication for CMR, reduces costs, and increases patient comfort.
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Affiliation(s)
- Sandra Gómez-Talavera
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, IIS-Hospital Fundacion Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rodrigo Fernandez-Jimenez
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Cardiology, Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - Valentín Fuster
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | - Inés García-Lunar
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Cardiology, Hospital Universitario Quiron UEM, Madrid, Spain
| | | | - Felipe Navarro
- Department of Cardiology, IIS-Hospital Fundacion Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Braulio Pérez-Asenjo
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Leticia Fernández-Friera
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Cardiology, Hospital Montepríncipe-CEU, Madrid, Spain
| | - María J Calero
- Department of Cardiology, Hospital Universtario Rey Juan Carlos-Móstoles, Madrid, Spain
| | - Miguel Orejas
- Department of Cardiology, IIS-Hospital Fundacion Jiménez Díaz, Madrid, Spain
| | - José A Cabrera
- Department of Cardiology, Hospital Universitario Quiron UEM, Madrid, Spain
| | - Manuel Desco
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Departamento de Bioingeniería e Ingeniería Aerospacial, Universidad Carlos III, Madrid, Spain
| | - Gonzalo Pizarro
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Cardiology, Hospital Universitario Quiron UEM, Madrid, Spain
| | - Borja Ibáñez
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, IIS-Hospital Fundacion Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Abstract
Purpose of Review The purpose of this review is to summarize the application of cardiac magnetic resonance (CMR) in the diagnostic and prognostic evaluation of patients with heart failure (HF). Recent Findings CMR is an important non-invasive imaging modality in the assessment of ventricular volumes and function and in the analysis of myocardial tissue characteristics. The information derived from CMR provides a comprehensive evaluation of HF. Its unique ability of tissue characterization not only helps to reveal the underlying etiologies of HF but also offers incremental prognostic information. Summary CMR is a useful non-invasive tool for the diagnosis and assessment of prognosis in patients suffering from heart failure.
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Affiliation(s)
- Chuanfen Liu
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Victor A. Ferrari
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
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25
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Antonopoulos AS, Azzu A, Androulakis E, Tanking C, Papagkikas P, Mohiaddin RH. Eosinophilic heart disease: diagnostic and prognostic assessment by cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 2021; 22:1273-1284. [PMID: 33432319 DOI: 10.1093/ehjci/jeaa346] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Eosinophilic heart disease (EHD) is a rare cardiac condition with a wide spectrum of phenotypes. The diagnostic and prognostic value of cardiac magnetic resonance (CMR) in EHD remains unknown. METHODS AND RESULTS This was a retrospective analysis of 250 patients with eosinophilia referred for a CMR scan (period 2000-2020). CMR data sets and clinical/laboratory data were collected. Patients were followed up for a mean of 24 months (range 1-224) for the composite endpoint of death, acute coronary syndrome, hospitalization for acute heart failure, malignant ventricular arrhythmias, or the need for implantable cardiac defibrillator/pacemaker. The main objectives were to explore the diagnostic value of CMR in EHD; relationships between cardiac function, late gadolinium enhancement (LGE), and EHD phenotypes; and the prognostic value of fibrosis and oedema by CMR. The prevalence of findings compatible with EHD was 39% (patients with cardiac symptoms: 57% vs. screening: 20%, P < 0.001). EHD phenotypes included subendocardial LGE (n = 58), mid-wall/subepicardial LGE (n = 26), pericarditis (n = 5) or dilated cardiomyopathy (n = 8). Myocardial oedema was present in 10% of patients. Intracardiac thrombi (7%) were associated with EHD phenotype (χ2=47.3, P = 1.3×10-8). LGE extent correlated with LVEDVi (rho = 0.268, P = 5.3×10-5) and LVEF (rho=-0.415, P = 8.6×10-11). A CMR scan positive for EHD [hazard ratio (HR) = 5.61, 95% confidence interval (CI): 1.82-17.89, P = 0.0026] or a subendocardial LGE pattern (HR = 5.13, 95% CI: 1.29-20.38, P = 0.020) were independently associated with the composite clinical endpoint. CONCLUSION The diagnostic yield of CMR screening in patients with persistent eosinophilia, even if asymptomatic, is high. The extent of subendocardial fibrosis correlates with LV remodelling and independently predicts clinical outcomes in patients with eosinophilia.
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Affiliation(s)
- Alexios S Antonopoulos
- CMR Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
| | - Alessia Azzu
- CMR Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK.,Faculty of Medicine, National Heart and Lung Institute, Imperial College London, UK
| | - Emmanuel Androulakis
- CMR Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
| | - Chonthicha Tanking
- CMR Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
| | - Panagiotis Papagkikas
- CMR Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK
| | - Raad H Mohiaddin
- CMR Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, SW3 6NP London, UK.,Faculty of Medicine, National Heart and Lung Institute, Imperial College London, UK
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26
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Mendieta G, Ben-Aicha S, Gutiérrez M, Casani L, Aržanauskaitė M, Carreras F, Sabate M, Badimon L, Vilahur G. Intravenous Statin Administration During Myocardial Infarction Compared With Oral Post-Infarct Administration. J Am Coll Cardiol 2020; 75:1386-1402. [PMID: 32216907 DOI: 10.1016/j.jacc.2020.01.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 01/03/2020] [Accepted: 01/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Beyond lipid-lowering, statins exert cardioprotective effects. High-dose statin treatment seems to reduce cardiovascular complications in high-risk patients. The ideal timing and administration regime remain unknown. OBJECTIVES This study compared the cardioprotective effects of intravenous statin administration during myocardial infarction (MI) with oral administration immediately post-MI. METHODS Hypercholesterolemic pigs underwent MI induction (90 min of ischemia) and were kept for 42 days. Animals were distributed in 3 arms (A): A1 received an intravenous bolus of atorvastatin during MI; A2 received an intravenous bolus of vehicle during MI; and A3 received oral atorvastatin within 2 h post-MI. A1 and A3 remained on daily oral atorvastatin for the following 42 days. Cardiac magnetic resonance analysis (days 3 and 42 post-MI) and molecular/histological studies were performed. RESULTS At day 3, A1 showed a 10% reduction in infarct size compared with A3 and A2 and a 50% increase in myocardial salvage. At day 42, both A1 and A3 showed a significant decrease in scar size versus A2; however, A1 showed a further 24% reduction versus A3. Functional analyses revealed improved systolic performance in A1 compared with A2 and less wall motion abnormalities in the jeopardized myocardium versus both groups at day 42. A1 showed enhanced collagen content and AMP-activated protein kinase activation in the scar, increased vessel density in the penumbra, higher tumor necrosis factor α plasma levels and lower peripheral blood mononuclear cell activation versus both groups. CONCLUSIONS Intravenous administration of atorvastatin during MI limits cardiac damage, improves cardiac function, and mitigates remodeling to a larger extent than when administered orally shortly after reperfusion. This therapeutic approach deserves to be investigated in ST-segment elevation MI patients.
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Affiliation(s)
- Guiomar Mendieta
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; Department of Cardiology, Clinic Hospital, Barcelona, Spain
| | - Soumaya Ben-Aicha
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manuel Gutiérrez
- Radiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Laura Casani
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; Radiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Monika Aržanauskaitė
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Francesc Carreras
- Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manel Sabate
- Department of Cardiology, Clinic Hospital, Barcelona, Spain
| | - Lina Badimon
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; CiberCV, Institute Carlos III, Barcelona, Spain
| | - Gemma Vilahur
- Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; CiberCV, Institute Carlos III, Barcelona, Spain.
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Ahmed SW, Sultan FAT, Awan S, Ahmed I. Prognostic Significance of CMR Findings in Patients with Known Coronary Artery Disease - Experience from a South Asian Country. J Clin Imaging Sci 2020; 10:75. [PMID: 33274119 PMCID: PMC7708965 DOI: 10.25259/jcis_153_2020] [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: 08/29/2020] [Accepted: 10/25/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives: South Asians (SA) have a higher burden of coronary artery disease (CAD) and are known to have a worse prognosis compared to other ethnicities. Therefore, it is imperative to improve the risk stratification of SA patient with CAD and to seek out newer prognostic markers beyond the conventional echocardiography.The aim of this study was to investigate whether variables obtained by cardiac magnetic resonance (CMR) improve risk stratification of South Asian patients with known CAD. Material and Methods: We retrospectively analyzed 147 patients with evidence of CAD that had a CMR at our center between January 2011 and January 2019. LV volumes and regional wall motions were acquired by cine images, while infarct size (IS) was measured by late gadolinium enhancement. At a mean follow-up of 3.36 ± 2.22 years, cardiac events (non-fatal myocardial infarction, hospitalization due to heart failure, life-threatening arrhythmia, or cardiac death) occurred in 49 patients. An IS ≥35%, left ventricular ejection fraction (LVEF) ≤31%, and a wall motion score index (WMSI) ≥1.9 were strongly associated with follow-up cardiac events (P < 0.001). Patients that had none or less than 3 of these factors, showed a lower risk of cardiac events (HR 0.22 CI [0.11–0.44] P < 0.001 and HR 0.12 CI [0.04–0.32] P < 0.001, respectively) compared to those with all three factors. Conclusion: Integration of CMR derived factors such as IS and WMSI with LVEF can improve the prognostication of the SA population with CAD. Better risk stratification of patients can lead to improved and cost-effective therapeutic strategies to ameliorate the prognosis of these patients.
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Affiliation(s)
- Syed Waqar Ahmed
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Fateh Ali Tipoo Sultan
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Safia Awan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Imran Ahmed
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
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Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
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29
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Pizarro G. The Stress CMR Top SPINS On and On. JACC Cardiovasc Imaging 2020; 13:2146-2148. [PMID: 32771578 DOI: 10.1016/j.jcmg.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Ruber Juan Bravo Quironsalud Hospital UEM, Madrid, Spain; CIBER de Enfermedades CardioVasculares, Madrid, Spain.
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30
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Marcos-Garces V, Gavara J, Monmeneu JV, Lopez-Lereu MP, Perez N, Rios-Navarro C, De Dios E, Moratal D, Miñana G, Nuñez J, Chorro FJ, Bodi V. A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome. J Clin Med 2020; 9:E1957. [PMID: 32585832 PMCID: PMC7356983 DOI: 10.3390/jcm9061957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023] Open
Abstract
Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
| | - Jose Gavara
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), 46015 Valencia, Spain; (J.VM.); (M.PL.-L.)
| | - Maria P Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), 46015 Valencia, Spain; (J.VM.); (M.PL.-L.)
| | - Nerea Perez
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
| | - Cesar Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
| | - Elena De Dios
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Gema Miñana
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
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Whole blood transcriptome profile at hospital admission discriminates between patients with ST-segment elevation and non-ST-segment elevation acute myocardial infarction. Sci Rep 2020; 10:8731. [PMID: 32457432 PMCID: PMC7250845 DOI: 10.1038/s41598-020-65527-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/06/2020] [Indexed: 12/20/2022] Open
Abstract
Whether ST-segment (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) should be regarded as distinct pathophysiological entities is a matter of debate. We tested the hypothesis that peripheral blood gene-expression profiles at presentation distinguish STEMI from NSTEMI. We performed a case-control study collecting whole-blood from 60 STEMI and 58 NSTEMI (defined according to the third universal definition of MI) consecutive patients on hospital admission. We used RNA-sequencing for the discovery phase, comparing 15 STEMI vs. 15 NSTEMI patients, matched for age, sex, and cardiovascular risk factors, and quantitative PCR in the remaining unmatched patients for validating top-significant genes. Gene-level differential expression analysis identified significant differences in the expression of 323 genes: 153 genes withstood correction for admission cardiac troponin I (cTnI), differentiating the two conditions independently of myocardial necrosis extent. Functional annotation analysis uncovered divergent modulation in leukocyte and platelet activation, cell migration, and mitochondrial respiratory processes. Linear regression analysis revealed gene expression patterns on admission predicting infarct size, as indexed by cTnI peak (R2 = 0.58–0.75). Our results unveil distinctive pathological traits for these two MI subtypes and provide insights into the early assessment of injury extent. This could translate into RNA-based disease-specific biomarkers for precision diagnosis and risk stratification.
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32
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Saeed M. Editorial for "Prognostic Value of Late Gadolinium Enhancement in Predicting Life‐Threatening Arrhythmias in Heart Failure Patients With Implantable Cardioverter‐Defibrillators". J Magn Reson Imaging 2020; 51:1440-1441. [DOI: 10.1002/jmri.27006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of MedicineUniversity of California San Francisco San Francisco California USA
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33
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Kolentinis M, Le M, Nagel E, Puntmann VO. Contemporary Cardiac MRI in Chronic Coronary Artery Disease. Eur Cardiol 2020; 15:e50. [PMID: 32612708 PMCID: PMC7312615 DOI: 10.15420/ecr.2019.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic coronary artery disease remains an unconquered clinical problem, affecting an increasing number of people worldwide. Despite the improved understanding of the disease development, the implementation of the many advances in diagnosis and therapy is lacking. Many clinicians continue to rely on patient's symptoms and diagnostic methods, which do not enable optimal clinical decisions. For example, echocardiography and invasive coronary catheterisation remain the mainstay investigations for stable angina patients in many places, despite the evidence on their limitations and availability of better diagnostic options. Cardiac MRI is a powerful diagnostic method, supporting robust measurements of crucial markers of cardiac structure and function, myocardial perfusion and scar, as well as providing detailed insight into myocardial tissue. Accurate and informative diagnostic readouts can help with guiding therapy, monitoring disease progress and tailoring the response to treatment. In this article, the authors outline the evidence supporting the state-of-art applications based on cardiovascular magnetic resonance, allowing the clinician optimal use of this insightful diagnostic method in everyday clinical practice.
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Affiliation(s)
- Michalis Kolentinis
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Melanie Le
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
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34
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Lee DC, Albert CM, Narula D, Kadish AH, Panicker GK, Wu E, Schaechter A, Pester J, Chatterjee NA, Cook NR, Goldberger JJ. Estimating Myocardial Infarction Size With a Simple Electrocardiographic Marker Score. J Am Heart Assoc 2020; 9:e014205. [PMID: 31973600 PMCID: PMC7033860 DOI: 10.1161/jaha.119.014205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Myocardial infarction (MI) size is a key predictor of prognosis in post‐MI patients. Cardiovascular magnetic resonance (CMR) is the gold standard test for MI quantification, but the ECG is less expensive and more widely available. We sought to quantify the relationship between ECG markers and cardiovascular magnetic resonance infarct size. Methods and Results Patients with prior MI enrolled in the DETERMINE (Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation) and PRE‐DETERMINE Trial and Registry were included. ECG leads were analyzed for markers of MI: Q waves, fragmented QRS, and T wave inversion. DETERMINE Score=number of leads with [Q waves×2]+[fragmented QRS]+[T wave inversion]. Left ventricular ejection fraction (LVEF) and infarct size as a percentage of left ventricular mass (MI%) were quantified by cardiovascular magnetic resonance. The Modified Selvester Score estimates MI size from 37 ECG criteria. In 551 patients (aged 62.1±10.9 years, 79% men, and LVEF=40.3±11.0%), MI% increased as the number of ECG markers increased (P<0.001). By univariable linear regression, the DETERMINE Score (range 0–26) estimated MI% (R2=0.18, P<0.001) with an accuracy approaching that of LVEF (R2=0.22, P<0.001) and higher than the Modified Selvester Score (R2=0.09, P<0.001). By multivariable linear regression, addition of the DETERMINE Score improved estimation of MI% over LVEF alone (P<0.001) and over Modified Selvester Score alone (P<0.001). Conclusions In patients with prior MI, a simple ECG score estimates infarct size and improves infarct size estimation over LVEF alone. Because infarct size is a powerful prognostic indicator, the DETERMINE Score holds promise as a simple and inexpensive risk assessment tool.
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Affiliation(s)
- Daniel C Lee
- Northwestern University Feinberg School of Medicine Chicago IL
| | | | | | | | | | - Edwin Wu
- Northwestern University Feinberg School of Medicine Chicago IL
| | - Andi Schaechter
- Northwestern University Feinberg School of Medicine Chicago IL
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35
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Affiliation(s)
- Rong Bing
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc Richard Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Leiner T, Rueckert D, Suinesiaputra A, Baeßler B, Nezafat R, Išgum I, Young AA. Machine learning in cardiovascular magnetic resonance: basic concepts and applications. J Cardiovasc Magn Reson 2019; 21:61. [PMID: 31590664 PMCID: PMC6778980 DOI: 10.1186/s12968-019-0575-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 09/02/2019] [Indexed: 12/18/2022] Open
Abstract
Machine learning (ML) is making a dramatic impact on cardiovascular magnetic resonance (CMR) in many ways. This review seeks to highlight the major areas in CMR where ML, and deep learning in particular, can assist clinicians and engineers in improving imaging efficiency, quality, image analysis and interpretation, as well as patient evaluation. We discuss recent developments in the field of ML relevant to CMR in the areas of image acquisition & reconstruction, image analysis, diagnostic evaluation and derivation of prognostic information. To date, the main impact of ML in CMR has been to significantly reduce the time required for image segmentation and analysis. Accurate and reproducible fully automated quantification of left and right ventricular mass and volume is now available in commercial products. Active research areas include reduction of image acquisition and reconstruction time, improving spatial and temporal resolution, and analysis of perfusion and myocardial mapping. Although large cohort studies are providing valuable data sets for ML training, care must be taken in extending applications to specific patient groups. Since ML algorithms can fail in unpredictable ways, it is important to mitigate this by open source publication of computational processes and datasets. Furthermore, controlled trials are needed to evaluate methods across multiple centers and patient groups.
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Affiliation(s)
- Tim Leiner
- Department of Radiology | E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX Utrecht, The Netherlands
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College, London, UK
| | - Avan Suinesiaputra
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA USA
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, UK
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Wen LY, Yang ZG, Li ZL, Ai H, Xia CC, Zhang LZ, Lin BB, Zhang K, Fu H, Wu CQ, Yang L, Fan HM, Guo YK. Accurate identification of myocardial viability after myocardial infarction with novel manganese chelate-based MR imaging. NMR IN BIOMEDICINE 2019; 32:e4158. [PMID: 31393647 DOI: 10.1002/nbm.4158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/17/2019] [Accepted: 07/02/2019] [Indexed: 02/05/2023]
Abstract
We developed a novel manganese (Mn2+ ) chelate for magnetic resonance imaging (MRI) assessment of myocardial viability in acute and chronic myocardial infarct (MI) models, and compared it with Gadolinium-based delay enhancement MRI (Gd3+ -DEMRI) and histology. MI was induced in 14 rabbits by permanent occlusion of the left circumflex coronary artery. Gd3+ -DEMRI and Mn2+ chelate-based delayed enhancement MRI (Mn2+ chelate-DEMRI) were performed at 7 days (acute MI, n = 8) or 8 weeks (chronic MI, n = 6) after surgery with sequential injection of 0.15 mmol/kg Gd3+ and Mn2+ chelate. The biodistribution of Mn2+ in tissues and blood was measured at 1.5 and 24 h. Blood pressure, heart rate (HR), left ventricular (LV) function, and infarct fraction (IF) were analyzed, and IF was compared with the histology. The Mn2+ chelate group maintained a stable hemodynamic status during experiment. For acute and chronic MI, all rabbits survived without significant differences in HR or LV function before and after injection of Mn2+ chelate or Gd3+ (p > 0.05). Mn2+ chelate mainly accumulated in the kidney, liver, spleen, and heart at 1.5 h, with low tissue uptake and urine residue at 24 h after injection. In the acute MI group, there was no significant difference in IF between Mn2+ chelate-DEMRI and histology (22.92 ± 2.21% vs. 21.79 ± 2.25%, respectively, p = 0.87), while Gd3+ -DEMRI overestimated IF, as compared with histology (24.54 ± 1.73%, p = 0.04). In the chronic MI group, there was no significant difference in IF between the Mn2+ chelate-DEMRI, Gd3+ -DEMRI, and histology (29.50 ± 11.39%, 29.95 ± 9.40%, and 29.00 ± 10.44%, respectively, p > 0.05), and all three were well correlated (r = 0.92-0.96, p < 0.01). We conclude that the use of Mn2+ chelate-DEMRI is reliable for MI visualization and identifies acute MI more accurately than Gd3+ -DEMRI.
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Affiliation(s)
- Ling-Yi Wen
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Hua Ai
- National Engineering Research Center for Biomaterials, Sichuan University, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Li-Zhi Zhang
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Bin-Bin Lin
- National Engineering Research Center for Biomaterials, Sichuan University, China
| | - Kun Zhang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, China
| | - Chang-Qiang Wu
- Sichuan Key Laboratory of Medical Imaging and School of Medical Imaging, North Sichuan Medical College, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, China
| | - Hai-Ming Fan
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, China
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Joseph G, Zaremba T, Johansen MB, Ekeloef S, Heiberg E, Engblom H, Jensen SE, Sogaard P. Echocardiographic global longitudinal strain is associated with infarct size assessed by cardiac magnetic resonance in acute myocardial infarction. Echo Res Pract 2019; 6:81-89. [PMID: 31516720 PMCID: PMC6733366 DOI: 10.1530/erp-19-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to investigate if there was an association between infarct size (IS) measured by cardiac magnetic resonance (CMR) and echocardiographic global longitudinal strain (GLS) in the early stage of acute myocardial infarction in patients with preserved left ventricular ejection fraction (LVEF). Patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were assessed with CMR and transthoracic echocardiogram within 1 week of hospital admission. Two-dimensional speckle tracking was performed using a semi-automatic algorithm (EchoPac, GE Healthcare). Longitudinal strain curves were generated in a 17-segment model covering the entire left ventricular myocardium. GLS was calculated automatically. LVEF was measured by auto-LVEF in EchoPac. IS was measured by late gadolinium enhancement CMR in short-axis views covering the left ventricle. The study population consisted of 49 patients (age 60.4 ± 9.7 years; 92% male). The study population had preserved echocardiographic LVEF with a mean of 45.8 ± 8.7%. For each percent increase of IS, we found an impairment in GLS by 1.59% (95% CI 0.57–2.61), P = 0.02, after adjustment for sex, age and LVEF. No significant association between IS and echocardiographic LVEF was found: −0.25 (95% CI: −0.61 to 0.11), P = 0.51. At the segmental level, the strongest association between IS and longitudinal strain was found in the apical part of the LV: impairment of 1.69% (95% CI: 1.14–2.23), P < 0.001, for each percent increase in IS. In conclusion, GLS was significantly associated with IS in the early stage of acute myocardial infarction in patients with preserved LVEF, and this association was strongest in the apical part of the LV. No association between IS and LVEF was found.
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Affiliation(s)
- Gowsini Joseph
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, North Denmark Regional Hospital, Hjorring, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sarah Ekeloef
- Department of Cardiology, Nephrology and Endocrinology, North Zealand Hospital, Hillerod, Denmark
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University and Skaane University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Lund University and Skaane University Hospital, Lund, Sweden
| | - Svend Eggert Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Sogaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Ibanez B, Aletras AH, Arai AE, Arheden H, Bax J, Berry C, Bucciarelli-Ducci C, Croisille P, Dall'Armellina E, Dharmakumar R, Eitel I, Fernández-Jiménez R, Friedrich MG, García-Dorado D, Hausenloy DJ, Kim RJ, Kozerke S, Kramer CM, Salerno M, Sánchez-González J, Sanz J, Fuster V. Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 74:238-256. [PMID: 31296297 PMCID: PMC7363031 DOI: 10.1016/j.jacc.2019.05.024] [Citation(s) in RCA: 219] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
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Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, IIS Fundación Jiménez Díaz Hospital, Madrid, Spain.
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hakan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, and Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Pierre Croisille
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, United Kingdom
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Division of Cardiology, Department of Medicine, University of California, Los Angeles, California
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthias G Friedrich
- Departments of Medicine & Diagnostic Radiology, McGill University, Montreal, Quebec, Canada; Department of Medicine, Heidelberg University, Heidelberg, Germany
| | - David García-Dorado
- CIBERCV, Madrid, Spain; Vall d'Hebron University Hospital and Research Institute, Universtat Autònoma de Barcelona, Barcelona, Spain
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, National Heart Research Institute Singapore, National Heart Centre, Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, and The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London, United Kingdom; Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, and Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Christopher M Kramer
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | | | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
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Puntmann VO, Carr-White G, Jabbour A, Yu CY, Gebker R, Kelle S, Rolf A, Zitzmann S, Peker E, D'Angelo T, Pathan F, Elen, Valbuena S, Hinojar R, Arendt C, Narula J, Herrmann E, Zeiher AM, Nagel E. Native T1 and ECV of Noninfarcted Myocardium and Outcome in Patients With Coronary Artery Disease. J Am Coll Cardiol 2019; 71:766-778. [PMID: 29447739 DOI: 10.1016/j.jacc.2017.12.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) remains the major cause of cardiac morbidity and mortality worldwide, despite the advances in treatment with coronary revascularization and modern antiremodeling therapy. Risk stratification in CAD patients is primarily based on left ventricular volumes, ejection fraction (LVEF), risk scores, and the presence and extent of late gadolinium enhancement (LGE). The prognostic role of T1 mapping in noninfarcted myocardium in CAD patients has not yet been determined. OBJECTIVES This study sought to examine prognostic significance of native T1 mapping of noninfarcted myocardium in patients with CAD. METHODS A prospective, observational, multicenter longitudinal study of consecutive patients undergoing routine cardiac magnetic resonance imaging with T1 mapping and LGE. The primary endpoint was all-cause mortality. Major adverse cardiocerebrovascular events (MACCE) (cardiac mortality, nonfatal acute coronary syndrome, stroke, and appropriate device discharge) are also reported. RESULTS A total of 34 deaths and 71 MACCE (n = 665, males n = 424, median age [interquartile range] 57 [22] years; 64%; median follow-up period of 17 [11] months) were observed. Native T1 and extracellular volume were univariate predictors of outcome. Native T1 and LGE were stronger predictors of survival and MACCE compared with extracellular volume, LVEF, cardiac volumes, and clinical scores (p < 0.001). Native T1 of noninfarcted myocardium was the sole independent predictor of all-cause mortality (chi-square = 21.7; p < 0.001), which was accentuated in the absence of LGE or LVEF ≤35%. For MACCE, native T1 and LGE extent were joint independent predictors (chi-square = 25.6; p < 0.001). CONCLUSIONS Characterization of noninfarcted myocardium by native T1 is an important predictor of outcome in CAD patients, over and above the traditional risk stratifiers. The current study's results provide a basis for a novel risk stratification model in CAD based on a complementary assessment of noninfarcted myocardium and post-infarction scar, by native T1 mapping and LGE, respectively.
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Affiliation(s)
- Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany.
| | - Gerry Carr-White
- Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; King's College Hospital NHS Trust, Denmark Hill, London, United Kingdom
| | - Andrew Jabbour
- Department of Cardiology, St. Vincent's University, Sydney, New South Wales, Australia
| | - Chung-Yao Yu
- Department of Cardiology, St. Vincent's University, Sydney, New South Wales, Australia
| | - Rolf Gebker
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Sabine Zitzmann
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Elif Peker
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University Hospital, Ankara, Turkey
| | - Tommaso D'Angelo
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy
| | - Faraz Pathan
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Imaging, Menzies Institute for Medical Research, Hobart Tasmania, Australia
| | - Elen
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Jakarta, Jakarta, Indonesia
| | - Silvia Valbuena
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Rocio Hinojar
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Christophe Arendt
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Jagat Narula
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York
| | - Eva Herrmann
- DZHK Institute of Biostatistics and Mathematical Modelling at Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany; Department of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
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Harris JM, Brierley RC, Pufulete M, Bucciarelli-Ducci C, Stokes EA, Greenwood JP, Dorman SH, Anderson RA, Rogers CA, Wordsworth S, Berry S, Reeves BC. A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cardiovascular magnetic resonance (CMR) is increasingly used in patients who activate the primary percutaneous coronary intervention (PPCI) pathway to assess heart function. It is uncertain whether having CMR influences patient management or the risk of major adverse cardiovascular events in these patients.
Objective
To determine whether or not it is feasible to set up a national registry, linking routinely collected data from hospital information systems (HISs), to investigate the role of CMR in patients who activate the PPCI pathway.
Design
A feasibility prospective cohort study.
Setting
Four 24/7 PPCI hospitals in England and Wales (two with and two without a dedicated CMR facility).
Participants
Patients who activated the PPCI pathway and underwent an emergency coronary angiogram.
Interventions
CMR either performed or not performed within 10 weeks of the index event.
Main outcome measures
A. Feasibility parameters – (1) patient consent implemented at all hospitals, (2) data extracted from more than one HIS and successfully linked for > 90% of consented patients at all four hospitals, (3) HIS data successfully linked with Hospital Episode Statistics (HES) and Patient Episode Database Wales (PEDW) for > 90% of consented patients at all four hospitals and (4) CMR requested and carried out for ≥ 10% of patients activating the PPCI pathway in CMR hospitals. B. Key drivers of cost-effectiveness for CMR (identified from simple cost-effectiveness models) in patients with (1) multivessel disease and (2) unobstructed coronary arteries. C. A change in clinical management arising from having CMR (defined using formal consensus and identified using HES follow-up data in the 12 months after the index event).
Results
A. (1) Consent was implemented (for all hospitals, consent rates were 59–74%) and 1670 participants were recruited. (2) Data submission was variable – clinical data available for ≥ 82% of patients across all hospitals, biochemistry and echocardiography (ECHO) data available for ≥ 98%, 34% and 87% of patients in three hospitals and medications data available for 97% of patients in one hospital. (3) HIS data were linked with hospital episode data for 99% of all consented patients. (4) At the two CMR hospitals, 14% and 20% of patients received CMR. B. In both (1) multivessel disease and (2) unobstructed coronary arteries, the difference in quality-adjusted life-years (QALYs) between CMR and no CMR [‘current’ comparator, stress ECHO and standard ECHO, respectively] was very small [0.0012, 95% confidence interval (CI) –0.0076 to 0.0093 and 0.0005, 95% CI –0.0050 to 0.0077, respectively]. The diagnostic accuracy of the ischaemia tests was the key driver of cost-effectiveness in sensitivity analyses for both patient subgroups. C. There was consensus that CMR leads to clinically important changes in management in five patient subgroups. Some changes in management were successfully identified in hospital episode data (e.g. new diagnoses/procedures, frequency of outpatient episodes related to cardiac events), others were not (e.g. changes in medications, new diagnostic tests).
Conclusions
A national registry is not currently feasible. Patients were consented successfully but conventional consent could not be implemented nationally. Linking HIS and hospital episode data was feasible but HIS data were not uniformly available. It is feasible to identify some, but not all, changes in management in the five patient subgroups using hospital episode data. The delay in obtaining hospital episode data influenced the relevance of some of our study objectives.
Future work
To test the feasibility of conducting the study using national data sets (e.g. HES, British Cardiovascular Intervention Society audit database, Diagnostic Imaging Dataset, Clinical Practice Research Datalink).
Funding
The National Institute for Health Research (NIHR) Health Services and Delivery Research programme. This study was designed and delivered in collaboration with the Clinical Trials and Evaluation Unit, a UK Clinical Research Collaboration-registered clinical trials unit that, as part of the Bristol Trials Centre, is in receipt of NIHR clinical trials unit support funding.
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Affiliation(s)
- Jessica M Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Rachel C Brierley
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- National Institute for Health Research (NIHR) Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Stephen H Dorman
- National Institute for Health Research (NIHR) Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sunita Berry
- NHS England, South West Clinical Networks and Senate, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
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Ghotbi AA, Clemmensen A, Kyhl K, Follin B, Hasbak P, Engstrøm T, Ripa RS, Kjaer A. Rubidium-82 PET imaging is feasible in a rat myocardial infarction model. J Nucl Cardiol 2019; 26:798-809. [PMID: 28721647 PMCID: PMC6517336 DOI: 10.1007/s12350-017-0994-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/29/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Small-animal myocardial infarct models are frequently used in the assessment of new cardioprotective strategies. A validated quantification of perfusion using a non-cyclotron-dependent PET tracer would be of importance in monitoring response to therapy. We tested whether myocardial PET perfusion imaging is feasible with Rubidium-82 (82Rb) in a small-animal scanner using a rat myocardial infarct model. METHODS 18 Sprague-Dawley rats underwent permanent coronary artery ligation (infarct group), and 11 rats underwent ischemia-reperfusion (reperfusion group) procedure. 82Rb-PET and magnetic resonance imaging (MRI) were conducted before and after the intervention. Perfusion was compared to both left ventricle ejection fraction (LVEF) and infarct size assessed by MRI. RESULTS Follow-up global 82Rb-uptake correlated significantly with infarct size (infarct group: r = -0.81, P < 0.001 and reperfusion group: r = -0.61, P = 0.04). Only 82Rb-uptake in the infarct group correlated with LVEF. At follow-up, a higher segmental 82Rb-uptake in the infarct group was associated with better wall motion (β = 0.034, CI [0.028;0.039], P < 0.001, R2 = 0.30), and inversely associated with scar transmurality (β = -2.4 [-2.6; -2.2], P < 0.001, R2 = 0.59). The associations were similar for the reperfusion group. CONCLUSION 82Rb-PET is feasible in small animal scanners despite the long positron range and enables fast and time-efficient myocardial perfusion imaging in rat models.
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Affiliation(s)
- Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Andreas Clemmensen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kasper Kyhl
- Department of Cardiology, The Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Bjarke Follin
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Cardiology Stem Cell Center, The Heart Center, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Juárez-Orozco LE, Tio RA, Alexanderson E, Dweck M, Vliegenthart R, El Moumni M, Prakken N, Gonzalez-Godinez I, Slart RHJA. Quantitative myocardial perfusion evaluation with positron emission tomography and the risk of cardiovascular events in patients with coronary artery disease: a systematic review of prognostic studies. Eur Heart J Cardiovasc Imaging 2019; 19:1179-1187. [PMID: 29293983 PMCID: PMC6148746 DOI: 10.1093/ehjci/jex331] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/05/2017] [Indexed: 01/05/2023] Open
Abstract
Aims To evaluate the prognostic value of quantitative myocardial perfusion imaging with positron emission tomography (PET) for adverse cardiovascular outcomes in patients with known or suspected coronary artery disease (CAD). Methods and results A search in MEDLINE and Embase was conducted for studies that evaluated (i) myocardial perfusion in absolute terms with PET, (ii) prognostic value for the development of major adverse cardiovascular events (MACE), cardiac death, and/or all-cause mortality, and (iii) patients with known or suspected CAD. Studies were divided according to the radiotracer utilized and their included population (patients with and without previous infarction). Comprehensive description and a selected instance of pooling were performed. Eight studies (n = 6804) were analysed and documented clear variability in population, quantitative PET variables operationalization [stress myocardial blood flow (sMBF) and flow reserve (MFR)], statistical covariate structure, follow-up, and radiotracer utilized. MFR was independently associated with MACE in eight studies [range of adjusted hazard ratios (HRs): 1.19–2.93]. The pooling instance demonstrated that MFR significantly associates with the development of MACEs (HR: 1.92 [1.29, 2.84]; P = 0.001). sMBF was only associated with MACE in two studies that evaluated it, and only one study documented sMBF as a better predictor than MFR. Conclusion This systematic review demonstrates the prognostic value of quantitative myocardial perfusion evaluated with PET, in the form of MFR and sMBF, for the development of major adverse cardiovascular outcomes in populations with known or suspected CAD. In the qualitative comparison, MFR seems to outperform sMBF as an independent prognostic factor. Evidence is still lacking for assessing quantitative PET for the occurrence of cardiac death and all-cause mortality. There is clear heterogeneity in predictor operationalization and study performances.
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Affiliation(s)
- Luis Eduardo Juárez-Orozco
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Internal Postcode: EB50, 9700 RB, Groningen, The Netherlands
| | - Rene A Tio
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, EJ, Eindhoven, The Netherlands
| | - Erick Alexanderson
- Department of Nuclear Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez", Juan Badiano 1, Belisario Domínguez Secc 16, Tlalpan, CDMX, Mexico
| | - Marc Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, Center for Medical Imaging, University of Groningen, Hanzeplein 1 UMCG, RB, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Traumatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1 UMCG, 9700RB, Groningen, The Netherlands
| | - Niek Prakken
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Internal Postcode: EB50, 9700 RB, Groningen, The Netherlands
| | - Ivan Gonzalez-Godinez
- Department of Internal Medicine, Dalinde Medical Center, Tuxpan 25, Colonia Roma, C.P. CDMX, Mexico
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Internal Postcode: EB50, 9700 RB, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging Group, University of Twente, Zuidhorst ZH164 Dienstweg 1, ND, Enschede, The Netherlands
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Effect of Dual-Source Radiofrequency Transmission on Left Ventricular Measurements and Measurement Reproducibility at 3.0 T Cardiac MR Imaging: Comparison with Conventional Single-Source Transmission Reference. Acad Radiol 2019; 26:e56-e66. [PMID: 30172713 DOI: 10.1016/j.acra.2018.06.007] [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: 04/07/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES To prospectively assess effect of dual-source radiofrequency (RF) transmission on left ventricular (LV) measurements and measurements reproducibility at 3.0 T MR using balanced steady-state free precession (b-SSFP) cine imaging, compared to the conventional single-source RF transmission reference approach. MATERIALS AND METHODS Cardiac b-SSFP cine imaging was performed in 19 subjects at 3.0 T MR equipped with dual-source RF transmission. All images were analyzed to obtain LV end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, mass, LV end-diastolic inferior wall thickness, and interventricular septal thickness. The difference of all LV measurements between the two imaging techniques was tested with the paired t test and the intertechnique agreement was tested through linear regression and Bland-Altman analyses. Additionally, repeated LV measurements were performed to determine intra and interobserver variability with the Bland-Altman method, the 95% limits of agreement, the coefficient of variation (CV) and the intraclass correlation coefficient. RESULTS Compared to conventional single-source, dual-source slightly overestimated end-diastolic volume, end-systolic volume, and stroke volume (mean differences, 3.9 mL ± 9.7, 1.1 mL ± 2.6, and 2.8 mL ± 9.1, respectively; p > 0.05), resulting in a small but significant positive bias in ejection fraction (1.5% ± 2.6; p = 0.021). Mass was significantly smaller with dual-source than with single-source (-4.0 g ± 6.5, p = 0.001). Dual-source slightly underestimated interventricular septal thickness (-0.29 mm ± 0.6, p = 0.067) and significantly underestimated LV end-diastolic inferior wall thickness (-0.55 mm ± 0.4, p < 0.0001). The two techniques in measurements correlated highly (r2 = 0.81 to 0.96, p < 0.0001). Intra and interobserver variability in dual-source measurements was much lower than that in single-source, and variability values were <14.0%. CONCLUSION Improved image quality of b-SSFP cine imaging at 3.0 T MR with dual-source RF transmission may provide more reproducible LV measurements compared to conventional single-source approach. Dual-source RF transmission also provides a reasonable estimate of the LV measurements.
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Stojanovic I, Schneider JE, Cooper J. Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S. J Med Econ 2019; 22:430-438. [PMID: 30732489 DOI: 10.1080/13696998.2019.1580713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS The purpose of this study is to assess the economic cost differences and the associated treatment resource changes between the developing coronary artery disease (CAD) diagnostic tool fast strain-encoded cardiac imaging (Fast-SENC) and the current commonly used stress test single-photon emission computed tomography (SPECT). MATERIALS AND METHODS A "payer perspective" model was created first, consisting of long-term and short-term components that used a hypothetical cohort of patients of average age (60.8 years) presenting with chest pain and suspected CAD to assess cost-impact. A cost impact model was then built that assessed likely savings from a "hospital perspective" from substituting Fast-SENC for a portion of SPECTs assuming an average number of annual SPECT tests performed in US hospitals. RESULTS In the payer model, using Fast-SENC followed by coronary angiography (CA) and percutaneous coronary intervention (PCI) treatment when necessary is less costly than the SPECT method when considering both direct and indirect costs of testing. Expected costs of the Fast-SENC were between $2,510 and $2,632 per correct diagnosis, while expected costs for the SPECT were between $3,157 and $4,078. Fast-SENC reduced false positives by 50% and false negatives by 86%, generating additional cost savings. The hospital model showed total costs per CAD patient visit of $825 for SPECT and $376 for Fast-SENC. LIMITATIONS Limitations of this study are that clinical data are sourced from other published clinical trials on how CAD diagnostic strategies impact clinical outcome, and that necessary assumptions were made which impact health outcomes. CONCLUSION The lower cost, higher sensitivity and specificity rates, and faster, less burdensome process for detecting CAD patients make Fast-SENC a more capable and economically beneficial stress test than SPECT. The payer model and hospital model demonstrate an alignment between payer and provider economics as Fast-SENC provides monetary savings for patients and resource benefits for hospitals.
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Affiliation(s)
| | | | - Jacie Cooper
- a Avalon Health Economics , Morristown , NJ , USA
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Ghotbi AA, Hasbak P, Nepper-Christensen L, Lønborg J, Atharovski K, Christensen T, Holmvang L, Engstrøm T, Ripa RS, Kjær A. Early risk stratification using Rubidium-82 positron emission tomography in STEMI patients. J Nucl Cardiol 2019; 26:471-482. [PMID: 28718077 PMCID: PMC6430746 DOI: 10.1007/s12350-017-0993-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/30/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Assessment of infarct size after myocardial infarction is predictive of subsequent morphological changes and clinical outcome. This study aimed to assess subacute post-intervention Rubidium-82 (82Rb)-PET imaging in predicting left ventricle ejection fraction, regional wall motion, and final infarct size by CMR at 3-months after STEMI. METHODS STEMI patients undergoing percutaneous coronary intervention were included prospectively. Rest-only 82Rb-PET perfusion imaging was performed at median 36 hours [IQR: 22 to 50] after the treatment. The extent of hypoperfusion and absolute blood flow (mL·min·g) were estimated on a global and a 17-segment model with dedicated software. At 3-months follow-up patients completed the CMR functional and late gadolinium enhancement imaging. RESULTS 42 patients were included, but only 35 had follow-up CMR and constituted the study population. Absolute blood flow was significantly lower in the infarct-related territory compared to remote myocardium, P < .005. Extent of hypoperfusion correlated with final infarct size, r = 0.58, P < .001, while blood flow correlated with ejection fraction, r = 0.41, P < .05. In linear mixed models, higher subacute absolute blood flow (β = 4.6, confidence interval [3.5; 5.2], P < .001, R2 = 0.67) was associated with greater wall motion. Segmental extent of subacute hypoperfusion (β = 0.43 [0.38; 0.49], P < .001, R2 = 0.58) was associated with the degree of late gadolinium enhancement at 3-months. CONCLUSIONS Subacute rest-only 82Rb-PET is feasible following STEMI and seems predictive of myocardial function and infarct size at 3-months.
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Affiliation(s)
- Adam Ali Ghotbi
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Center, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Jacob Lønborg
- Department of Cardiology, The Heart Center, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Kiril Atharovski
- Department of Cardiology, The Heart Center, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Thomas Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, The Heart Center, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Center, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Slart RHJA, Juarez-Orozco LE. Early post-STEMI PET, a judicious investment? J Nucl Cardiol 2019; 26:483-485. [PMID: 28776315 DOI: 10.1007/s12350-017-1015-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands.
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Curran J, Burkhoff D, Kloner RA. Beyond Reperfusion: Acute Ventricular Unloading and Cardioprotection During Myocardial Infarction. J Cardiovasc Transl Res 2019; 12:95-106. [PMID: 30671717 PMCID: PMC6497619 DOI: 10.1007/s12265-019-9863-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/02/2019] [Indexed: 12/21/2022]
Abstract
Heart failure is a major cause of morbidity and mortality around the world, and myocardial infarction is its leading cause. Myocardial infarction destroys viable myocardium, and this dead tissue is replaced by a non-contractile scar that results in impaired cardiac function and a significantly increased likelihood of the patient developing heart failure. Limiting infarct scar size has been the target of pre-clinical and clinical investigations for decades. However, beyond reperfusion, few therapies have translated into the clinic that limit its formation. New approaches are needed. This review will focus on new clinical and pre-clinical data demonstrating that acute ventricular unloading prior to reperfusion by means of percutaneous left ventricular support devices reduces ischemia-reperfusion injury and limits infarct scar size. Emphasis will be given to summarizing our current mechanistic understanding of this new therapeutic approach to treating myocardial infarction.
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Affiliation(s)
| | | | - Robert A Kloner
- Huntington Medical Research Institutes, Pasadena, CA, USA
- University of Southern California, Los Angeles, CA, USA
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Ora M, Gambhir S. Myocardial Perfusion Imaging: A Brief Review of Nuclear and Nonnuclear Techniques and Comparative Evaluation of Recent Advances. Indian J Nucl Med 2019; 34:263-270. [PMID: 31579355 PMCID: PMC6771197 DOI: 10.4103/ijnm.ijnm_90_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Invasive coronary angiography (ICA) is the gold standard for the evaluation of epicardial CAD. In the pathogenesis of the CAD, myocardial perfusion abnormalities are the first changes that appear followed by wall motion abnormalities, electrocardiogram changes, and angina. Myocardial perfusion imaging (MPI) demonstrates the cumulative effect of pathology at epicardial coronary arteries, small vessels, and endothelium. Thus, it evaluates the overall burden of ischemic heart disease (IHD). MPI is used noninvasively to diagnose early asymptomatic CAD or to know the functional significance of known CAD. There are evidence that early detection of myocardial perfusion abnormalities followed by aggressive intervention against cardiovascular risk factors may restore myocardial perfusion. This may lead to reduce morbidity and mortality. Various MPI modalities have been used to diagnose and define the severity of CAD. Cardiac myocardial perfusion single-photon emission computed tomography (myocardial perfusion scintigraphy [MPS]) has been in use since decades. Several newer modalities such as positron emission tomography, cardiac magnetic resonance imaging, computed tomography perfusion, and myocardial contrast echocardiography are developing utilizing the similar principle of MPS. We shall be reviewing briefly these modalities, their performance, comparison to each other, and with ICA.
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Affiliation(s)
- Manish Ora
- Professor and Head of the Department, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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50
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Tan NY, Hayes SN, Young PM, Gulati R, Tweet MS. Usefulness of Cardiac Magnetic Resonance Imaging in Patients With Acute Spontaneous Coronary Artery Dissection. Am J Cardiol 2018; 122:1624-1629. [PMID: 30220414 DOI: 10.1016/j.amjcard.2018.07.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/15/2022]
Abstract
Cardiac magnetic resonance (CMR) has significant diagnostic and prognostic utility in myocardial infarction evaluation. However, its application in spontaneous coronary artery dissection (SCAD) is not described. Patients with confirmed SCAD who had CMR performed within 8 days of the index SCAD were reviewed. Clinical variables including demographics and medical history were recorded. CMR indexes, including myocardial delayed enhancement (MDE), microvascular obstruction, perfusion defects, left ventricular ejection fraction, and wall motion score index were measured. A total of 18 patients (all women, mean age 47.1 years) were included. Overall burden of atherosclerotic risk factors was low; 3 had a previous SCAD. Two patients underwent CMR before coronary angiography, whereas the others received CMR thereafter. Mean time between SCAD diagnosis and CMR completion was 2.7 days (range 0 to 8). Mean left ventricular ejection fraction and wall motion score index were 56.1% and 1.27, respectively. A total of 15 patients had MDE consistent with myocardial infarction in the SCAD distribution(s) identified on coronary angiography, with 8 patients having concomitant microvascular obstruction. Ten patients had transmural MDE. At follow-up (mean 386 days), all patients were alive; extracoronary vascular abnormalities were identified in 14; 6 had recurrent chest pain; and 2 had recurrent SCAD. Both patients with recurrent SCAD had no unique features on CMR to predict a future event. In conclusion, CMR provided significant value in clarifying the diagnosis and assessing for adverse sequelae after acute SCAD. Further studies are needed to determine its role in SCAD prognostication.
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Affiliation(s)
- Nicholas Y Tan
- Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota
| | - Phillip M Young
- Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota
| | - Marysia S Tweet
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.
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