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Pätz T, Stiermaier T, Meusel M, Reinhard I, Jensch PJ, Rawish E, Wang J, Feistritzer HJ, Schuster A, Koschalka A, Lange T, Kowallick JT, Desch S, Thiele H, Eitel I. Myocardial injury and clinical outcome in octogenarians after non-ST-elevation myocardial infarction. Front Cardiovasc Med 2024; 11:1422878. [PMID: 39105073 PMCID: PMC11299492 DOI: 10.3389/fcvm.2024.1422878] [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: 04/24/2024] [Accepted: 06/25/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction The aim of this study was to analyze age-associated myocardial injury and clinical outcome after non-ST-elevation myocardial infarction (NSTEMI). Methods This prospective, multicenter study consists of 440 patients with NSTEMI enrolled at 7 centers. All patients were treated with primary percutaneous coronary intervention and underwent cardiac magnetic resonance (CMR) imaging 1-10 days after study inclusion. CMR parameters of myocardial injury and clinical outcome were evaluated by creating 2 subgroups: <80 years vs. ≥80 years. The clinical endpoint was the 1-year incidence of major adverse cardiac events (MACE) consisting of death, re-infarction and new congestive heart failure. Results Elderly patients ≥80 years accounted for 13.9% of the study population and showed a divergent cardiovascular risk profile compared to the subgroup of patients <80 years. CMR imaging did not reveal significant differences regarding infarct size, microvascular obstruction, left ventricular ejection fraction or multidimensional strain analysis between the study groups. At 1-year follow-up, MACE rate was significantly increased in patients ≥80 years compared to patients aged <80 years (19.7% vs. 9.6%; p = 0.019). In a multiple stepwise logistic regression model, the number of diseased vessels, aldosterone antagonist use and left ventricular global longitudinal strain were identified as independent predictors for MACE in all patients, while there was no independent predictive value of age regarding 1-year clinical outcome. Conclusion This prospective, multicenter analysis shows that structural and functional myocardial damage is similar in younger and older patients with NSTEMI. Furthermore, in this heterogeneous but also clinically representative cohort with reduced sample size, age was not independently associated with 1-year clinical outcome, despite an increased event rate in patients ≥80 years.
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Affiliation(s)
- Toni Pätz
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Moritz Meusel
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Philipp-Johannes Jensch
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Elias Rawish
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Juan Wang
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Johannes T. Kowallick
- Institute for Diagnostic and Interventional Radiology, German Center for Cardiovascular Research (DZHK), University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
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Janwetchasil P, Yindeengam A, Krittayaphong R. Prognostic value of global longitudinal strain in patients with preserved left ventricular systolic function: A cardiac magnetic resonance real-world study. J Cardiovasc Magn Reson 2024; 26:101057. [PMID: 38971500 PMCID: PMC11283226 DOI: 10.1016/j.jocmr.2024.101057] [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: 12/17/2023] [Revised: 05/29/2024] [Accepted: 06/29/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Myocardial strain is a more sensitive parameter for cardiac function evaluation than left ventricular ejection fraction (LVEF). This study aimed to assess the predictive value of left ventricular global longitudinal strain (LV-GLS) by feature tracking-cardiac magnetic resonance (FT-CMR) imaging in patients with known or suspected coronary artery disease (CAD) with preserved left ventricular systolic function. METHODS This retrospective cohort analysis enrolled patients with known or suspected CAD who underwent cardiac magnetic resonance imaging from September 2017 to December 2019. LV-GLS was analyzed via feature-tracking analysis. Patients with LVEF <50% were excluded. The composite outcome comprised all-cause death, non-fatal myocardial infarction, and heart failure. RESULTS There was a total of 2613 patients. Mean follow-up duration was 39.7 ± 13.9 months. During follow-up, 194 patients (7.4%) experienced a composite outcome. The best cutoff of LV-GLS in the prediction of composite outcome from receiver operating characteristics was -14.4%. Patients were classified into 2 groups according to the LV-GLS; 1489 (57.0%) had LV-GLS <-14.4% and 1124 (43.0%) had LV-GLS ≥-14.4%. Patients with LV-GLS ≥-14.4% had a significantly higher rate of composite outcome than LV-GLS <-14.4% patients (3.59 vs. 1.39 per 100 person-years, respectively; p < 0.001). Multivariable analysis showed that patients with LV-GLS ≥-14.4% had a significantly higher risk of experiencing a composite outcome event compared to global longitudinal strain <-14.4% patients (adjusted hazard ratio: 1.83, 95% confidence interval: 1.28-2.61; p = 0.001). CONCLUSION LV-GLS by FT-CMR was shown to be useful for predicting the prognosis of patients with known or suspected CAD with preserved left ventricular systolic function. LV-GLS -14.4% was the identified cutoff for prognostic determination.
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Affiliation(s)
- Preeyaporn Janwetchasil
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ahthit Yindeengam
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Lange T, Backhaus SJ, Schulz A, Hashemi D, Evertz R, Kowallick JT, Hasenfuß G, Kelle S, Schuster A. CMR-based cardiac phenotyping in different forms of heart failure. Int J Cardiovasc Imaging 2024; 40:1585-1596. [PMID: 38878148 PMCID: PMC11258094 DOI: 10.1007/s10554-024-03145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/15/2024] [Indexed: 07/19/2024]
Abstract
Heart failure (HF) is a heterogenous disease requiring precise diagnostics and knowledge of pathophysiological processes. Since structural and functional imaging data are scarce we hypothesized that cardiac magnetic resonance (CMR)-based analyses would provide accurate characterization and mechanistic insights into different HF groups comprising preserved (HFpEF), mid-range (HFmrEF) and reduced ejection fraction (HFrEF). 22 HFpEF, 17 HFmrEF and 15 HFrEF patients as well as 19 healthy volunteers were included. CMR image assessment contained left atrial (LA) and left ventricular (LV) volumetric evaluation as well as left atrioventricular coupling index (LACI). Furthermore, CMR feature-tracking included LV and LA strain in terms of reservoir (Es), conduit (Ee) and active boosterpump (Ea) function. CMR-based tissue characterization comprised T1 mapping as well as late-gadolinium enhancement (LGE) analyses. HFpEF patients showed predominant atrial impairment (Es 20.8%vs.25.4%, p = 0.02 and Ee 8.3%vs.13.5%, p = 0.001) and increased LACI compared to healthy controls (14.5%vs.23.3%, p = 0.004). Patients with HFmrEF showed LV enlargement but mostly preserved LA function with a compensatory increase in LA boosterpump (LA Ea: 15.0%, p = 0.049). In HFrEF LA and LV functional impairment was documented (Es: 14.2%, Ee: 5.4% p < 0.001 respectively; Ea: 8.8%, p = 0.02). This was paralleled by non-invasively assessed progressive fibrosis (T1 mapping and LGE; HFrEF > HFmrEF > HFpEF). CMR-imaging reveals insights into HF phenotypes with mainly atrial affection in HFpEF, ventricular affection with atrial compensation in HFmrEF and global impairment in HFrEF paralleled by progressive LV fibrosis. These data suggest a necessity for a personalized HF management based on imaging findings for future optimized patient management.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre of Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-Universität Gießen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre of Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
| | - Djawid Hashemi
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre of Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre of Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre of Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
- German Centre of Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany.
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Chen Q, Zhang Z, Chen L, Zhou Z, Lu Y, Zhang C, Li C, Zhang Z, Chen W. Association between cardiac magnetic resonance ventricular strain and left ventricular thrombus in patients with ST-segment elevation myocardial infarction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03163-2. [PMID: 38884697 DOI: 10.1007/s10554-024-03163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Myocardial strain can analyze early myocardial dysfunction after myocardial infarction (MI). However, the correlation between left ventricular (LV) strain (including regional and global strain) obtained by cardiac magnetic resonance (CMR) imaging and left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS The retrospective clinical observation study included patients with LVT (n = 20) and non-LVT (n = 195) who underwent CMR within two weeks after STEMI. CMR images were analyzed using CVI 42 (Circle Cardiovascular Imaging, Canada) to obtain LV strain values. Logistic regression analysis identified risk factors for LVT among baseline characteristics, CMR ventricular strain, and left ventricular ejection fraction (LVEF). Considering potential correlations between strains, the ability of LV strain to identify LVT was evaluated using 9 distinct models. Receiver operating characteristic curves were generated with GraphPad Prism, and the area under the curve (AUC) of LVEF, apical longitudinal strain (LS), and circumferential strain (CS) was calculated to determine their capacity to distinguish LVT. RESULTS Among 215 patients, 9.3% developed LVT, with a 14.5% incidence in those with anterior MI. Univariate regression indicated associations of LAD infarct-related artery, lower NT-proBNP, lower LVEF, and reduced global, midventricular, and apical strain with LVT. Further multivariable regression analysis showed that apical LS, LVEF and NT-proBNP were still independently related to LVT (Apical LS: OR = 1.14, 95%CI (1.01, 1.30), P = 0.042; LVEF: OR = 0.91, 95%CI (0.85, 0.97), P = 0.005; NT-proBNP: OR = 2.35, 95%CI (1.04, 5.31) ). CONCLUSION Reduced apical LS on CMR is independently associated with LVT after STEMI.
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Affiliation(s)
- Qing Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Zeqing Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Lei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziyu Zhou
- School of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China
| | - Zhuoqi Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China.
| | - Wensu Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99#, Huaihai West Road, Xuzhou, 221002, China.
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Deshmukh T, Selvakumar D, Thavapalachandran S, Archer O, Figtree GA, Feneley M, Grieve SM, Thomas L, Pathan F, Chong JJH. Correlation of Noninvasive Cardiac MRI Measures of Left Ventricular Myocardial Function and Invasive Pressure-Volume Parameters in a Porcine Ischemia-Reperfusion Model. Radiol Cardiothorac Imaging 2024; 6:e230252. [PMID: 38842454 PMCID: PMC11211950 DOI: 10.1148/ryct.230252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/24/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024]
Abstract
Purpose To assess the correlation between noninvasive cardiac MRI-derived parameters with pressure-volume (PV) loop data and evaluate changes in left ventricular function after myocardial infarction (MI). Materials and Methods Sixteen adult female swine were induced with MI, with six swine used as controls and 10 receiving platelet-derived growth factor-AB (PDGF-AB). Load-independent measures of cardiac function, including slopes of end-systolic pressure-volume relationship (ESPVR) and preload recruitable stroke work (PRSW), were obtained on day 28 after MI. Cardiac MRI was performed on day 2 and day 28 after infarct. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Ventriculo-arterial coupling (VAC) was derived from PV loop and cardiac MRI data. Pearson correlation analysis was performed. Results GCS (r = 0.60, P = .01), left ventricular ejection fraction (LVEF) (r = 0.60, P = .01), and cardiac MRI-derived VAC (r = 0.61, P = .01) had a significant linear relationship with ESPVR. GCS (r = 0.75, P < .001) had the strongest significant linear relationship with PRSW, followed by LVEF (r = 0.67, P = .005) and cardiac MRI-derived VAC (r = 0.60, P = .01). GLS was not significantly correlated with ESPVR or PRSW. There was a linear correlation (r = 0.82, P < .001) between VAC derived from cardiac MRI and from PV loop data. GCS (-3.5% ± 2.3 vs 0.5% ± 1.4, P = .007) and cardiac MRI-derived VAC (-0.6 ± 0.6 vs 0.3 ± 0.3, P = .001) significantly improved in the animals treated with PDGF-AB 28 days after MI compared with controls. Conclusion Cardiac MRI-derived parameters of MI correlated with invasive PV measures, with GCS showing the strongest correlation. Cardiac MRI-derived measures also demonstrated utility in assessing therapeutic benefit using PDGF-AB. Keywords: Cardiac MRI, Myocardial Infarction, Pressure Volume Loop, Strain Imaging, Ventriculo-arterial Coupling Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Tejas Deshmukh
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Dinesh Selvakumar
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Sujitha Thavapalachandran
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Oliver Archer
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Gemma A. Figtree
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Michael Feneley
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Stuart M. Grieve
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Liza Thomas
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
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Elzoghby MM, Salama MMA, Elsetiha MA, El Ahwal HM, Romeih SA, Shaaban MN, Elmozy WE. Territorial Post-Revascularization Remodeling of Chronic Coronary Syndromes: Cardiac Magnetic Resonance Feature Tracking Study. J Magn Reson Imaging 2024; 59:2265-2274. [PMID: 37772452 DOI: 10.1002/jmri.29026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear. PURPOSE To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT. STUDY TYPE Prospective. SUBJECTS 50 CCS patients (age: 62.22 ± 8.70 years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33 ± 11.57 years). FIELD STRENGTH/SEQUENCE 1.5T with balanced steady-state free precession cine sequence. ASSESSMENT Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory. STATISTICAL TESTS Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level. RESULTS Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean - 11.41% ± 3.45% pre, -13.01% ± 3.53% post; RCA: mean - 11.11% ± 2.65% pre, -13.25% ± 2.81% post; and LCX: mean - 15.43% ± 3.97% pre, -16.17% ± 4.38% post, P = 0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean - 13.73% ± 6.56% pre, -16.98% ± 6.01% post; LCX: mean - 13.23% ± 4.23% pre, -16.34% ± 3.45% post; and RCA: mean - 11.24% ± 3.36% pre, -13.80% ± 3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73% ± 12.38% pre, 21.79% ± 11.55% post, P = 0.541; LCX: mean 27.73% ± 7.95% pre, 29.0% ± 7.25% post, P = 0.264; and RCA: mean 36.68% ± 11.10% pre, 31.75% ± 10.95% post, P = 0.208). DATA CONCLUSION Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Mohamed M Elzoghby
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Mai M A Salama
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed A Elsetiha
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hanan M El Ahwal
- Radiodiagnosis Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Soha A Romeih
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Mahmoud N Shaaban
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
| | - Wesam E Elmozy
- Aswan Heart Centre (Magdi Yacoub Foundation), Aswan, Egypt
- Radiodiagnosis Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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7
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Bo K, Li W, Zhang H, Wang Y, Zhou Z, Gao Y, Sun Z, Lian J, Wang H, Xu L. Association of stress hyperglycemia ratio with left ventricular function and microvascular obstruction in patients with ST-segment elevation myocardial infarction: a 3.0 T cardiac magnetic resonance study. Cardiovasc Diabetol 2024; 23:179. [PMID: 38802898 PMCID: PMC11131267 DOI: 10.1186/s12933-024-02271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Stress hyperglycemia, which is associated with poor prognosis in patients with acute myocardial infarction (AMI), can be determined using the stress hyperglycemia ratio (SHR). Impaired left ventricular function and microvascular obstruction (MVO) diagnosed using cardiac magnetic resonance (CMR) have also been proven to be linked to poor prognosis in patients with AMI and aid in risk stratification. However, there have been no studies on the correlation between fasting SHR and left ventricular function and MVO in patients with acute ST-segment elevation myocardial infarction (ASTEMI). Therefore, this study aimed to investigate the additive effect of fasting SHR on left ventricular function and global deformation in patients with ASTEMI and to explore the association between fasting SHR and MVO. METHODS Consecutive patients who underwent CMR at index admission (3-7 days) after primary percutaneous coronary intervention (PPCI) were enrolled in this study. Basic clinical, biochemical, and CMR data were obtained and compared among all patients grouped by fasting SHR tertiles: SHR1: SHR < 0.85; SHR2: 0.85 ≤ SHR < 1.01; and SHR3: SHR ≥ 1.01. Spearman's rho (r) was used to assess the relationship between fasting SHR and left ventricular function, myocardial strain, and the extent of MVO. Multivariable linear regression analysis was performed to evaluate the determinants of left ventricular function and myocardial strain impairment in all patients with AMI. Univariable and multivariable regression analyses were performed to investigate the correlation between fasting SHR and the presence and extent of MVO in patients with AMI and those with AMI and diabetes mellitus (DM). RESULTS A total of 357 patients with ASTEMI were enrolled in this study. Left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI) were significantly lower in SHR2 and SHR3 than in SHR1. Compared with SHR1 and SHR2 groups, left ventricular strain was lower in SHR3, as evidenced by global radial (GRS), global circumferential (GCS), and global longitudinal (GLS) strains. Fasting SHR were negatively correlated with LVEF, LVGFI, and GRS (r = - 0.252; r = - 0.261; and r = - 0.245; all P<0.001) and positively correlated with GCS (r = 0.221) and GLS (r = 0.249; all P <0.001). Multivariable linear regression analysis showed that fasting SHR was an independent determinant of impaired LVEF, LVGFI, GRS, and GLS. Furthermore, multivariable regression analysis after adjusting for covariates signified that fasting SHR was associated with the presence and extent of MVO in patients with AMI and those with AMI and DM. CONCLUSION Fasting SHR in patients with ASTEMI successfully treated using PPCI is independently associated with impaired cardiac function and MVO. In patients with AMI and DM, fasting SHR is an independent determinant of the presence and extent of MVO.
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Affiliation(s)
- Kairui Bo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China
| | - Weibo Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China
| | - Yan Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia
| | | | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China.
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, China.
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8
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Gissler MC, Antiochos P, Ge Y, Heydari B, Gräni C, Kwong RY. Cardiac Magnetic Resonance Evaluation of LV Remodeling Post-Myocardial Infarction: Prognosis, Monitoring and Trial Endpoints. JACC Cardiovasc Imaging 2024:S1936-878X(24)00127-X. [PMID: 38819335 DOI: 10.1016/j.jcmg.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 06/01/2024]
Abstract
Adverse left ventricular remodeling (ALVR) and subsequent heart failure after myocardial infarction (MI) remain a major cause of patient morbidity and mortality worldwide. Overt inflammation has been identified as the common pathway underlying myocardial fibrosis and development of ALVR post-MI. With its ability to simultaneously provide information about cardiac structure, function, perfusion, and tissue characteristics, cardiac magnetic resonance (CMR) is well poised to inform prognosis and guide early surveillance and therapeutics in high-risk cohorts. Further, established and evolving CMR-derived biomarkers may serve as clinical endpoints in prospective trials evaluating the efficacy of novel anti-inflammatory and antifibrotic therapies. This review provides an overview of post-MI ALVR and illustrates how CMR may help clinical adoption of novel therapies via mechanistic or prognostic imaging markers.
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Affiliation(s)
- Mark Colin Gissler
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Panagiotis Antiochos
- Cardiology and Cardiac MR Centre, University Hospital Lausanne, Lausanne, Switzerland
| | - Yin Ge
- Division of Cardiology, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Bobak Heydari
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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9
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Choi IY, Kim HW, Gim DH, Ki YJ, Kim HK, Kim SS, Park KH, Song H, Choi DH. Long-Term Prognostic Value of Infarct Transmurality Determined by Contrast-Enhanced Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction. Chonnam Med J 2024; 60:120-128. [PMID: 38841612 PMCID: PMC11148306 DOI: 10.4068/cmj.2024.60.2.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 06/07/2024] Open
Abstract
The long-term prognostic significance of maximal infarct transmurality evaluated by contrast-enhanced cardiac magnetic resonance (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients has yet to be determined. This study aimed to see if maximal infarct transmurality has any additional long-term prognostic value over other CE-CMR predictors in STEMI patients, such as microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). The study included 112 consecutive patients who underwent CE-CMR after STEMI to assess established parameters of myocardial injury as well as the maximal infarct transmurality. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE), which included all-cause death, non-fatal reinfarction, and new heart failure hospitalization. The MACE occurred in 10 patients over a median follow-up of 7.9 years (IQR, 5.8 to 9.2 years) (2 deaths, 3 nonfatal MI, and 5 heart failure hospitalization). Patients with MACE had significantly higher rates of transmural extent of infarction, infarct size >5.4 percent, MVO, and IMH compared to patients without MACE. In stepwise multivariable Cox regression analysis, the transmural extent of infarction defined as 75 percent or more of infarct transmurality was an independent predictor of the MACE after correction for MVO and IMH (hazard ratio 8.7, 95% confidence intervals [CIs] 1.1-71; p=0.043). In revascularized STEMI patients, post-infarction CE-CMR-based maximal infarct transmurality is an independent long-term prognosticator. Adding maximal infarct transmurality to CE-CMR parameters like MVO and IMH could thus identify patients at high risk of long-term adverse outcomes in STEMI.
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Affiliation(s)
- In Young Choi
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyun-Wook Kim
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Dong Hyun Gim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Young-Jae Ki
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Sung Soo Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Keun-Ho Park
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Heesang Song
- Biochemistry and Molecular Biology, Chosun University School of Medicine, Gwangju, Korea
| | - Dong-Hyun Choi
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
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10
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Corral Acero J, Lamata P, Eitel I, Zacur E, Evertz R, Lange T, Backhaus SJ, Stiermaier T, Thiele H, Bueno-Orovio A, Schuster A, Grau V. Comprehensive characterization of cardiac contraction for improved post-infarction risk assessment. Sci Rep 2024; 14:8951. [PMID: 38637609 PMCID: PMC11026383 DOI: 10.1038/s41598-024-59114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
This study aims at identifying risk-related patterns of left ventricular contraction dynamics via novel volume transient characterization. A multicenter cohort of AMI survivors (n = 1021) who underwent Cardiac Magnetic Resonance (CMR) after infarction was considered for the study. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE, n = 73), consisting of all-cause death, reinfarction, and new congestive heart failure. Cardiac function was characterized from CMR in 3 potential directions: by (1) volume temporal transients (i.e. contraction dynamics); (2) feature tracking strain analysis (i.e. bulk tissue peak contraction); and (3) 3D shape analysis (i.e. 3D contraction morphology). A fully automated pipeline was developed to extract conventional and novel artificial-intelligence-derived metrics of cardiac contraction, and their relationship with MACE was investigated. Any of the 3 proposed directions demonstrated its additional prognostic value on top of established CMR indexes, myocardial injury markers, basic characteristics, and cardiovascular risk factors (P < 0.001). The combination of these 3 directions of enhancement towards a final CMR risk model improved MACE prediction by 13% compared to clinical baseline (0.774 (0.771-0.777) vs. 0.683 (0.681-0.685) cross-validated AUC, P < 0.001). The study evidences the contribution of the novel contraction characterization, enabled by a fully automated pipeline, to post-infarction assessment.
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Affiliation(s)
- Jorge Corral Acero
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
| | - Pablo Lamata
- Department of Digital Twins for Healthcare, School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor North Wing, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Ingo Eitel
- Medical Clinic II, Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
- University Hospital Schleswig-Holstein, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ernesto Zacur
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Thomas Stiermaier
- Medical Clinic II, Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
- University Hospital Schleswig-Holstein, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Centre Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Vicente Grau
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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11
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Bernhard B, Joss P, Greisser N, Stark AW, Schütze J, Shiri I, Safarkhanlo Y, Fischer K, Guensch DP, Bastiaansen JAM, Pavlicek M, Benz DC, Kwong RY, Gräni C. Prognostic value of visual and quantitative CMR regional myocardial function in patients with suspected myocarditis. Int J Cardiovasc Imaging 2024; 40:907-920. [PMID: 38427272 PMCID: PMC11052711 DOI: 10.1007/s10554-024-03059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
According to updated Lake-Louise Criteria, impaired regional myocardial function serves as a supportive criterion in diagnosing myocarditis. This study aimed to assess visual regional wall motional abnormalities (RWMA) and novel quantitative regional longitudinal peak strain (RLS) for risk stratification in the clinical setting of myocarditis. In patients undergoing CMR and meeting clinical criteria for suspected myocarditis global longitudinal strain (GLS), late gadolinium enhancement (LGE), RWMA and RLS were assessed in the anterior, septal, inferior, and lateral regions and correlated to the occurrence of major adverse cardiac events (MACE), including heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis, and all-cause death. In 690 consecutive patients (age: 48.0 ± 16.0 years; 37.7% female) with suspected myocarditis impaired RLS was correlated with RWMA and LV-GLS but not with the presence of LGE. At median follow up of 3.8 years, MACE occurred in 116 (16.8%) patients. Both, RWMA and RLS in anterior-, septal-, inferior-, and lateral- locations were univariately associated with outcomes (all p < 0.001), but not after adjusting for clinical characteristics and LV-GLS. In the subgroup of patients with normal LV function, RWMA were not predictive of outcomes, whereas septal RLS had incremental and independent prognostic value over clinical characteristics (HRadjusted = 1.132, 95% CI 1.020-1.256; p = 0.020). RWMA and RLS can be used to assess regional impairment of myocardial function in myocarditis but are of limited prognostic value in the overall population. However, in the subgroup of patients with normal LV function, septal RLS represents a distinctive marker of regional LV dysfunction, offering potential for risk-stratification.
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Affiliation(s)
- Benedikt Bernhard
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philippe Joss
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noah Greisser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasaman Safarkhanlo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jessica A M Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Translation Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Maryam Pavlicek
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik C Benz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Cardiology, University Hospital Bern, Freiburgstrasse, CH - 3010, Bern, Switzerland.
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12
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Bolz C, Blaszczyk E, Mayr T, Lim C, Haufe S, Jordan J, Barckow P, Gröschel J, Schulz-Menger J. Adiposity influences on myocardial deformation: a cardiovascular magnetic resonance feature tracking study in people with overweight to obesity without established cardiovascular disease. Int J Cardiovasc Imaging 2024; 40:643-654. [PMID: 38308113 PMCID: PMC10951011 DOI: 10.1007/s10554-023-03034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024]
Abstract
The objective of this study was to assess whether dietary-induced weight loss improves myocardial deformation in people with overweight to obesity without established cardiovascular disease applying cardiovascular magnetic resonance (CMR) with feature tracking (FT) based strain analysis. Ninety people with overweight to obesity without established cardiovascular disease (age 44.6 ± 9.3 years, body mass index (BMI) 32.6 ± 4 kg/m2) underwent CMR. We retrospectively quantified FT based strain and LA size and function at baseline and after a 6-month hypocaloric diet, with either low-carbohydrate or low-fat intake. The study cohort was compared to thirty-four healthy normal-weight controls (age 40.8 ± 16.0 years, BMI 22.5 ± 1.4 kg/m2). At baseline, the study cohort with overweight to obesity without established cardiovascular disease displayed significantly increased global circumferential strain (GCS), global radial strain (GRS) and LA size (all p < 0.0001 versus controls) but normal global longitudinal strain (GLS) and normal LA ejection fraction (all p > 0.05 versus controls). Dietary-induced weight loss led to a significant reduction in GCS, GRS and LA size irrespective of macronutrient composition (all p < 0.01). In a population with overweight to obesity without established cardiovascular disease subclinical myocardial changes can be detected applying CMR. After dietary-induced weight loss improvement of myocardial deformation could be shown. A potential clinical impact needs further studies.
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Affiliation(s)
- Constantin Bolz
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Edyta Blaszczyk
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Thomas Mayr
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Carolin Lim
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Sven Haufe
- Clinic for Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | - Philipp Barckow
- Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada
| | - Jan Gröschel
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
- Helios Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany.
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13
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Ghugre NR. Editorial for "Prognostic Value of Segmental Strain After ST-Elevation Myocardial Infarction: Insights From the EARLY Assessment of MYOcardial Tissue Characteristics by Cardiac Magnetic Resonance (EARLY-MYO-CMR) Study". J Magn Reson Imaging 2024. [PMID: 38366870 DOI: 10.1002/jmri.29280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Nilesh R Ghugre
- Biomarkers and Imaging, Vertex Pharmaceuticals, Boston, Massachusetts, USA
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14
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He J, Kong L, An D, Chen B, Zhao C, Li Z, Yang F, Dong J, Wei L, Shan P, Chen Y, Wu L, Xu J, Ge H, Pu J. Prognostic Value of Segmental Strain After ST-Elevation Myocardial Infarction: Insights From the EARLY Assessment of MYOcardial Tissue Characteristics by Cardiac Magnetic Resonance (EARLY-MYO-CMR) Study. J Magn Reson Imaging 2024. [PMID: 38363170 DOI: 10.1002/jmri.29274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The prognostic value of left ventricular segmental strain (SS) in ST-elevation myocardial infarction (STEMI) remains unclear. HYPOTHESIS To assess the prognostic value and application of SS. STUDY TYPE Retrospective analysis of a prospective registry. POPULATION Five hundred and forty-four patients after STEMI (500 in Cohort 1, 44 in Cohort 2). FIELD STRENGTH/SEQUENCE 3 T, balanced steady-state free precession, gradient echo, and gradient echo contrast-enhanced images. ASSESSMENT Participants underwent cardiac MR during the acute phase after STEMI. Infarct-related artery (IRA) strain was determined based on SS obtained from cine images. The primary endpoint was the composite of major adverse cardiovascular events (MACEs) after 8 years of follow-up. In Cohort 2, SS stability was assessed by MR twice within 8 days. Contrast and non-contrast risk models based on SS were established, leading to the development of an algorithm. STATISTICAL TEST Student's t-test, Mann-Whitney U-test, Cox and logistic regression, Kaplan-Meier analysis, net reclassification index (NRI). P < 0.05 was considered significant. RESULTS During a median follow-up of 5.2 years, 83 patients from Cohort 1 experienced a MACE. Among SS, IRA peak circumferential strain (IRA-CS) was an independent factor for MACEs (adjusted hazard ratio 1.099), providing incremental prognostic value (NRI 0.180, P = 0.10). Patients with worse IRA-CS (>-8.64%) demonstrated a heightened susceptibility to MACE. Additionally, IRA-CS was significantly associated with microvascular obstruction (MVO) (adjusted odds ratio 1.084) and infarct size (r = 0.395). IRA-CS showed comparable prognostic effectiveness to global peak circumferential strain (NRI 0.100, P = 0.39), also counterbalancing contrast and non-contrast risk models (NRI 0.205, P = 0.05). In Cohort 2, IRA-CS demonstrated stability between two time points (P = 0.10). Based on risk models incorporating IRA-CS, algorithm "HJKL" was preliminarily proposed for stratification. DATA CONCLUSIONS IRA-CS is an important prognostic factor, and an algorithm based on it is proposed for stratification. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingcong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongaolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Binghua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chengxu Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianxun Dong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lai Wei
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peiren Shan
- Department of Cardiology, Wenzhou Medical University Affiliated NO. 1 Hospital, Wenzhou, China
| | - Yingmin Chen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lianming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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15
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Gröschel J, Kuhnt J, Viezzer D, Hadler T, Hormes S, Barckow P, Schulz-Menger J, Blaszczyk E. Comparison of manual and artificial intelligence based quantification of myocardial strain by feature tracking-a cardiovascular MR study in health and disease. Eur Radiol 2024; 34:1003-1015. [PMID: 37594523 PMCID: PMC10853310 DOI: 10.1007/s00330-023-10127-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES The analysis of myocardial deformation using feature tracking in cardiovascular MR allows for the assessment of global and segmental strain values. The aim of this study was to compare strain values derived from artificial intelligence (AI)-based contours with manually derived strain values in healthy volunteers and patients with cardiac pathologies. MATERIALS AND METHODS A cohort of 136 subjects (60 healthy volunteers and 76 patients; of those including 46 cases with left ventricular hypertrophy (LVH) of varying etiology and 30 cases with chronic myocardial infarction) was analyzed. Comparisons were based on quantitative strain analysis and on a geometric level by the Dice similarity coefficient (DSC) of the segmentations. Strain quantification was performed in 3 long-axis slices and short-axis (SAX) stack with epi- and endocardial contours in end-diastole. AI contours were checked for plausibility and potential errors in the tracking algorithm. RESULTS AI-derived strain values overestimated radial strain (+ 1.8 ± 1.7% (mean difference ± standard deviation); p = 0.03) and underestimated circumferential (- 0.8 ± 0.8%; p = 0.02) and longitudinal strain (- 0.1 ± 0.8%; p = 0.54). Pairwise group comparisons revealed no significant differences for global strain. The DSC showed good agreement for healthy volunteers (85.3 ± 10.3% for SAX) and patients (80.8 ± 9.6% for SAX). In 27 cases (27/76; 35.5%), a tracking error was found, predominantly (24/27; 88.9%) in the LVH group and 22 of those (22/27; 81.5%) at the insertion of the papillary muscle in lateral segments. CONCLUSIONS Strain analysis based on AI-segmented images shows good results in healthy volunteers and in most of the patient groups. Hypertrophied ventricles remain a challenge for contouring and feature tracking. CLINICAL RELEVANCE STATEMENT AI-based segmentations can help to streamline and standardize strain analysis by feature tracking. KEY POINTS • Assessment of strain in cardiovascular magnetic resonance by feature tracking can generate global and segmental strain values. • Commercially available artificial intelligence algorithms provide segmentation for strain analysis comparable to manual segmentation. • Hypertrophied ventricles are challenging in regards of strain analysis by feature tracking.
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Affiliation(s)
- Jan Gröschel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Johanna Kuhnt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Darian Viezzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Hadler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sophie Hormes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | | | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine and HELIOS Hospital Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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16
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Lechner I, Reindl M, Oberhollenzer F, Tiller C, Holzknecht M, Fink P, Kremser T, Bonatti P, Troger F, Henninger B, Mayr A, Bauer A, Metzler B, Reinstadler SJ. Association of dysglycaemia with persistent infarct core iron in patients with acute ST-segment elevation myocardial infarction. J Cardiovasc Magn Reson 2024; 26:100996. [PMID: 38237898 PMCID: PMC11211234 DOI: 10.1016/j.jocmr.2024.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Dysglycaemia increases the risk of myocardial infarction and subsequent recurrent cardiovascular events. However, the role of dysglycaemia in ischemia/reperfusion injury with development of irreversible myocardial tissue alterations remains poorly understood. In this study we aimed to investigate the association of ongoing dysglycaemia with persistence of infarct core iron and their longitudinal changes over time in patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). METHODS We analyzed 348 STEMI patients treated with primary PCI between 2016 and 2021 that were included in the prospective MARINA-STEMI study (NCT04113356). Peripheral venous blood samples for glucose and glycated hemoglobin (HbA1c) measurements were drawn on admission and 4 months after STEMI. Cardiac magnetic resonance (CMR) imaging including T2 * mapping for infarct core iron assessment was performed at both time points. Associations of dysglycaemia with persistent infarct core iron and iron resolution at 4 months were calculated using multivariable regression analysis. RESULTS Intramyocardial hemorrhage was observed in 147 (42%) patients at baseline. Of these, 89 (61%) had persistent infarct core iron 4 months after infarction with increasing rates across HbA1c levels (<5.7%: 33%, ≥5.7: 79%). Persistent infarct core iron was independently associated with ongoing dysglycaemia defined by HbA1c at 4 months (OR: 7.87 [95% CI: 2.60-23.78]; p < 0.001), after adjustment for patient characteristics and CMR parameters. The independent association was present even after exclusion of patients with diabetes (pre- and newly diagnosed, n = 16). CONCLUSIONS In STEMI patients treated with primary PCI, ongoing dysglycaemia defined by HbA1c is independently associated with persistent infarct core iron and a lower likelihood of iron resolution. These findings suggest a potential association between ongoing dysglycaemia and persistent infarct core iron, which warrants further investigation for therapeutic implications.
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Affiliation(s)
- Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Fritz Oberhollenzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Priscilla Fink
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Thomas Kremser
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Paolo Bonatti
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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17
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Lange T, Backhaus SJ, Schulz A, Evertz R, Schneider P, Kowallick JT, Hasenfuß G, Kelle S, Schuster A. Inter-study reproducibility of cardiovascular magnetic resonance-derived hemodynamic force assessments. Sci Rep 2024; 14:634. [PMID: 38182625 PMCID: PMC10770352 DOI: 10.1038/s41598-023-50405-9] [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: 04/19/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR)-derived hemodynamic force (HDF) analyses have been introduced recently enabling more in-depth cardiac function evaluation. Inter-study reproducibility is important for a widespread clinical use but has not been quantified for this novel CMR post-processing tool yet. Serial CMR imaging was performed in 11 healthy participants in a median interval of 63 days (range 49-87). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, diastolic deceleration as well as atrial thrust acceleration forces. Inter-study reproducibility and study sample sizes required to demonstrate 10%, 15% or 20% relative changes of HDF measurements were calculated. In addition, intra- and inter-observer analyses were performed. Intra- and inter-observer reproducibility was excellent for all HDF parameters according to intraclass correlation coefficient (ICC) values (> 0.80 for all). Inter-study reproducibility of all HDF parameters was excellent (ICC ≥ 0.80 for all) with systolic parameters showing lower coeffients of variation (CoV) than diastolic measurements (CoV 15.2% for systolic impulse vs. CoV 30.9% for atrial thrust). Calculated sample sizes to detect relative changes ranged from n = 12 for the detection of a 20% relative change in systolic impulse to n = 200 for the detection of 10% relative change in atrial thrust. Overall inter-study reproducibility of CMR-derived HDF assessments was sufficient with systolic HDF measurements showing lower inter-study variation than diastolic HDF analyses.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Patrick Schneider
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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18
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Shen LT, Shi R, Yang ZG, Gao Y, Jiang YN, Fang H, Min CY, Li Y. Progress in Cardiac Magnetic Resonance Feature Tracking for Evaluating Myocardial Strain in Type-2 Diabetes Mellitus. Curr Diabetes Rev 2024; 20:98-109. [PMID: 38310480 PMCID: PMC11327751 DOI: 10.2174/0115733998277127231211063107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/28/2023] [Accepted: 11/10/2023] [Indexed: 02/05/2024]
Abstract
The global prevalence of type-2 diabetes mellitus (T2DM) has caused harm to human health and economies. Cardiovascular disease is one main cause of T2DM mortality. Increased prevalence of diabetes and associated heart failure (HF) is common in older populations, so accurately evaluating heart-related injury and T2DM risk factors and conducting early intervention are important. Quantitative cardiovascular system imaging assessments, including functional imaging during cardiovascular disease treatment, are also important. The left-ventricular ejection fraction (LVEF) has been traditionally used to monitor cardiac function; it is often preserved or increased in early T2DM, but subclinical heart deformation and dysfunction can occur. Myocardial strains are sensitive to global and regional heart dysfunction in subclinical T2DM. Cardiac magnetic resonance feature-tracking technology (CMR-FT) can visualize and quantify strain and identify subclinical myocardial injury for early management, especially with preserved LVEF. Meanwhile, CMR-FT can be used to evaluate the multiple cardiac chambers involvement mediated by T2DM and the coexistence of complications. This review discusses CMR-FT principles, clinical applications, and research progress in the evaluation of myocardial strain in T2DM.
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Affiliation(s)
- Li-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi-Ning Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Fang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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19
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Wang J, Meng Y, Zhang C, Lu Y, Hu C, Xu K. Delays in first medical contact to primary interventional therapy and left ventricular remodelling in ST-segment elevation myocardial infarction. Ir J Med Sci 2023; 192:2143-2150. [PMID: 36732417 PMCID: PMC9894669 DOI: 10.1007/s11845-023-03283-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early reperfusion and early evaluation of adverse cardiovascular events have become important aspects of treatment for ST-segment elevation myocardial infarction post-primary percutaneous coronary intervention (PPCI). However, emergency medical service (EMS) delays always occur, especially in developing countries. AIMS The aim of this study was to investigate the impact of EMS delays on short-term predictions of the severity of myocardial injury in STEMI patients after PPCI. METHODS A total of 151 STEMI patients who underwent successful PPCI and two postoperative cardiac magnetic resonance (CMR) imaging examinations (1 week and 4 months postoperatively) were retrospectively analysed. CMR cine and late gadolinium enhancement (LGE) images were analysed to evaluate left ventricular (LV) function, LV global longitudinal peak strain (GLS) and scar characteristics. The time from first medical contact to balloon (FMC2B) and door-to-balloon (D2B) time, expressed in minutes, were recorded and compared with the recommended timelines. Unadjusted and multivariable analyses were used to assess the impact of EMS delays on short-term left ventricular remodelling (ALVR). RESULTS EMS delays (FMC2B time > 90 min) led to larger infarct size (IS) and microcirculation obstruction (MVO) and poor recovery of the LV ejection fraction and GLS (all p < 0.05). Logistic regression analysis showed that an FMC2B time > 90 min (p = 0.028, OR = 2.661, 95% CI 1.112-6.367) and baseline IS (p = 0.016, OR = 1.079, 95% CI 1.015-1.148) were independent predictors of short-term ALVR. CONCLUSION Delays in FMC2B time were strongly associated with short-term ALVR; shorter ischaemic times may improve the cardiac function and prognosis of patients.
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Affiliation(s)
- Jiali Wang
- Department of Radiology, Nanjing Medical University, Nanjing, 211166, China
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yankai Meng
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao Zhang
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuan Lu
- Department of Cardiac Care Unit, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunfeng Hu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kai Xu
- Department of Radiology, Nanjing Medical University, Nanjing, 211166, China.
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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20
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Barison A, Ceolin R, Palmieri A, Tamborrino PP, Todiere G, Grigoratos C, Gueli IA, De Gori C, Clemente A, Pistoia L, Pepe A, Aquaro GD, Positano V, Emdin M, Cademartiri F, Meloni A. Biventricular Tissue Tracking with Cardiovascular Magnetic Resonance: Reference Values of Left- and Right-Ventricular Strain. Diagnostics (Basel) 2023; 13:2912. [PMID: 37761278 PMCID: PMC10527573 DOI: 10.3390/diagnostics13182912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
We derived reference values of left-ventricular (LV) and right-ventricular (RV) strain parameters in a cohort of 100 healthy subjects by feature tracking cardiac magnetic resonance (FT-CMR). Global and regional strain values were calculated for the LV; circumferential and radialSAX strain parameters were derived from the short-axis (SAX) stack, while longitudinal and radialLAX strain parameters were assessed in three long-axis (LAX) views. Only global longitudinal strain (GLS) was calculated for the RV. Peak global LV circumferential strain was -16.7% ± 2.1%, LV radialSAX strain was 26.4% ± 5.1%, LV radialLAX strain was 31.1% ± 5.2%, LV GLS was -17.7% ± 1.9%, and RV GLS was -23.9% ± 4.1%. Women presented higher global LV and RV strain values than men; all strain values presented a weak relationship with body surface area, while there was no association with age or heart rate. A significant association was detected between all LV global strain measures and LV ejection fraction, while RV GLS was correlated to RV end-diastolic volume. The intra- and inter-operator reproducibility was good for all global strain measures. In the regional analysis, circumferential and radial strain values resulted higher at the apical level, while longitudinal strain values were higher at the basal level. The assessment of cardiac deformation by FT-CMR is feasible and reproducible and gender-specific reference values should be used.
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Affiliation(s)
- Andrea Barison
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Roberto Ceolin
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, 34128 Trieste, Italy
| | - Alessandro Palmieri
- Cardiothoracovascular Department, Careggi University Hospital, 50134 Florence, Italy
| | - Pietro Paolo Tamborrino
- Cardiology Division, Cardiothoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Giancarlo Todiere
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Chrysanthos Grigoratos
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Ignazio Alessio Gueli
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Carmelo De Gori
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Clinical Research Unit, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35128 Padova, Italy
| | - Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical Medical and Molecular Pathology and Critical Area, University of Pisa, 56124 Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
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21
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Lange T, Gertz RJ, Schulz A, Backhaus SJ, Evertz R, Kowallick JT, Hasenfuß G, Desch S, Thiele H, Stiermaier T, Eitel I, Schuster A. Impact of myocardial deformation on risk prediction in patients following acute myocardial infarction. Front Cardiovasc Med 2023; 10:1199936. [PMID: 37636296 PMCID: PMC10449121 DOI: 10.3389/fcvm.2023.1199936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Strain analyses derived from cardiovascular magnetic resonance-feature tracking (CMR-FT) provide incremental prognostic benefit in patients sufferring from acute myocardial infarction (AMI). This study aims to evaluate and revalidate previously reported prognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardial infarction (STEMI). Methods Overall, 566 STEMI patients enrolled in the CONDITIONING-LIPSIA trial including pre- and/or postconditioning treatment in addition to conventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronary intervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee), and boosterpump (Ea) strain analyses, as well as left ventricular (LV) global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) analyses were carried out. Previously identified cutoff values were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction, and new congestive heart failure were assessed within 12 months after the occurrence of the index event. Results Both atrial and ventricular strain values were significantly reduced in patients with MACE (p < 0.01 for all). Predetermined LA and LV strain cutoffs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariable regression modeling (p < 0.001 for all), with LA Es emerging as an independent predictor of MACE on multivariable regression modeling (HR 0.92, p = 0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (a c-index increase from 0.7 to 0.74, p = 0.03). Conclusion External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiac deformation assessment in STEMI patients. In the present study, LA strain parameters especially enabled further risk stratification and prognostic assessment over and above clinically established risk parameters. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02158468.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Roman J. Gertz
- Institute for Diagnostic and Interventional Radiology,Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
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22
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Nabeta T, Meucci MC, Westenberg JJM, Reiber JH, Knuuti J, van der Bijl P, Marsan NA, Bax JJ. Prognostic implications of left ventricular inward displacement assessed by cardiac magnetic resonance imaging in patients with myocardial infarction. Int J Cardiovasc Imaging 2023; 39:1525-1533. [PMID: 37249652 PMCID: PMC10427538 DOI: 10.1007/s10554-023-02861-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 05/31/2023]
Abstract
Risk stratification of patients with ischemic heart disease (IHD) still depends mainly on the left ventricular ejection fraction (LVEF). LV inward displacement (InD) is a novel parameter of LV systolic function, derived from feature tracking cardiac magnetic resonance (CMR) imaging. We aimed to investigate the prognostic impact of InD in patients with IHD and prior myocardial infarction. A total of 111 patients (mean age 57 ± 10, 86% male) with a history of myocardial infarction who underwent CMR were included. LV InD was quantified by measuring the displacement of endocardially tracked points towards the centreline of the LV during systole with feature tracking CMR. The endpoint was a composite of all-cause mortality, heart failure hospitalization and arrhythmic events. During a median follow-up of 142 (IQR 107-159) months, 31 (27.9%) combined events occurred. Kaplan-Meier analysis demonstrated that patients with LV InD below the study population median value (23.0%) had a significantly lower event-free survival (P < 0.001). LV InD remained independently associated with outcomes (HR 0.90, 95% CI 0.84-0.98, P = 0.010) on multivariate Cox regression analysis. InD also provided incremental prognostic value to LVEF, LV global radial strain and CMR scar burden. LV InD, measured with feature tracking CMR, was independently associated with outcomes in patients with IHD and prior myocardial infarction. LV InD also provided incremental prognostic value, in addition to LVEF and LV global radial strain. LV InD holds promise as a pragmatic imaging biomarker for post-infarct risk stratification.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Johan Hc Reiber
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Medis Medical Imaging Systems, Schuttersveld 9, Leiden, 2316 XG, The Netherlands
| | - Juhani Knuuti
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
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23
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Virbickiene A, Lapinskas T, Garlichs CD, Mattecka S, Tanacli R, Ries W, Torzewski J, Heigl F, Pfluecke C, Darius H, Ince H, Nordbeck P, Butter C, Schuster A, Mitzner S, Dobiliene O, Sheriff A, Kelle S. Imaging Predictors of Left Ventricular Functional Recovery after Reperfusion Therapy of ST-Elevation Myocardial Infarction Assessed by Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:294. [PMID: 37504550 PMCID: PMC10380630 DOI: 10.3390/jcdd10070294] [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: 05/03/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Left ventricular global longitudinal strain (LV GLS) is a superior predictor of adverse cardiac events in patients with myocardial infarction and heart failure. We investigated the ability of morphological features of infarcted myocardium to detect acute left ventricular (LV) dysfunction and predict LV functional recovery after three months in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS Sixty-six STEMI patients were included in the C-reactive protein (CRP) apheresis in Acute Myocardial Infarction Study (CAMI-1). LV ejection fraction (LVEF), LV GLS, LV global circumferential strain (LV GCS), infarct size (IS), area-at-risk (AAR), and myocardial salvage index (MSI) were assessed by CMR 5 ± 3 days (baseline) and 12 ± 2 weeks after (follow-up) the diagnosis of first acute STEMI. RESULTS Significant changes in myocardial injury parameters were identified after 12 weeks of STEMI diagnosis. IS decreased from 23.59 ± 11.69% at baseline to 18.29 ± 8.32% at follow-up (p < 0.001). AAR and MVO also significantly reduced after 12 weeks. At baseline, there were reasonably moderate correlations between IS and LVEF (r = -0.479, p < 0.001), LV GLS (r = 0.441, p < 0.001) and LV GCS (r = 0.396, p = 0.001) as well as between AAR and LVEF (r = -0.430, p = 0.003), LV GLS (r = 0.501, p < 0.001) and weak with LV GCS (r = 0.342, p = 0.020). At follow-up, only MSI and change in LV GCS over time showed a weak but significant correlation (r = -0.347, p = 0.021). Patients with larger AAR at baseline improved more in LVEF (p = 0.019) and LV GLS (p = 0.020) but not in LV GCS. CONCLUSION The CMR tissue characteristics of myocardial injury correlate with the magnitude of LV dysfunction during the acute stage of STEMI. AAR predicts improvement in LVEF and LV GLS, while MSI is a sensitive marker of LV GCS recovery at three months follow-up after STEMI.
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Affiliation(s)
- Agneta Virbickiene
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | | | | | - Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Wolfgang Ries
- Medical Clinic, DIAKO Flensburg, 24939 Flensburg, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, 87439 Kempten, Germany
| | - Franz Heigl
- Medical Care Center Kempten-Allgäu, 87437 Kempten, Germany
| | - Christian Pfluecke
- Christian Pfluecke, Department of Internal Medicine I, Städtisches Klinikum Görlitz, Girbigsdorfer Straße 1-3, 02828 Görlitz, Germany
| | - Harald Darius
- Clinic for Cardiology, Angiology, Nephrology, Intensive Care Medicine, Vivantes Clinic Neukölln, 12351 Berlin, Germany
| | - Hueseyin Ince
- Divisions of Cardiology and Nephrology, Department of Internal Medicine, University Medicine Rostock, 18057 Rostock, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg in Bernau, Brandenburg Medical School (MHB) Theodor Fontane, 16321 Berlin, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, 10785 Göttingen, Germany
| | - Steffen Mitzner
- Divisions of Cardiology and Nephrology, Department of Internal Medicine, University Medicine Rostock, 18057 Rostock, Germany
| | - Olivija Dobiliene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ahmed Sheriff
- Pentracor GmbH, 16761 Hennigsdorf, Germany
- Gastroenterology/Infectiology/Rheumatology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, 13353 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
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24
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De Raffele M, Di Domenico A, Balla C, Vitali F, Boccadoro A, Pavasini R, Micillo M, Cocco M, Campo G, Bertini M, Tonet E. Structural Abnormalities in Brugada Syndrome and Non-Invasive Cardiac Imaging: A Systematic Review. BIOLOGY 2023; 12:biology12040606. [PMID: 37106806 PMCID: PMC10136319 DOI: 10.3390/biology12040606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
The aim of this review is to identify possible structural abnormalities of BrS and their potential association with symptoms, risk stratification, and prognosis. (1) Background: BrS has always been considered a purely electrical disease and imaging techniques do not currently play a specific role in the diagnosis of this arrhythmic syndrome. Some authors have recently hypothesized the presence of structural and functional abnormalities. Therefore, several studies investigated the presence of pathological features in echocardiography and cardiac magnetic resonance imaging (MRI) in patients with BrS, but results were controversial. (2) Methods: We performed a systematic review of the literature on the spectrum of features detected by echocardiography and cardiac MRI. Articles were searched in Pubmed, Cochrane Library, and Biomed Central. Only papers published in English and in peer-reviewed journals up to November 2021 were selected. After an initial evaluation, 596 records were screened; the literature search identified 19 relevant articles. (3) Results: The imaging findings associated with BrS were as follows: right ventricular dilation, right ventricular wall motion abnormalities, delayed right ventricular contraction, speckle and feature tracking abnormalities, late gadolinium enhancement, and fat infiltration in the right ventricle. Furthermore, these features emerged more frequently in patients carrying the genetic mutation on the sodium voltage-gated channel α-subunit 5 (SCN5A) gene. (4) Conclusions: Specific imaging features detected by echocardiography and cardiac magnetic resonance are associated with BrS. However, this population appears to be heterogeneous and imaging anomalies emerged to be more frequent in patients carrying genetic mutations of SCN5A. Future studies with an evaluation of BrS patients are needed to identify the specific association linking the Brugada pattern, imaging abnormalities and their possible correlation with prognosis.
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Affiliation(s)
- Martina De Raffele
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Assunta Di Domenico
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Cristina Balla
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Marco Micillo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Matteo Bertini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
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25
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Lange T, Backhaus SJ, Schulz A, Evertz R, Kowallick JT, Bigalke B, Hasenfuß G, Thiele H, Stiermaier T, Eitel I, Schuster A. Cardiovascular magnetic resonance-derived left atrioventricular coupling index and major adverse cardiac events in patients following acute myocardial infarction. J Cardiovasc Magn Reson 2023; 25:24. [PMID: 37046343 PMCID: PMC10099819 DOI: 10.1186/s12968-023-00929-w] [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: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Recently, a novel left atrioventricular coupling index (LACI) has been introduced providing prognostic value to predict cardiovascular events beyond common risk factors in patients without cardiovascular disease. Since data on cardiovascular magnetic resonance (CMR)-derived LACI in patients following acute myocardial infarction (AMI) are scarce, we aimed to assess the diagnostic and prognostic implications of LACI in a large AMI patient cohort. METHODS In total, 1046 patients following AMI were included. After primary percutaneous coronary intervention CMR imaging and subsequent functional analyses were performed. LACI was defined by the ratio of the left atrial end-diastolic volume divided by the left ventricular (LV) end-diastolic volume. Major adverse cardiac events (MACE) including death, reinfarction or heart failure within 12 months after the index event were defined as primary clinical endpoint. RESULTS LACI was significantly higher in patients with MACE compared to those without MACE (p < 0.001). Youden Index identified an optimal LACI cut-off at 34.7% to classify patients at high-risk (p < 0.001 on log-rank testing). Greater LACI was associated with MACE on univariate regression modeling (HR 8.1, 95% CI 3.4-14.9, p < 0.001) and after adjusting for baseline confounders and LV ejection fraction (LVEF) on multivariate regression analyses (HR 3.1 95% CI 1.0-9, p = 0.049). Furthermore, LACI assessment enabled further risk stratification in high-risk patients with impaired LV systolic function (LVEF ≤ 35%; p < 0.001 on log-rank testing). CONCLUSION Atrial-ventricular interaction using CMR-derived LACI is a superior measure of outcome beyond LVEF especially in high-risk patients following AMI. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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26
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Feher A, Miller EJ, Peters DC, Mojibian HR, Sinusas AJ, Hinchcliff M, Baldassarre LA. Impaired left-ventricular global longitudinal strain by feature-tracking cardiac MRI predicts mortality in systemic sclerosis. Rheumatol Int 2023; 43:849-858. [PMID: 36894756 DOI: 10.1007/s00296-023-05294-6] [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: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
Impaired left-ventricular (LV) and right-ventricular (RV) cardiac magnetic resonance (CMR) strain has been documented in systemic sclerosis (SSc). However, it is unknown whether the CMR strain is predictive of adverse outcomes in SSc. Therefore, we set out to investigate the prognostic value of CMR strain in SSc. Patients with SSc who underwent CMR for clinical indications between 11/2010 and 07/2020 were retrospectively studied. LV and RV strain was evaluated by feature tracking. The association between strain, late gadolinium enhancement (LGE), and survival was evaluated with time to event and Cox-regression analyses. During the study period, 42 patients with SSc (age: 57 ± 14 years, 83% female, 57% limited cutaneous SSc, SSc duration: 7 ± 8 years) underwent CMR. During the median follow-up of 3.6 years, 11 patients died (26%). Compared to surviving patients, patients who died had significantly worse LV GLS (- 8.2 ± 6.2% versus - 12.1 ± 2.9%, p = 0.03), but no difference in LV global radial, circumferential, or RV strain values. Patients within the quartile of most impaired LV GLS (≥ - 12.8%, n = 10) had worse survival when compared to patients with preserved LV GLS (< - 12.8%, n = 32, log-rank p = 0.02), which persisted after controlling for LV cardiac output, LV cardiac index, reduced LV ejection fraction, or presence of LGE. In addition, patients who had both impaired LV GLS and LGE (n = 5) had worse survival than patients with LGE or impaired GLS alone (n = 14) and compared to those without any of these features (n = 17, p = 0.003). In our retrospective cohort of patients with SSc undergoing CMR for clinical indications, LV GLS and LGE were found to be predictive of overall survival.
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Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA. .,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Hamid R Mojibian
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Monique Hinchcliff
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lauren A Baldassarre
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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27
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Wang J, Kong Y, Xi J, Zhang M, Lu Y, Hu C, Xu K. Recovery and prognostic values of myocardial strain in acute anterior and non-anterior wall myocardial infarction. PLoS One 2023; 18:e0282027. [PMID: 36800349 PMCID: PMC9937471 DOI: 10.1371/journal.pone.0282027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND To assess the recovery and prognostic values of myocardial strain using cardiac magnetic resonance (CMR)- feature tracking (FT) in acute anterior and non-anterior wall myocardial infarction. METHODS 103 reperfused patients after STEMI who underwent CMR at about 4 days (baseline) and 4 months (follow-up) were included, including 48 and 55 patients with anterior wall myocardial infarction (AWMI) and non-anterior wall myocardial infarction(NAWMI). CMR-FT analysis was performed using cine images to measure LV global radial, circumferential, and longitudinal peak strains (GRS, GCS, and GLS, respectively). Infarct size (IS) and microvascular obstruction (MVO) were estimated by late-gadolinium enhancement imaging. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE) after infarction. RESULTS Patients with AWMI had higher IS, higher MVO, lower ejection fraction, and more significantly impaired CMR-FT strain values than patients with NAWMI (all p<0.05). Global strain significantly improved at 4 months (all p<0.01), especial in NAWMI. GLS was an independent predictor (odds ratio = 2.08, 95% confidence interval = 1.032-4.227, p = 0.04] even after adjustment for IS and MVO. The optimal cutoff of GLS was -7.9%, with sensitivity and specificity were 73.3% and 75.0%, respectively. In receiver operating characteristic analysis, IS remained the strongest predictor (area under the curve [AUC] = 0.83, p<0.01), followed by MVO (AUC = 0.81, p<0.01) and GLS (AUC = 0.78, p<0.01). CONCLUSION CMR-FT-derived global myocardial strains significantly improved over time, especial in NAWMI. GLS measurement independently predicted the occurrence of medium-term MACE.
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Affiliation(s)
- Jiali Wang
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ying Kong
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jianning Xi
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Min Zhang
- Department of Cardiac Care Unit, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuan Lu
- Department of Cardiac Care Unit, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunfeng Hu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kai Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- * E-mail:
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Konijnenberg LSF, Luiken TTJ, Veltien A, Uthman L, Kuster CTA, Rodwell L, de Waard GA, Kea-Te Lindert M, Akiva A, Thijssen DHJ, Nijveldt R, van Royen N. Imatinib attenuates reperfusion injury in a rat model of acute myocardial infarction. Basic Res Cardiol 2023; 118:2. [PMID: 36639597 PMCID: PMC9839396 DOI: 10.1007/s00395-022-00974-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
Following an acute myocardial infarction, reperfusion of an occluded coronary artery is often accompanied by microvascular injury, leading to worse long-term prognosis. Experimental studies have revealed the potential of tyrosine-kinase inhibitor imatinib to reduce vascular leakage in various organs. Here, we examined the potential of imatinib to attenuate microvascular injury in a rat model of myocardial reperfusion injury. Isolated male Wistar rat hearts (n = 20) in a Langendorff system and male Wistar rats (n = 37) in an in vivo model were randomly assigned to imatinib or placebo and subjected to ischaemia and reperfusion. Evans-blue/Thioflavin-S/TTC staining and Cardiac Magnetic Resonance Imaging were performed to assess the extent of reperfusion injury. Subsequently, in vivo hearts were perfused ex vivo with a vascular leakage tracer and fluorescence and electron microscopy were performed. In isolated rat hearts, imatinib reduced global infarct size, improved end-diastolic pressure, and improved rate pressure product recovery compared to placebo. In vivo, imatinib reduced no-reflow and infarct size with no difference between imatinib and placebo for global cardiac function. In addition, imatinib showed lower vascular resistance, higher coronary flow, and less microvascular leakage in the affected myocardium. At the ultrastructural level, imatinib showed higher preserved microvascular integrity compared to placebo. We provide evidence that low-dose imatinib can reduce microvascular injury and accompanying myocardial infarct size in a rat model of acute myocardial infarction. These data warrant future work to examine the potential of imatinib to reduce reperfusion injury in patients with acute myocardial infarction.
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Affiliation(s)
- Lara S F Konijnenberg
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Tom T J Luiken
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andor Veltien
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laween Uthman
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carolien T A Kuster
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Epidemiology and Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guus A de Waard
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mariska Kea-Te Lindert
- Department of Cell Biology, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Electron Microscopy Center, Radboudumc Technology Center Microscopy, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Biochemistry, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anat Akiva
- Electron Microscopy Center, Radboudumc Technology Center Microscopy, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Biochemistry, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
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29
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Shanmuganathan M, Masi A, Burrage MK, Kotronias RA, Borlotti A, Scarsini R, Banerjee A, Terentes-Printzios D, Zhang Q, Hann E, Tunnicliffe E, Lucking A, Langrish J, Kharbanda R, De Maria GL, Banning AP, Choudhury RP, Channon KM, Piechnik SK, Ferreira VM. Acute Response in the Noninfarcted Myocardium Predicts Long-Term Major Adverse Cardiac Events After STEMI. JACC Cardiovasc Imaging 2023; 16:46-59. [PMID: 36599569 PMCID: PMC9834063 DOI: 10.1016/j.jcmg.2022.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute ST-segment elevation myocardial infarction (STEMI) has effects on the myocardium beyond the immediate infarcted territory. However, pathophysiologic changes in the noninfarcted myocardium and their prognostic implications remain unclear. OBJECTIVES The purpose of this study was to evaluate the long-term prognostic value of acute changes in both infarcted and noninfarcted myocardium post-STEMI. METHODS Patients with acute STEMI undergoing primary percutaneous coronary intervention underwent evaluation with blood biomarkers and cardiac magnetic resonance (CMR) at 2 days and 6 months, with long-term follow-up for major adverse cardiac events (MACE). A comprehensive CMR protocol included cine, T2-weighted, T2∗, T1-mapping, and late gadolinium enhancement (LGE) imaging. Areas without LGE were defined as noninfarcted myocardium. MACE was a composite of cardiac death, sustained ventricular arrhythmia, and new-onset heart failure. RESULTS Twenty-two of 219 patients (10%) experienced an MACE at a median of 4 years (IQR: 2.5-6.0 years); 152 patients returned for the 6-month visit. High T1 (>1250 ms) in the noninfarcted myocardium was associated with lower left ventricular ejection fraction (LVEF) (51% ± 8% vs 55% ± 9%; P = 0.002) and higher NT-pro-BNP levels (290 pg/L [IQR: 103-523 pg/L] vs 170 pg/L [IQR: 61-312 pg/L]; P = 0.008) at 6 months and a 2.5-fold (IQR: 1.03-6.20) increased risk of MACE (2.53 [IQR: 1.03-6.22]), compared with patients with normal T1 in the noninfarcted myocardium (P = 0.042). A lower T1 (<1,300 ms) in the infarcted myocardium was associated with increased MACE (3.11 [IQR: 1.19-8.13]; P = 0.020). Both noninfarct and infarct T1 were independent predictors of MACE (both P = 0.001) and significantly improved risk prediction beyond LVEF, infarct size, and microvascular obstruction (C-statistic: 0.67 ± 0.07 vs 0.76 ± 0.06, net-reclassification index: 40% [IQR: 12%-64%]; P = 0.007). CONCLUSIONS The acute responses post-STEMI in both infarcted and noninfarcted myocardium are independent incremental predictors of long-term MACE. These insights may provide new opportunities for treatment and risk stratification in STEMI.
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Affiliation(s)
- Mayooran Shanmuganathan
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ambra Masi
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rafail A. Kotronias
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alessandra Borlotti
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Roberto Scarsini
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Abhirup Banerjee
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Dimitrios Terentes-Printzios
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Elizabeth Tunnicliffe
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Andrew Lucking
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy Langrish
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rajesh Kharbanda
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adrian P. Banning
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Keith M. Channon
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom,Address for correspondence: Prof Keith Channon, Level 2–Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Acute Vascular Imaging Centre (AVIC), University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom,Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom
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30
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Calvieri C, Riva A, Sturla F, Dominici L, Conia L, Gaudio C, Miraldi F, Secchi F, Galea N. Left Ventricular Adverse Remodeling in Ischemic Heart Disease: Emerging Cardiac Magnetic Resonance Imaging Biomarkers. J Clin Med 2023; 12:jcm12010334. [PMID: 36615133 PMCID: PMC9820966 DOI: 10.3390/jcm12010334] [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: 11/24/2022] [Revised: 12/10/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Post-ischemic left ventricular (LV) remodeling is a biologically complex process involving myocardial structure, LV shape, and function, beginning early after myocardial infarction (MI) and lasting until 1 year. Adverse remodeling is a post-MI maladaptive process that has been associated with long-term poor clinical outcomes. Cardiac Magnetic Resonance (CMR) is the best tool to define adverse remodeling because of its ability to accurately measure LV end-diastolic and end-systolic volumes and their variation over time and to characterize the underlying myocardial changes. Therefore, CMR is the gold standard method to assess in vivo myocardial infarction extension and to detect the presence of microvascular obstruction and intramyocardial hemorrhage, both associated with adverse remodeling. In recent times, new CMR quantitative biomarkers emerged as predictive of post-ischemic adverse remodeling, such as T1 mapping, myocardial strain, and 4D flow. Additionally, CMR T1 mapping imaging may depict infarcted tissue and assess diffuse myocardial fibrosis by using surrogate markers such as extracellular volume fraction, which may predict functional recovery or risk stratification of remodeling. Finally, there is emerging evidence supporting the utility of intracavitary blood flow kinetic energy and hemodynamic features assessed by the 4D flow CMR technique as early predictors of remodeling.
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Affiliation(s)
- Camilla Calvieri
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
- Correspondence:
| | - Alessandra Riva
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Lorenzo Dominici
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Carlo Gaudio
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20129 Milan, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
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31
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Eitel I, Stiermaier T. Characterization of the Remote Noninfarcted Myocardium by Cardiac Magnetic Resonance for Postinfarction Risk Prediction: Ready for Primetime? JACC Cardiovasc Imaging 2023; 16:60-62. [PMID: 36599570 DOI: 10.1016/j.jcmg.2022.11.006] [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: 10/28/2022] [Accepted: 11/17/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
| | - Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
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32
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Beetz M, Corral Acero J, Banerjee A, Eitel I, Zacur E, Lange T, Stiermaier T, Evertz R, Backhaus SJ, Thiele H, Bueno-Orovio A, Lamata P, Schuster A, Grau V. Interpretable cardiac anatomy modeling using variational mesh autoencoders. Front Cardiovasc Med 2022; 9:983868. [PMID: 36620629 PMCID: PMC9813669 DOI: 10.3389/fcvm.2022.983868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022] Open
Abstract
Cardiac anatomy and function vary considerably across the human population with important implications for clinical diagnosis and treatment planning. Consequently, many computer-based approaches have been developed to capture this variability for a wide range of applications, including explainable cardiac disease detection and prediction, dimensionality reduction, cardiac shape analysis, and the generation of virtual heart populations. In this work, we propose a variational mesh autoencoder (mesh VAE) as a novel geometric deep learning approach to model such population-wide variations in cardiac shapes. It embeds multi-scale graph convolutions and mesh pooling layers in a hierarchical VAE framework to enable direct processing of surface mesh representations of the cardiac anatomy in an efficient manner. The proposed mesh VAE achieves low reconstruction errors on a dataset of 3D cardiac meshes from over 1,000 patients with acute myocardial infarction, with mean surface distances between input and reconstructed meshes below the underlying image resolution. We also find that it outperforms a voxelgrid-based deep learning benchmark in terms of both mean surface distance and Hausdorff distance while requiring considerably less memory. Furthermore, we explore the quality and interpretability of the mesh VAE's latent space and showcase its ability to improve the prediction of major adverse cardiac events over a clinical benchmark. Finally, we investigate the method's ability to generate realistic virtual populations of cardiac anatomies and find good alignment between the synthesized and gold standard mesh populations in terms of multiple clinical metrics.
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Affiliation(s)
- Marcel Beetz
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Jorge Corral Acero
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Abhirup Banerjee
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II, Cardiology, Angiology, and Intensive Care Medicine, Lübeck, Germany
- University Hospital Schleswig-Holstein, Lübeck, Germany
- German Centre for Cardiovascular Research, Partner Site Lübeck, Lübeck, Germany
| | - Ernesto Zacur
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II, Cardiology, Angiology, and Intensive Care Medicine, Lübeck, Germany
- University Hospital Schleswig-Holstein, Lübeck, Germany
- German Centre for Cardiovascular Research, Partner Site Lübeck, Lübeck, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
| | | | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Centre for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Vicente Grau
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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33
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Diana G, Locorotondo G, Manfredonia L, Graziani F, Lombardo A, Lanza GA, Pedicino D, Liuzzo G, Massetti M, Crea F. Subclinical dysfunction of remote myocardium is related to high NT-proBNP and affects global contractility at follow-up, independently of infarct area. Front Cardiovasc Med 2022; 9:997821. [PMID: 36601063 PMCID: PMC9806135 DOI: 10.3389/fcvm.2022.997821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background In ST-segment elevation myocardial infarction (STEMI), predictors of subclinical dysfunction of remote myocardium are unknown. We prospectively aimed at identifying clinical and biochemical correlates of remote subclinical dysfunction and its impact on left ventricular ejection fraction (LVEF). Methods One-hundred thirty-three patients (63.9 ± 12.1 years, 68% male) with first successfully treated (54% anterior, 46% non-anterior, p = 0.19) STEMI underwent echocardiography at 5 ± 2 days after onset and at 8 ± 2-month follow-up, and were compared to 13 age and sex-matched (63.3 ± 11.4) healthy controls. All 16 left ventricular (LV) segments were grouped into ischemic, border, and remote myocardium: mean value of longitudinal strain (LS) within grouped segments were expressed as iLS, bLS, rLS, respectively. LV end-diastolic (EDV), end-systolic (ESV) volumes indexed for body surface area (EDVi, ESVi, respectively), LVEF and global LS (GLS) were determined. Creatinine, glomerular filtration rate, admission level of NT-pro-brain-natriuretic peptide (NT-proBNP) and troponin peaks were considered for the analysis. Results At baseline, rLS (15.5 ± 4.4) was better than iLS (12.9 ± 4.8, p < 0.001), but lower than that in controls (19.1 ± 2.7, p < 0.001) and similar to bLS (15 ± 5.4, p = ns), and did not differ between patients with single or multivessel coronary artery disease (CAD). At multivariate regression analysis, only admission NT-proBNP levels but not peak Tn levels independently predicted rLS (β = -0.58, p = 0.001), as well as iLS (β = -0.52, p = 0.001). Both at baseline and at follow-up, rLS correlated to LVEF similarly to iLS and bLS (p < 0.001 for all). Median value of rLS at baseline was 15%: compared to patients with rLS ≥ 15% at baseline, patients with rLS < 15% showed lower LVEF (52.3 ± 9.4 vs. 58.6 ± 7.6, p < 0.001) and GLS (16.3 ± 3.9 vs. 19.9 ± 3.2), and higher EDVi (62.3 ± 19.9 vs. 54 ± 12, p = 0.009) and ESVi (30.6 ± 15.5 vs. 22.3 ± 7.6, p < 0.001) at follow-up. Conclusion In optimally treated STEMI, dysfunction of remote myocardium assessed by LS: (1) is predicted by elevated NT-proBNP; (2) could be independent of CAD extent and infarct size; (3) is associated to worse LV morphological and functional indexes at follow-up.
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Affiliation(s)
- Giovanni Diana
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,*Correspondence: Gabriella Locorotondo, ,
| | - Laura Manfredonia
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesca Graziani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,Department of Cardiovascular Sciences, University of the Sacred Heart, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,Department of Cardiovascular Sciences, University of the Sacred Heart, Rome, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,Department of Cardiovascular Sciences, University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,Department of Cardiovascular Sciences, University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy,Department of Cardiovascular Sciences, University of the Sacred Heart, Rome, Italy
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Sharrack N, Das A, Kelly C, Teh I, Stoeck CT, Kozerke S, Swoboda PP, Greenwood JP, Plein S, Schneider JE, Dall'Armellina E. The relationship between myocardial microstructure and strain in chronic infarction using cardiovascular magnetic resonance diffusion tensor imaging and feature tracking. J Cardiovasc Magn Reson 2022; 24:66. [PMID: 36419059 PMCID: PMC9685947 DOI: 10.1186/s12968-022-00892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiac diffusion tensor imaging (cDTI) using cardiovascular magnetic resonance (CMR) is a novel technique for the non-invasive assessment of myocardial microstructure. Previous studies have shown myocardial infarction to result in loss of sheetlet angularity, derived by reduced secondary eigenvector (E2A) and reduction in subendocardial cardiomyocytes, evidenced by loss of myocytes with right-handed orientation (RHM) on helix angle (HA) maps. Myocardial strain assessed using feature tracking-CMR (FT-CMR) is a sensitive marker of sub-clinical myocardial dysfunction. We sought to explore the relationship between these two techniques (strain and cDTI) in patients at 3 months following ST-elevation MI (STEMI). METHODS 32 patients (F = 28, 60 ± 10 years) underwent 3T CMR three months after STEMI (mean interval 105 ± 17 days) with second order motion compensated (M2), free-breathing spin echo cDTI, cine gradient echo and late gadolinium enhancement (LGE) imaging. HA maps divided into left-handed HA (LHM, - 90 < HA < - 30), circumferential HA (CM, - 30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) were reported as relative proportions. Global and segmental analysis was undertaken. RESULTS Mean left ventricular ejection fraction (LVEF) was 44 ± 10% with a mean infarct size of 18 ± 12 g and a mean infarct segment LGE enhancement of 66 ± 21%. Mean global radial strain was 19 ± 6, mean global circumferential strain was - 13 ± - 3 and mean global longitudinal strain was - 10 ± - 3. Global and segmental radial strain correlated significantly with E2A in infarcted segments (p = 0.002, p = 0.011). Both global and segmental longitudinal strain correlated with RHM of infarcted segments on HA maps (p < 0.001, p = 0.003). Mean Diffusivity (MD) correlated significantly with the global infarct size (p < 0.008). When patients were categorised according to LVEF (reduced, mid-range and preserved), all cDTI parameters differed significantly between the three groups. CONCLUSION Change in sheetlet orientation assessed using E2A from cDTI correlates with impaired radial strain. Segments with fewer subendocardial cardiomyocytes, evidenced by a lower proportion of myocytes with right-handed orientation on HA maps, show impaired longitudinal strain. Infarct segment enhancement correlates significantly with E2A and RHM. Our data has demonstrated a link between myocardial microstructure and contractility following myocardial infarction, suggesting a potential role for CMR cDTI to clinically relevant functional impact.
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Affiliation(s)
- N Sharrack
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A Das
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C Kelly
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - I Teh
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Centre for Surgical Research, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - P P Swoboda
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J P Greenwood
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S Plein
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J E Schneider
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - E Dall'Armellina
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Zhao X, Zhao X, Jin F, Wang L, Zhang L. Prognostic Value of
Cardiac‐MRI
Scar Heterogeneity Combined With Left Ventricular Strain in Patients With Myocardial Infarction. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Xiaoying Zhao
- Department of Radiology The Second Affiliated Hospital of Kunming Medical University Kunming China
| | - Xinxiang Zhao
- Department of Radiology The Second Affiliated Hospital of Kunming Medical University Kunming China
| | - Fuwei Jin
- Department of Radiology The Second Affiliated Hospital of Kunming Medical University Kunming China
| | - Lujing Wang
- Department of Radiology The Second Affiliated Hospital of Kunming Medical University Kunming China
| | - Li Zhang
- Department of Radiology The Second Affiliated Hospital of Kunming Medical University Kunming China
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The prognostic value of global myocardium strain by CMR-feature tracking in immune checkpoint inhibitor-associated myocarditis. Eur Radiol 2022; 32:7657-7667. [PMID: 35567603 DOI: 10.1007/s00330-022-08844-x] [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: 03/08/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Immune checkpoint inhibitor (ICI)-associated myocarditis is a potentially fatal complication. Sparse published researches evaluated the prognostic value of cardiovascular magnetic resonance feature tracking (CMR-FT) for ICI-associated myocarditis. METHODS In the single-center retrospective study, 52 patients with ICI-associated myocarditis and CMR were included from August 2018 to July 2021. The ICI-associated myocarditis was diagnosed by using the clinical criteria of the European Society of Cardiology guidelines. Major adverse cardiovascular events (MACE) were comprised of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. RESULTS During a median follow-up of 171 days, 14 (27%) patients developed MACE. For patients with MACE, the global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), and left ventricular ejection fraction (LVEF) were significantly worse and native T1 values and late gadolinium enhancement (LGE) extent were significantly increased, compared with patients without MACE (p < 0.05). The GLS remained the independent factor associated with a higher risk of MACE (hazard ratio (HR): 2.115; 95% confidence interval (CI): 1.379-3.246; p = 0.001) when adjusting for LVEF, LGE extent, age, sex, body mass index, steroid treatment, and prior cardiotoxic chemotherapy or radiation. After adjustment for LVEF, the GLS remained the independent risk factor associated with a higher rate of MACE among patients with a preserved LVEF (HR: 1.358; 95% CI: 1.007-1.830; p = 0.045). CONCLUSIONS GLS could provide independent prognostic value over GCS, GRS, traditional CMR features, and clinical features in patients with ICI-associated myocarditis. KEY POINTS • The global circumferential strain (GCS), global radial strain (GRS), and global longitudinal strain (GLS) by cardiovascular magnetic resonance feature tracking were significantly impaired in patients with an immune checkpoint inhibitor (ICI)-associated myocarditis. • GLS was still significantly impaired in patients with preserved left ventricular ejection fraction. • The worse GLS was an independent risk factor over GCS, GRS, traditional CMR features, and clinical features for predicting major adverse cardiovascular events in patients with ICI-associated myocarditis.
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Wang Q, Wang J, Ma Y, Wang P, Li Y, Tian J, Yue X, Su G, Li B. Predictive value of myocardial strain on myocardial infarction size by cardiac magnetic resonance imaging in ST-segment elevation myocardial infarction with preserved left ventricular ejection fraction. Front Pharmacol 2022; 13:1015390. [PMID: 36313364 PMCID: PMC9613930 DOI: 10.3389/fphar.2022.1015390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The correlation between myocardial strain and infraction size by cardiac magnetic resonance imaging in ST-segment elevation myocardial infarction (STEMI) with preserved left ventricular ejection fraction (LVEF) is not clear. Objective: To investigate the correlation between myocardial strain and myocardial infarction size in patients of acute STEMI with preserved LVEF. Materials and Methods: A retrospective study was conducted to assess 31 patients with acute ST-segment elevation myocardial infarction (STEMI)after primary percutaneous coronary intervention (PCI) who received cardiac magnetic resonance (CMR) imaging during hospitalization at the Central Hospital of Shandong First Medical University from 2019 to 2022 and whose echocardiography indicated preserved LVEF (LVEF≥50%). The control group consisted of 21 healthy adults who underwent CMR during the same period. We compared the CMR characteristics, global and segmental strain between the two groups. Furthermore, the correlation between the global strain and the segmental strain of the left ventricle and late gadolinium enhancement (LGE) were evaluated. Results: Compared with healthy controls, the left ventricular ejection fraction (LVEF) of STEMI patients with preserved LVEF was significantly decreased (p < 0.05). Moreover, the global radial strain (GRS) (24.09% [IQR:17.88–29.60%] vs. 39.56% [IQR:29.19–42.20%], p < 0.05), global circumferential strain (GCS) [−14.66% (IQR: 17.91–11.56%) vs. −19.26% (IQR: 21.03–17.73%), p < 0.05], and global longitudinal strains (GLS) (−8.88 ± 2.25% vs. −13.46 ± 2.63%, p < 0.05) were damaged in patients. Furthermore, GCS and GLS were associated with LGE size (%left ventricle) (GCS: r = 0.58, p < 0.05; GLS: r = 0.37, p < 0.05). In the multivariate model, we found that LGE size was significantly associated with GCS (β coefficient = 2.110, p = 0.016) but was not associated with GLS (β coefficient = −0.102, p = 0.900) and LVEF (β coefficient = 0.227, p = 0.354). The receiver operating characteristic (ROC) results showed that GCS emerged as the strongest LGE size (LGE >25%) prognosticator among strain parameters (AUC: 0.836 [95% CI, 0.692—0.981], sensitivity: 91%, specificity: 80%) and was significantly better (p = 0.001) than GLS [AUC: 0.761 (95% CI, 0.583—0.939), sensitivity: 64%, specificity: 85%] and LVEF [AUC: 0.673 (95% CI, 0.469—0.877), sensitivity: 73%, specificity: 70%]. Conclusion: Among STEMI patients with preserved LVEF after PCI, CMR-FT-derived GCS had superior diagnostic accuracy than GLS and LVEF in predicting myocardial infarction size.
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Affiliation(s)
- Qiang Wang
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jian Wang
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yingjie Ma
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Peng Wang
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yang Li
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Tian
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Guohai Su
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Guohai Su, ; Bin Li,
| | - Bin Li
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Guohai Su, ; Bin Li,
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Spinelli L. Left ventricular strain analysis by positron emission tomography: Beyond myocardial perfusion. J Nucl Cardiol 2022; 29:2115-2118. [PMID: 34318396 DOI: 10.1007/s12350-021-02747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
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Kawakubo M, Nagao M, Yamamoto A, Nakao R, Matsuo Y, Fukushim K, Watanabe E, Sakai A, Sasaki M, Sakai S. 13N-ammonia positron emission tomography-derived endocardial strain for the assessment of ischemia using feature-tracking in high-resolution cine imaging. J Nucl Cardiol 2022; 29:2103-2114. [PMID: 34117615 DOI: 10.1007/s12350-021-02677-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Assessing endocardial strain using a single 13N-ammonia positron emission tomography (PET) scan would be clinically useful, given the association between ischemia and myocardial deformation. However, no software has been developed for strain analysis using PET. We evaluated the clinical potential of feature tracking-derived strain values measured using PET, based on associations with the myocardial flow reserve (MFR). METHODS AND RESULTS This retrospective study included 95 coronary artery disease patients who underwent myocardial 13N-ammonia PET. Semi-automatic measurements were made using a feature-tracking technique during myocardial cine imaging, and values were calculated using a 16-segment model. Adenosine-stressed global circumferential strain (CS) and global longitudinal strain (LS) values were compared with global MFR values. Stressed and resting global strain values were also compared. Global strain values were significantly lower in 39 patients with abnormal MFRs [< 2.0] than in 56 patients with normal MFRs [≥ 2.0]. The global CS values in the stressed state were significantly decreased than the resting state values in patients with abnormal MFRs. CONCLUSIONS This study applied endocardial feature-tracking to 13N-ammonia PET, and the results suggested that blood flow and myocardial motility could be clinically assessed in ischemic patients using a single PET scan.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Matsuo
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kenji Fukushim
- Department of Nuclear Medicine, Saitama Medical University, Saitama, Japan
| | - Eri Watanabe
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Evertz R, Schulz A, Lange T, Backhaus SJ, Vollmann D, Kowallick JT, von Haehling S, Hasenfuß G, Schuster A. Cardiovascular magnetic resonance imaging patterns of acute COVID-19 mRNA vaccine-associated myocarditis in young male patients: A first single-center experience. Front Cardiovasc Med 2022; 9:965512. [PMID: 36082124 PMCID: PMC9445185 DOI: 10.3389/fcvm.2022.965512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/14/2023] Open
Abstract
Background The risk of myocarditis after mRNA vaccination against COVID-19 has emerged recently. Current evidence suggests that young male patients are predominantly affected. In the majority of the cases, only mild symptoms were observed. However, little is known about cardiac magnetic resonance (CMR) imaging patterns in mRNA-related myocarditis and their differences when compared to classical viral myocarditis in the acute phase of inflammation. Methods and results In total, 10 mRNA vaccination-associated patients with myocarditis were retrospectively enrolled in this study and compared to 10 patients suffering from viral myocarditis, who were matched for age, sex, comorbidities, and laboratory markers. All patients (n = 20) were hospitalized and underwent a standardized clinical examination, as well as an echocardiography and a CMR. Both, clinical and imaging findings and, in particular, functional and volumetric CMR assessments, as well as detailed tissue characterization using late gadolinium enhancement and T1 + T2-weighted sequences, were compared between both groups. The median age of the overall cohort was 26 years (group 1: 25.5; group 2: 27.5; p = 0.57). All patients described chest pain as the leading reason for their initial presentation. CMR volumetric and functional parameters did not differ significantly between both groups. In all cases, the lateral left ventricular wall showed late gadolinium enhancement without significant differences in terms of the localization or in-depth tissue characterization (late gadolinium enhancement [LGE] enlargement: group 1: 5.4%; group 2: 6.5%; p = 0.14; T2 global/maximum value: group 1: 38.9/52 ms; group 2: 37.8/54.5 ms; p = 0.79 and p = 0.80). Conclusion This study yielded the first evidence that COVID-19 mRNA vaccine-associated myocarditis does not show specific CMR patterns during the very acute stage in the most affected patient group of young male patients. The observed imaging markers were closely related to regular viral myocarditis in our cohort. Additionally, we could not find any markers implying adverse outcomes in this relatively little number of patients; however, this has to be confirmed by future studies that will include larger sample sizes.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Dirk Vollmann
- Herz- and Gefäßzentrum Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
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Lange T, Backhaus SJ, Beuthner BE, Topci R, Rigorth KR, Kowallick JT, Evertz R, Schnelle M, Ravassa S, Díez J, Toischer K, Seidler T, Puls M, Hasenfuß G, Schuster A. Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:45. [PMID: 35897100 PMCID: PMC9331125 DOI: 10.1186/s12968-022-00874-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented. RESULTS Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (- 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (- 36.9 ± 14.3% to - 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001). CONCLUSION CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients. Trial registration DRKS, DRKS00024479. Registered 10 December 2021-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Rodi Topci
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Karl-Rudolf Rigorth
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Moritz Schnelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Clinical Chemistry, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Susana Ravassa
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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San-Martín-Martínez D, Serrano-Lemus D, Cornejo V, Gajardo AIJ, Rodrigo R. Pharmacological Basis for Abrogating Myocardial Reperfusion Injury Through a Multi-Target Combined Antioxidant Therapy. Clin Pharmacokinet 2022; 61:1203-1218. [DOI: 10.1007/s40262-022-01151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
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43
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Backhaus SJ, Aldehayat H, Kowallick JT, Evertz R, Lange T, Kutty S, Bigalke B, Gutberlet M, Hasenfuß G, Thiele H, Stiermaier T, Eitel I, Schuster A. Artificial intelligence fully automated myocardial strain quantification for risk stratification following acute myocardial infarction. Sci Rep 2022; 12:12220. [PMID: 35851282 PMCID: PMC9293901 DOI: 10.1038/s41598-022-16228-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Feasibility of automated volume-derived cardiac functional evaluation has successfully been demonstrated using cardiovascular magnetic resonance (CMR) imaging. Notwithstanding, strain assessment has proven incremental value for cardiovascular risk stratification. Since introduction of deformation imaging to clinical practice has been complicated by time-consuming post-processing, we sought to investigate automation respectively. CMR data (n = 1095 patients) from two prospectively recruited acute myocardial infarction (AMI) populations with ST-elevation (STEMI) (AIDA STEMI n = 759) and non-STEMI (TATORT-NSTEMI n = 336) were analysed fully automated and manually on conventional cine sequences. LV function assessment included global longitudinal, circumferential, and radial strains (GLS/GCS/GRS). Agreements were assessed between automated and manual strain assessments. The former were assessed for major adverse cardiac event (MACE) prediction within 12 months following AMI. Manually and automated derived GLS showed the best and excellent agreement with an intraclass correlation coefficient (ICC) of 0.81. Agreement was good for GCS and poor for GRS. Amongst automated analyses, GLS (HR 1.12, 95% CI 1.08-1.16, p < 0.001) and GCS (HR 1.07, 95% CI 1.05-1.10, p < 0.001) best predicted MACE with similar diagnostic accuracy compared to manual analyses; area under the curve (AUC) for GLS (auto 0.691 vs. manual 0.693, p = 0.801) and GCS (auto 0.668 vs. manual 0.686, p = 0.425). Amongst automated functional analyses, GLS was the only independent predictor of MACE in multivariate analyses (HR 1.10, 95% CI 1.04-1.15, p < 0.001). Considering high agreement of automated GLS and equally high accuracy for risk prediction compared to the reference standard of manual analyses, automation may improve efficiency and aid in clinical routine implementation.Trial registration: ClinicalTrials.gov, NCT00712101 and NCT01612312.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Haneen Aldehayat
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Kite TA, Banning AS, Ladwiniec A, Gale CP, Greenwood JP, Dalby M, Hobson R, Barber S, Parker E, Berry C, Flather MD, Curzen N, Banning AP, McCann GP, Gershlick AH. Very early invasive angiography versus standard of care in higher-risk non-ST elevation myocardial infarction: study protocol for the prospective multicentre randomised controlled RAPID N-STEMI trial. BMJ Open 2022; 12:e055878. [PMID: 35504645 PMCID: PMC9066091 DOI: 10.1136/bmjopen-2021-055878] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There are a paucity of randomised data on the optimal timing of invasive coronary angiography (ICA) in higher-risk patients with non-ST elevation myocardial infarction (N-STEMI). International guideline recommendations for early ICA are primarily based on retrospective subgroup analyses of neutral trials. AIMS The RAPID N-STEMI trial aims to determine whether very early percutaneous revascularisation improves clinical outcomes as compared with a standard of care strategy in higher-risk N-STEMI patients. METHODS AND ANALYSIS RAPID N-STEMI is a prospective, multicentre, open-label, randomised-controlled, pragmatic strategy trial. Higher-risk N-STEMI patients, as defined by Global Registry of Acute Coronary Events 2.0 score ≥118, or >90 with at least one additional high-risk feature, were randomised to either: very early ICA±revascularisation or standard of care timing of ICA±revascularisation. The primary outcome is the proportion of participants with at least one of the following events (all-cause mortality, non-fatal myocardial infarction and hospital admission for heart failure) at 12 months. Key secondary outcomes include major bleeding and stroke. A hypothesis generating cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage and residual ischaemia post percutaneous coronary intervention. On 7 April 2021, the sponsor discontinued enrolment due to the impact of the COVID-19 pandemic and lower than expected event rates. 425 patients were enrolled, and 61 patients underwent CMR. ETHICS AND DISSEMINATION The trial has been reviewed and approved by the East of England Cambridge East Research Ethics Committee (18/EE/0222). The study results will be submitted for publication within 6 months of completion. TRIAL REGISTRATION NUMBER NCT03707314; Pre-results.
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Affiliation(s)
- Thomas A Kite
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
| | - Amerjeet S Banning
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
| | - Andrew Ladwiniec
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds and the Department of Cardiology Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds and the Department of Cardiology Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Miles Dalby
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Rachel Hobson
- Leicester Clinical Trials Unit, University of Leicester, Leicester, Leicestershire, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, Leicestershire, UK
| | - Emma Parker
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Nick Curzen
- Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
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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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46
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Brunetti G, Cardaioli F, De Lazzari M, Cipriani A, Cecere A, Cecchetto A, Baritussio A, Motta R, De Conti G, Corrado D, Tarantini G, Iliceto S, Perazzolo Marra M. Left Ventricular Thrombosis Following Apical Myocardial Infarction: Might Cardiac Magnetic Resonance Strain Analysis Tell Us Something? J Am Heart Assoc 2022; 11:e024704. [PMID: 35470681 PMCID: PMC9238624 DOI: 10.1161/jaha.121.024704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giulia Brunetti
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Francesco Cardaioli
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Manuel De Lazzari
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Alberto Cipriani
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Annagrazia Cecere
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Antonella Cecchetto
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Anna Baritussio
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Raffaella Motta
- Radiology Unit Department of Medicine Institute of Radiology University of Padua Italy
| | - Giorgio De Conti
- Radiology Unit Department of Medicine Institute of Radiology University of Padua Italy
| | - Domenico Corrado
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Giuseppe Tarantini
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Sabino Iliceto
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
| | - Martina Perazzolo Marra
- Cardiology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padova Italy
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Left ventricular thrombus after acute ST-segment elevation myocardial infarction: multi-parametric cardiac magnetic resonance imaging with long-term outcomes. Int J Cardiovasc Imaging 2022; 38:2373-2384. [DOI: 10.1007/s10554-022-02598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/11/2022] [Indexed: 11/05/2022]
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48
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Ma Y, Ma Q, Wang X, Yu T, Dang Y, Shang J, Li G, Hou Y. Incremental Prognostic Value of Pericoronary Adipose Tissue Thickness Measured Using Cardiac Magnetic Resonance Imaging After Revascularization in Patients With ST-Elevation Myocardial Infarction. Front Cardiovasc Med 2022; 9:781402. [PMID: 35317286 PMCID: PMC8934413 DOI: 10.3389/fcvm.2022.781402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimPericoronary adipose tissue (PCAT) reflects pericoronary inflammation and is associated with coronary artery disease. We aimed to identify the association between local PCTA thickness using cardiac magnetic resonance (CMR) and prognosis of patients with ST-elevation myocardial infarction (STEMI), and to investigate the incremental prognostic value of PCAT thickness in STEMI after reperfusion.MethodsA total of 245 patients with STEMI (mean age, 55.61 ± 10.52 years) who underwent CMR imaging within 1 week of percutaneous coronary intervention therapy and 35 matched controls (mean age, 53.89 ± 9.45 years) were enrolled. PCAT thickness indexed to body surface area at five locations, ventricular volume and function, infarct-related parameters, and global strain indices were evaluated using CMR. Associations between PCAT thickness index and 1-year major adverse cardiovascular events (MACE) after STEMI were calculated. The prognostic value of the standard model based on features of clinical and CMR and updated model including PACT thickness index were further assessed.ResultsPatients with MACE had a more significant increase in PCAT thickness index at superior interventricular groove (SIVGi) than patients without MACE. The SIVGi was significantly associated with left ventricular ejection fraction (LVEF), infarct size, and global deformation. SIVGi > 4.98 mm/m2 was an independent predictor of MACE (hazard ratio, 3.2; 95% CI: 1.6–6.38; p < 0.001). The updated model significantly improved the power of prediction and had better discrimination ability than that of the standard model for predicting 1-year MACE (areas under the ROC curve [AUC] = 0.8 [95% CI: 0.74–0.87] vs. AUC = 0.76 [95% CI: 0.68–0.83], p < 0.05; category-free net reclassification index [cfNRI] = 0.38 [95% CI: 0.1–0.53, p = 0.01]; integrated discrimination improvement [IDI] = 0.09 [95% CI: 0.01–0.18, p = 0.02]).ConclusionsThis study demonstrated SIVGi as an independent predictor conferred incremental value over standard model based on clinical and CMR factors in 1-year MACE predictions for STEMI.
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Affiliation(s)
- Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaonan Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuxue Dang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yang Hou
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49
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Bulluck H, Carberry J, Carrick D, McCartney PJ, Maznyczka AM, Greenwood JP, Maredia N, Chowdhary S, Gershlick AH, Appleby C, Cotton JM, Wragg A, Curzen N, McEntegart M, Petrie MC, Eteiba H, Watkins S, Lindsay M, Mahrous A, Oldroyd KG, Berry C. A Noncontrast CMR Risk Score for Long-Term Risk Stratification in Reperfused ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15:431-440. [PMID: 35272808 DOI: 10.1016/j.jcmg.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure. BACKGROUND A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI). METHODS The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score. RESULTS There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score. CONCLUSIONS This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).
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Affiliation(s)
- Heerajnarain Bulluck
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; University of East Anglia, Norwich, United Kingdom; Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | | | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Neil Maredia
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Saqib Chowdhary
- South Manchester Hospitals NHS Trust, Manchester, United Kingdom
| | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - James M Cotton
- Royal Wolverhampton University Hospital NHS Trust, Wolverhampton, United Kingdom
| | - Andrew Wragg
- Barts and the London Hospital, London, United Kingdom
| | - Nick Curzen
- University Hospital Southampton Foundation Trust, Southampton, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mark C Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
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50
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Acute-Phase Inflammatory Reaction Predicts CMR Myocardial Scar Pattern and 2-Year Mortality in STEMI Patients Undergoing Primary PCI. J Clin Med 2022; 11:jcm11051222. [PMID: 35268316 PMCID: PMC8911521 DOI: 10.3390/jcm11051222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: The inflammatory response following MI plays an important role in the healing, scar formation, and left ventricle (LV) remodeling. Cardiac magnetic resonance (CMR) imaging can accurately quantify the extent of myocardial scarring. The study aimed to investigate: (a) the relationship between acute inflammatory response and the CMR parameters of the scarring extent, and (b) the predictive power of inflammatory biomarkers and myocardial scarring for 2-year mortality. (2) Methods: The study included 202 STEMI patients, who underwent pPCI. Serum hs-CRP, IL-6, P-selectin, E-selectin, I-CAM, and V-CAM levels were determined at admission, and hs-CRP on the fifth day. Patients underwent LGE-CMR after 1 month, for LV volumes, ejection fraction (EF), infarct size (IS), and transmurality. Subjects were divided into tertiles according to the IS, and 2-year all-cause mortality was determined. (3) Results: IL-6 was associated with IS (r = 0.324, p = 0.01), increased transmurality index (r = 0.3, p = 0.01), and lower LVEF (r = −0.3, p = 0.02). Admission hs-CRP levels were not associated with IS, transmurality, or mortality, while hs-CRP at day 5 was a significant predictor for IS (AUC = 0.635, p = 0.05) as well as IL-6 levels (AUC = 0.685, p < 0.001). Mortality was significantly higher in the upper IS tertiles (6% vs. 8.7% vs. 24.52%, p = 0.005). IS was a significant predictor of 2-year mortality (AUC = 0.673, p = 0.002), with a cut-off value of 28.81 g, as well as high transmurality (AUC = 0.641, p = 0.013), with a cut off value of 18.38 g. (4) Conclusions: The serum levels of IL-6 and day-5 hs-CRP predict IS and transmurality, and day-5 hs-CRP levels are independent predictors of 2-year mortality in STEMI patients treated with pPCI. The CMR pattern of myocardial scarring after 1 month, as expressed by the magnitude of IS and transmurality, is a significant predictor for 2-year mortality after revascularized STEMI.
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