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Role of Echocardiography in Diabetic Cardiomyopathy: From Mechanisms to Clinical Practice. J Cardiovasc Dev Dis 2023; 10:jcdd10020046. [PMID: 36826542 PMCID: PMC9959745 DOI: 10.3390/jcdd10020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
It has been well established that diabetes mellitus (DM) is considered as a core risk factor for the development of cardiovascular diseases. However, what is less appreciated is the fact that DM may affect cardiac function irrespective of cardiac pathologies to which it contributes, such as coronary artery disease and hypertension. Although echocardiography provides accurate and reproducible diagnostic and prognostic data in patients with DM, its use in these patients is still underappreciated, resulting in progression of DM-related heart failure in many patients. Hence, in the present review, we aimed to discuss the role of echocardiography in the contemporary management of diabetic cardiomyopathy (DCM), as well as the role of emerging echocardiographic techniques, which may contribute to earlier diagnosis and more appropriate management of this complication of DM. In order to improve outcomes, focus must be placed on early diagnosis of this condition using a combination of echocardiography and emerging biomarkers, but perhaps the more important thing is to change perspective when it comes to the clinical importance of DCM.
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Ruddy TD, Al-Mallah M, Arrighi JA, Bois JP, Bluemke DA, Di Carli MF, Dilsizian V, Gropler RJ, Jadvar H, Malhotra S, Pelletier-Galarneau M, Schindler TH, Woodard PK, Chareonthaitawee P. SNMMI/ACR/ASNC/SCMR Joint Credentialing Statement for Cardiac PET/MRI: Endorsed by the American Heart Association. J Nucl Med 2023; 64:149-152. [PMID: 36599473 PMCID: PMC9841259 DOI: 10.2967/jnumed.122.264200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/27/2022] [Accepted: 04/22/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
| | | | - James A. Arrighi
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ruddy TD, Al-Mallah M, Arrighi JA, Bois JP, Bluemke DA, Di Carli MF, Dilsizian V, Gropler RJ, Jadvar H, Malhotra S, Pelletier-Galarneau M, Schindler TH, Woodard PK, Chareonthaitawee P. SNMMI/ACR/ASNC/SCMR Joint Credentialing Statement for Cardiac PET/MRI: Endorsed by the American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014576. [PMID: 35920160 PMCID: PMC9384825 DOI: 10.1161/circimaging.122.014576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | - James A. Arrighi
- Warren Alpert Medical School of Brown University, Providence, RI (J.A.A.)
| | | | | | | | | | - Robert J. Gropler
- Washington University School of Medicine, St. Louis, MO (R.J.G., T.H.S., P.K.W.)
| | - Hossein Jadvar
- University of Southern California, Los Angeles, CA (H.J.)
| | | | | | - Thomas H. Schindler
- Washington University School of Medicine, St. Louis, MO (R.J.G., T.H.S., P.K.W.)
| | - Pamela K. Woodard
- Washington University School of Medicine, St. Louis, MO (R.J.G., T.H.S., P.K.W.)
| | - Panithaya Chareonthaitawee
- Mayo Clinic, Rochester, MN (J.P.B., P.C.)
- Correspondence to: Panithaya Chareonthaitawee, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email
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Ruddy TD, Al-Mallah M, Arrighi JA, Bois JP, Bluemke DA, Di Carli MF, Dilsizian V, Gropler RJ, Jadvar H, Malhotra S, Pelletier-Galarneau M, Schindler TH, Woodard PK, Chareonthaitawee P. SNMMI/ACR/ASNC/SCMR joint credentialing statement for cardiac PET/MRI. J Cardiovasc Magn Reson 2022; 24:43. [PMID: 35850721 PMCID: PMC9295497 DOI: 10.1186/s12968-022-00867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - James A Arrighi
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - John P Bois
- Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Diabetes Mellitus and Heart Failure. J Clin Med 2021; 10:jcm10163682. [PMID: 34441977 PMCID: PMC8396967 DOI: 10.3390/jcm10163682] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus (DM) is a major risk factor for new-onset heart failure (HF) and vice versa. The pathogenesis of new-onset HF in DM is complex and has been largely attributed to the toxic cardiovascular effects of hyperglycemia and relevant metabolic abnormalities (diabetic cardiomyopathy) as well as the frequently coexisting morbidities such as hypertension (HTN), coronary artery disease (CAD), and diabetic nephropathy. In patients with type 1 DM (T1DM), HF develops in the setting of a dysregulated immune response, whereas in most patients with type 2 DM (T2DM), against a background of overweight/obesity. HF prevention in DM is feasible with rigorous treatment of cardiovascular risk factors and selective antidiabetic agents. Conversely, development of new-onset T2DM in HF (cardiogenic DM) is common and has been attributed to an increase in the resistance to insulin, especially in the skeletal muscle, liver, and adipose tissue as well as in diminished insulin secretory response to hyperglycemia by pancreatic β-cells. Cardiogenic DM further deteriorates cardiac dysfunction and adversely affects outcome in HF. Novel lifesaving medications employed in HF management such as sacubitril/valsartan and sodium glucose cotransporter 2 inhibitors (SGLT-2i) have a favorable metabolic profile and lower the incidence of cardiogenic diabetes. Whether mitigation of cardiogenic DM should be a treatment target in HF deserves further investigation.
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Gullberg GT, Shrestha UM, Veress AI, Segars WP, Liu J, Ordovas K, Seo Y. Novel Methodology for Measuring Regional Myocardial Efficiency. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1711-1725. [PMID: 33690114 PMCID: PMC8325923 DOI: 10.1109/tmi.2021.3065219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Our approach differs from the usual global measure of cardiac efficiency by using PET/MRI to measure efficiency of small pieces of cardiac tissue whose limiting size is equal to the spatial resolution of the PET scanner. We initiated a dynamic cardiac PET study immediately prior to the injection of 15.1 mCi of 11C-acetate acquiring data for 25 minutes while simultaneously acquiring MRI cine data. 1) A 3D finite element (FE) biomechanical model of the imaged heart was constructed by utilizing nonrigid deformable image registration to alter the Dassault Systèmes FE Living Heart Model (LHM) to fit the geometry in the cardiac MRI cine data. The patient specific FE cardiac model with estimates of stress, strain, and work was transformed into PET/MRI format. 2) A 1-tissue compartment model was used to calculate wash-in (K1) and the linear portion of the decay in the PET 11C-acetate time activity curve (TAC) was used to calculate the wash-out k2(mono) rate constant. K1 was used to calculate blood flow and k2(mono) was used to calculate myocardial volume oxygen consumption ( MVO2 ). 3) Estimates of stress and strain were used to calculate Myocardial Equivalent Minute Work ( MEMW ) and Cardiac Efficiency = MEMW/MVO2 was then calculated for 17 tissue segments of the left ventricle. The global MBF was 0.96 ± 0.15 ml/min/gm and MVO2 ranged from 8 to 17 ml/100gm/min. Six central slices of the MRI cine data provided a range of MEMW of 0.1 to 0.4 joules/gm/min and a range of Cardiac Efficiency of 6 to 18%.
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Gropler RJ. Imaging Myocardial Metabolism. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
The term diabetic cardiomyopathy is defined as the presence of abnormalities in myocardial structure and function that occur in the absence of, or in addition to, well-established cardiovascular risk factors. A key contributor to this abnormal structural-functional relation is the complex interplay of myocardial metabolic remodeling, defined as the loss the flexibility in myocardial substrate metabolism and its downstream detrimental effects, such as mitochondrial dysfunction, inflammation, and fibrosis. In parallel with the growth in understanding of these biological underpinnings has been developmental advances in imaging tools such as positron emission tomography and magnetic resonance imaging and spectroscopy that permit the detection and in many cases quantification, of the processes that typifies the myocardial metabolic remodeling in diabetic cardiomyopathy. The imaging readouts can be obtained in both preclinical models of diabetes mellitus and patients with diabetes mellitus facilitating the bi-directional movement of information between bench and bedside. Moreover, imaging biomarkers provided by these tools are now being used to enhance discovery and development of therapies designed to reduce the myocardial effects of diabetes mellitus through metabolic modulation. In this review, the use of these imaging tools in the patient with diabetes mellitus from a mechanistic, therapeutic effect, and clinical management perspective will be discussed.
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Affiliation(s)
- Linda R Peterson
- From the Cardiovascular Division, Department of Medicine (L.R.P.), Washington University School of Medicine, St Louis, MO
| | - Robert J Gropler
- Division of Radiological Sciences, Edward Mallinckrodt Institute of Radiology (R.J.G.), Washington University School of Medicine, St Louis, MO
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Abstract
PURPOSE This pilot study aimed to evaluate the amino acid tracer F-FACBC with simultaneous PET/MRI in diagnostic assessment and neurosurgery of gliomas. MATERIALS AND METHODS Eleven patients with suspected primary or recurrent low- or high-grade glioma received an F-FACBC PET/MRI examination before surgery. PET and MRI were used for diagnostic assessment, and for guiding tumor resection and histopathological tissue sampling. PET uptake, tumor-to-background ratios (TBRs), time-activity curves, as well as PET and MRI tumor volumes were evaluated. The sensitivities of lesion detection and to detect glioma tissue were calculated for PET, MRI, and combined PET/MRI with histopathology (biopsies for final diagnosis and additional image-localized biopsies) as reference. RESULTS Overall sensitivity for lesion detection was 54.5% (95% confidence interval [CI], 23.4-83.3) for PET, 45.5% (95% CI, 16.7-76.6) for contrast-enhanced MRI (MRICE), and 100% (95% CI, 71.5-100.0) for combined PET/MRI, with a significant difference between MRICE and combined PET/MRI (P = 0.031). TBRs increased with tumor grade (P = 0.004) and were stable from 10 minutes post injection. PET tumor volumes enclosed most of the MRICE volumes (>98%) and were generally larger (1.5-2.8 times) than the MRICE volumes. Based on image-localized biopsies, combined PET/MRI demonstrated higher concurrence with malignant findings at histopathology (89.5%) than MRICE (26.3%). CONCLUSIONS Low- versus high-grade glioma differentiation may be possible with F-FACBC using TBR. F-FACBC PET/MRI outperformed MRICE in lesion detection and in detection of glioma tissue. More research is required to evaluate F-FACBC properties, especially in grade II and III tumors, and for different subtypes of gliomas.
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Pellico J, Fernández-Barahona I, Benito M, Gaitán-Simón Á, Gutiérrez L, Ruiz-Cabello J, Herranz F. Unambiguous detection of atherosclerosis using bioorthogonal nanomaterials. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 17:26-35. [DOI: 10.1016/j.nano.2018.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/13/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022]
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State-of-the-Art Imaging in Cardiac Oncology. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee DH, Park JH. Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging. J Lipid Atheroscler 2017. [DOI: 10.12997/jla.2017.6.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong Hyun Lee
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
| | - Jong-Ho Park
- Department of Stroke Neurology, Seonam University Myongji Hospital, Goyang-si, Korea
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