1
|
Canton L, Suma N, Amicone S, Impellizzeri A, Bodega F, Marinelli V, Ciarlantini M, Casuso M, Bavuso L, Belà R, Salerno J, Armillotta M, Angeli F, Sansonetti A, Attinà D, Russo V, Lovato L, Tuttolomondo D, Gaibazzi N, Bergamaschi L, Pizzi C. Clinical impact of multimodality assessment of myocardial viability. Echocardiography 2024; 41:e15854. [PMID: 38940225 DOI: 10.1111/echo.15854] [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: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
Collapse
Affiliation(s)
- Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Casuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Bavuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rebecca Belà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jessica Salerno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Russo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| |
Collapse
|
2
|
Ha S, Jang Y, Lee BK, Hong Y, Kim BK, Park S, Yoo SK, Chang HJ. Simultaneous Viability Assessment and Invasive Coronary Angiography Using a Therapeutic CT System in Chronic Myocardial Infarction Patients. Yonsei Med J 2024; 65:257-264. [PMID: 38653564 PMCID: PMC11045343 DOI: 10.3349/ymj.2023.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 04/25/2024] Open
Abstract
PURPOSE In a preclinical study using a swine myocardial infarction (MI) model, a delayed enhancement (DE)-multi-detector computed tomography (MDCT) scan was performed using a hybrid system alongside diagnostic invasive coronary angiography (ICA) without the additional use of a contrast agent, and demonstrated an excellent correlation in the infarct area compared with histopathologic specimens. In the present investigation, we evaluated the feasibility and diagnostic accuracy of a myocardial viability assessment by DE-MDCT using a hybrid system comprising ICA and MDCT alongside diagnostic ICA without the additional use of a contrast agent. MATERIALS AND METHODS We prospectively enrolled 13 patients (median age: 67 years) with a previous MI (>6 months) scheduled to undergo ICA. All patients underwent cardiac magnetic resonance (CMR) imaging before diagnostic ICA. MDCT viability scans were performed concurrently with diagnostic ICA without the use of additional contrast. The total myocardial scar volume per patient and average transmurality per myocardial segment measured by DE-MDCT were compared with those from DE-CMR. RESULTS The DE volume measured by MDCT showed an excellent correlation with the volume measured by CMR (r=0.986, p<0.0001). The transmurality per segment by MDCT was well-correlated with CMR (r=0.900, p<0.0001); the diagnostic performance of MDCT in differentiating non-viable from viable myocardium using a 50% transmurality criterion was good with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 87.5%, 99.5%, 87.5%, 99.5%, and 99.1%, respectively. CONCLUSION The feasibility of the DE-MDCT viability assessment acquired simultaneously with conventional ICA was proven in patients with chronic MI using DE-CMR as the reference standard.
Collapse
Affiliation(s)
- Seongmin Ha
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeonggul Jang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science Yonsei University, Seoul, Korea
| | - Byoung Kwon Lee
- Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Youngtaek Hong
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
- Ontact Health Co., Ltd., Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seil Park
- Cardiovascular Product Evaluation Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Kook Yoo
- Department of Medical Engineering, Yonsei University College of Medicine, Seoul, Korea.
| | - Hyuk-Jae Chang
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, Korea
- Ontact Health Co., Ltd., Seoul, Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
3
|
Zhang Q, Burrage MK, Shanmuganathan M, Gonzales RA, Lukaschuk E, Thomas KE, Mills R, Leal Pelado J, Nikolaidou C, Popescu IA, Lee YP, Zhang X, Dharmakumar R, Myerson SG, Rider O, Channon KM, Neubauer S, Piechnik SK, Ferreira VM. Artificial Intelligence for Contrast-Free MRI: Scar Assessment in Myocardial Infarction Using Deep Learning-Based Virtual Native Enhancement. Circulation 2022; 146:1492-1503. [PMID: 36124774 PMCID: PMC9662825 DOI: 10.1161/circulationaha.122.060137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Myocardial scars are assessed noninvasively using cardiovascular magnetic resonance late gadolinium enhancement (LGE) as an imaging gold standard. A contrast-free approach would provide many advantages, including a faster and cheaper scan without contrast-associated problems. METHODS Virtual native enhancement (VNE) is a novel technology that can produce virtual LGE-like images without the need for contrast. VNE combines cine imaging and native T1 maps to produce LGE-like images using artificial intelligence. VNE was developed for patients with previous myocardial infarction from 4271 data sets (912 patients); each data set comprises slice position-matched cine, T1 maps, and LGE images. After quality control, 3002 data sets (775 patients) were used for development and 291 data sets (68 patients) for testing. The VNE generator was trained using generative adversarial networks, using 2 adversarial discriminators to improve the image quality. The left ventricle was contoured semiautomatically. Myocardial scar volume was quantified using the full width at half maximum method. Scar transmurality was measured using the centerline chord method and visualized on bull's-eye plots. Lesion quantification by VNE and LGE was compared using linear regression, Pearson correlation (R), and intraclass correlation coefficients. Proof-of-principle histopathologic comparison of VNE in a porcine model of myocardial infarction also was performed. RESULTS VNE provided significantly better image quality than LGE on blinded analysis by 5 independent operators on 291 data sets (all P<0.001). VNE correlated strongly with LGE in quantifying scar size (R, 0.89; intraclass correlation coefficient, 0.94) and transmurality (R, 0.84; intraclass correlation coefficient, 0.90) in 66 patients (277 test data sets). Two cardiovascular magnetic resonance experts reviewed all test image slices and reported an overall accuracy of 84% for VNE in detecting scars when compared with LGE, with specificity of 100% and sensitivity of 77%. VNE also showed excellent visuospatial agreement with histopathology in 2 cases of a porcine model of myocardial infarction. CONCLUSIONS VNE demonstrated high agreement with LGE cardiovascular magnetic resonance for myocardial scar assessment in patients with previous myocardial infarction in visuospatial distribution and lesion quantification with superior image quality. VNE is a potentially transformative artificial intelligence-based technology with promise in reducing scan times and costs, increasing clinical throughput, and improving the accessibility of cardiovascular magnetic resonance in the near future.
Collapse
Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Matthew K. Burrage
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, Australia (M.K.B.)
| | - Mayooran Shanmuganathan
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Ricardo A. Gonzales
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Katharine E. Thomas
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Rebecca Mills
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Joana Leal Pelado
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Iulia A. Popescu
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Yung P. Lee
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Xinheng Zhang
- Krannert Cardiovascular Research Center, Indiana School of Medicine/IU Health Cardiovascular Institute, Indianapolis (X.Z., R.D.)
- Department of Bioengineering, University of California in Los Angeles (X.Z.)
| | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana School of Medicine/IU Health Cardiovascular Institute, Indianapolis (X.Z., R.D.)
| | - Saul G. Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Keith M. Channon
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
- Division of Cardiovascular Medicine (Q.Z., M.K.B., M.S., R.A.G., E.L., K.E.T., R.M., J.L.P., C.N., I.A.P., Y.P.L., S.G.M., O.R., K.M.C., S.N., S.K.P., V.M.F.), Radcliffe Department of Medicine, University of Oxford, United Kingdom
| |
Collapse
|
4
|
Holtackers RJ, Emrich T, Botnar RM, Kooi ME, Wildberger JE, Kreitner KF. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. ROFO-FORTSCHR RONTG 2022; 194:491-504. [PMID: 35196714 DOI: 10.1055/a-1718-4355] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) is a widely used cardiac magnetic resonance imaging (MRI) technique to diagnose a broad range of ischemic and non-ischemic cardiomyopathies. Since its development and validation against histology already more than two decades ago, the clinical utility of LGE and its span of applications have increased considerably. METHODS In this review we will present the basic concepts of LGE imaging and its diagnostic and prognostic value, elaborate on recent developments and emerging methods, and finally discuss future prospects. RESULTS Continuous developments in 3 D imaging methods, motion correction techniques, water/fat-separated imaging, dark-blood methods, and scar quantification improved the performance and further expanded the clinical utility of LGE imaging. CONCLUSION LGE imaging is the current noninvasive reference standard for the assessment of myocardial viability. Improvements in spatial resolution, scar-to-blood contrast, and water/fat-separated imaging further strengthened its position. KEY POINTS · LGE MRI is the reference standard for the noninvasive assessment of myocardial viability. · LGE MRI is used to diagnose a broad range of non-ischemic cardiomyopathies in everyday clinical practice.. · Improvements in spatial resolution and scar-to-blood contrast further strengthened its position. · Continuous developments improve its performance and further expand its clinical utility. CITATION FORMAT · Holtackers RJ, Emrich T, Botnar RM et al. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging: From Basic Concepts to Emerging Methods. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1718-4355.
Collapse
Affiliation(s)
- Robert J Holtackers
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands.,School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.,Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - René M Botnar
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.,Pontificia Universidad Católica de Chile, Escuela de Ingeniería, Santiago, Chile
| | - M Eline Kooi
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, the Netherlands
| | - K-F Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany
| |
Collapse
|
5
|
Valente FX, Gavara J, Gutierrez L, Rios-Navarro C, Rello P, Maymi M, Fernandez-Galera R, Monmeneu JV, Sao-Aviles A, Lopez-Lereu MP, Gonzalez-Alujas MT, Moratal D, Cuellar H, Barrabés J, Otaegui I, Evangelista A, Ferreira I, Bodi V, Rodriguez-Palomares J. Predictive Value of Cardiac Magnetic Resonance Feature Tracking after Acute Myocardial Infarction: A Comparison with Dobutamine Stress Echocardiography. J Clin Med 2021; 10:jcm10225261. [PMID: 34830543 PMCID: PMC8624532 DOI: 10.3390/jcm10225261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
In acute ST-segment elevation myocardial infarction (STEMI) late gadolinium enhancement (LGE) may underestimate segmental functional recovery. We evaluated the predictive value of cardiac magnetic resonance (CMR) feature-tracking (FT) for functional recovery and whether it incremented the value of LGE compared to low-dose dobutamine stress echocardiography (LDDSE) and speckle-tracking echocardiography (STE). Eighty patients underwent LDDSE and CMR within 5–7 days after STEMI and segmental functional recovery was defined as improvement in wall-motion at 6-months CMR. Optimal conventional and FT parameters were analyzed and then also applied to an external validation cohort of 222 STEMI patients. Circumferential strain (CS) was the strongest CMR-FT predictor and addition to LGE increased the overall accuracy to 74% and was especially relevant in segments with 50–74% LGE (AUC 0.60 vs. 0.75, p = 0.001). LDDSE increased the overall accuracy to 71%, and in the 50–74% LGE subgroup improved the AUC from 0.60 to 0.69 (p = 0.039). LGE + CS showed similar value as LGE + LDDSE. In the validation cohort, CS was also the strongest CMR-FT predictor of recovery and addition of CS to LGE improved overall accuracy to 73% although this difference was not significant (AUC 0.69, p = 0.44). Conclusion: CS is the strongest CMR-FT predictor of segmental functional recovery after STEMI. Its incremental value to LGE is comparable to that of LDDSE whilst avoiding an inotropic stress agent. CS is especially relevant in segments with 50–74% LGE where accuracy is lower and further testing is frequently required to clarify the potential for recovery.
Collapse
Affiliation(s)
- Filipa X. Valente
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
- Correspondence:
| | - José Gavara
- Centro de Biomateriales y Ingeniería de Tejidos, Universitat Politècnica de Valencia, 46022 Valencia, Spain; (J.G.); (D.M.)
| | - Laura Gutierrez
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (V.B.)
| | - Pau Rello
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Manel Maymi
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Ruben Fernandez-Galera
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - José V. Monmeneu
- Unidad de Resonancia Magnética Cardiovascular, Exploraciones Radiológicas Especiales (ERESA), 46015 Valencia, Spain; (J.V.M.); (M.P.L.-L.)
| | - Augusto Sao-Aviles
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Maria P. Lopez-Lereu
- Unidad de Resonancia Magnética Cardiovascular, Exploraciones Radiológicas Especiales (ERESA), 46015 Valencia, Spain; (J.V.M.); (M.P.L.-L.)
| | - M. Teresa Gonzalez-Alujas
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - David Moratal
- Centro de Biomateriales y Ingeniería de Tejidos, Universitat Politècnica de Valencia, 46022 Valencia, Spain; (J.G.); (D.M.)
| | - Hug Cuellar
- Radiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - José Barrabés
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Imanol Otaegui
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Artur Evangelista
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Ignacio Ferreira
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| | - Vicente Bodi
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (V.B.)
- Cardiology Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Centrode Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
- Medicine Department, Facultad de Medicina y Odontología, Universidad de Valencia, 46010 Valencia, Spain
| | - José Rodriguez-Palomares
- Cardiology Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.); (P.R.); (M.M.); (R.F.-G.); (A.S.-A.); (M.T.G.-A.); (J.B.); (I.O.); (A.E.); (I.F.); (J.R.-P.)
| |
Collapse
|
6
|
Dong Q, Wen X, Chang G, Xia R, Wang S, Yang Y, Tao Y, Zhang D, Qin S. ST-segment resolution as a marker for severe myocardial fibrosis in ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2021; 21:455. [PMID: 34548012 PMCID: PMC8454141 DOI: 10.1186/s12872-021-02269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods Forty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (> 75%) or non-transmural (< 75%) myocardial scars, according to previous study. Results The sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.925. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR < 40.15% had a 170.90-fold higher probability of developing transmural scars compared with patients with STR ≥ 40.15%. Pearson correlation and linear regression analyses showed STR percentage was significantly associated with myocardial scar thickness and size. Conclusion STR < 40.15% at 24 h after PCI may provide meaningful diagnostic information regarding the extent of myocardial scarification in STEMI patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02269-y.
Collapse
Affiliation(s)
- Qian Dong
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China
| | - Xuesong Wen
- Chongqing Medical University, Yuzhong, Chongqing, China
| | - Guanglei Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China
| | - Rui Xia
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China
| | - Sihang Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China
| | - Yunjing Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China
| | - Yi Tao
- Chongqing Medical University, Yuzhong, Chongqing, China
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China.
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China.
| |
Collapse
|
7
|
Abstract
Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
Collapse
|
8
|
Shi FH, Li H, Kong LC, Shen L, Jiang YH, Gu ZC, Ge H. Sulfonylureas Use Is Not Associated With Increased Infarct Size in Patients With Type 2 Diabetes and ST-Segment Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:658059. [PMID: 34124195 PMCID: PMC8194070 DOI: 10.3389/fcvm.2021.658059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Aims: This retrospective study assessed the association between sulfonylureas use and infarct size in patients with type 2 diabetes (T2DM) and ST-segment elevation myocardial infarction (STEMI) by myocardial enzymology indexes and cardiac magnetic resonance (CMR) imaging. Methods: Patients presenting STEMI between July 2013 and August 2019 were included in a retrospective database at our institution. Antidiabetic agents used before STEMI were recorded. Patients with maximum recorded troponin I (max cTNI) and creatine phosphokinase isoenzyme (CK-MB) within the first 72 h of chest pain onset were selected. Infarct size was quantified by CMR imaging, and cardiovascular outcomes were also obtained at 30 days and 6 months follow-up. Multivariable regression models explored potential risk factors associated with infarct size and clinical outcomes. Results: A total of 254 T2DM and STEMI patients were included, with 101 sulfonylurea users and 153 non-users. Sulfonylureas users were not associated with higher max cTnI and max CK-MB compared to non-users. Among 65 CMR patients, no significant differences in infarct size were detected between sulfonylureas users and non-users. Whereas, the incidence of microvascular obstruction (MVO) was higher in patients receiving sulfonylureas than those taking non-sulfonylureas (88.0 vs. 62.5%, p = 0.023). No higher cardiovascular events of sulfonylureas users vs. non-users were observed, except for heart failure events (24.0 vs. 2.5% at 30 days, p = 0.011; 28.0 vs. 2.5% at 6 months, p = 0.004). Multivariable regression analyses verified that sulfonylureas users increased the risks of MVO. Conclusions: Sulfonylureas use did not associate with larger infarct size in patients with T2DM and STEMI. A potentially higher incidence of MVO in sulfonylurea users was found. Notably, since most patients presented after a relatively long period of ischemia and glibenclamide was not used by the included patients in this observational study, the results of this study should not be extrapolated to clinical settings with short periods of ischemia or to patients using glibenclamide.
Collapse
Affiliation(s)
- Fang-Hong Shi
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hao Li
- Department of Pharmacy, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ling-Cong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Long Shen
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yi-Hong Jiang
- Department of Endocrinology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
9
|
A pilot image interpretation teaching intervention to improve competence and confidence of radiographers to detect left ventricular thrombus in routine cardiac MRI scans. Radiography (Lond) 2020; 27:527-532. [PMID: 33248882 DOI: 10.1016/j.radi.2020.11.008] [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: 06/16/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Prompt diagnosis of left ventricular (LV) thrombus is clinically important, as it may require immediate anti-coagulation treatment. The aim of this study was to determine if a teaching intervention delivered by cardiovascular magnetic resonance (CMR) physicians would increase the CMR radiographers' ability to detect LV thrombus on a routine CMR scan. METHODS A cohort of 25 patients (14 with and 11 without LV thrombus) were identified. A multi-parametric CMR protocol had been performed in all patients. Ten radiographers reviewed the 25 randomised anonymised studies on a workstation, documenting the presence/absence of LV thrombus and their confidence level on a 7-point Likert scale. Two senior CMR fellows then delivered a focused teaching programme to the radiographers and all 25 randomised scans were reassessed 1 month after the teaching intervention. RESULTS Following dedicated training, there was a significant improvement in correct thrombus identification per radiographer (pre-training: 75 ± 6% vs post-training: 85 ± 6%, p = 0.009). The size of the thrombus was not associated with the likelihood of incorrectly identifying LV thrombus size prior to the training session (p = 0.2), but a trend was observed between smaller thrombus size and incorrect identifications post-training (p = 0.06). The radiographers' overall confidence in assessing the cases prior to the teaching session was high (5.6 ± 0.8 out of 7). Following the teaching session, self-reported confidence did not vary significantly (5.9 ± 0.7 out of 7, p = 0.42). When evaluating the teaching session, radiographers provided very positive feedback, rating the usefulness of the teaching intervention as highly educative (8.8 ± 0.4 out of 10). CONCLUSIONS This is the first study that has explored the ability and confidence of CMR radiographers in detecting LV thrombus on routine CMR scans as a result of the teaching intervention delivered by CMR physicians. IMPLICATIONS FOR PRACTICE A teaching intervention can improve CMR radiographers' diagnostic skills and diagnostic confidence.
Collapse
|
10
|
Hess A, Thackeray JT, Wollert KC, Bengel FM. Radionuclide Image-Guided Repair of the Heart. JACC Cardiovasc Imaging 2020; 13:2415-2429. [DOI: 10.1016/j.jcmg.2019.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 01/12/2023]
|
11
|
Abstract
Ischemic heart disease is the most common cause of cardiovascular morbidity and mortality. Cardiac magnetic resonance (CMR) improves on other noninvasive modalities in detection, assessment, and prognostication of ischemic heart disease. The incorporation of CMR in clinical trials allows for smaller patient samples without the sacrifice of power needed to demonstrate clinical efficacy. CMR can accurately quantify infarct acuity, size, and complications; guide therapy; and prognosticate recovery. Timing of revascularization remains the holy grail of ischemic heart disease, and viability assessment using CMR may be the missing link needed to help reduce morbidity and mortality associated with the disease.
Collapse
Affiliation(s)
- Aneesh S Dhore-Patil
- Tulane University Heart and Vascular Center, Tulane University, 1415 Tulane Avenue, New Orleans, LA 70112, USA
| | - Ashish Aneja
- Department of Cardiovascular Diseases, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| |
Collapse
|
12
|
Hwang HY, Yeom SY, Park EA, Lee W, Jang MJ, Kim KB. Serial cardiac magnetic resonance imaging after surgical coronary revascularization for left ventricular dysfunction. J Thorac Cardiovasc Surg 2020; 159:1798-1805. [DOI: 10.1016/j.jtcvs.2019.04.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/11/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
|
13
|
Nakaoka H, Tsuda E, Morita Y, Kurosaki K. Cardiac Function by Magnetic Resonance Imaging in Coronary Artery Occlusions After Kawasaki Disease. Circ J 2020; 84:792-798. [DOI: 10.1253/circj.cj-19-0511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideyuki Nakaoka
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| |
Collapse
|
14
|
Beitzke D, Rasul S, Lassen ML, Pichler V, Senn D, Stelzmüller ME, Nolz R, Loewe C, Hacker M. Assessment of Myocardial Viability in Ischemic Heart Disease by PET/MRI: Comparison of Left Ventricular Perfusion, Hibernation, and Scar Burden. Acad Radiol 2020; 27:188-197. [PMID: 31053482 DOI: 10.1016/j.acra.2019.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/08/2019] [Accepted: 03/24/2019] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES Hybrid positron emission tomography-magnetic resonance (PET-MR) is a novel imaging technology that enables a comprehensive assessment of myocardial viability. The aim of this study was to intra-individually compare simultaneously acquired viability parameters from MRI and PET to determine complementary and redundant information. MATERIALS AND METHODS Thirty-nine patients with ischemic heart disease (IHD) underwent cardiac PET-MR for myocardial viability assessment. Cardiac magnetic resonance (CMR), including late gadolinium enhancement (LGE), and PET, including a dynamic dual-tracer acquisition of [13N]ammonia ([13N]NH3)/[18F]fluorodeoxyglucose ([18F]FDG), were performed simultaneously. Allocation, extent, and transmural degree of left ventricular (LV) scars were measured from LGE. Perfusion, viability, and hibernation were assessed by PET. RESULTS A comparison of scar location revealed six more areas of infarction on MR than on PET. Mean LV scarring by CMR was 14% (range, 2% to 42%) and 14% (range, 1% to 46%) by PET (CMR vs. PET: p = 0.9). An intra-individual comparison of scarring showed a good inter-method correlation (r = 0.7), which was also evident in the subgroup with low ejection fraction (EF) (r = 0.6). Hibernation and transmural degree of scars showed a moderate to weak correlation (r = 0.4), which was even worse in the low EF group (r = 0.1). CONCLUSIONS In patients with IHD, there was a good correlation between PET and CMR for the LV scar extent using hybrid cardiac PET-MR. The degree of transmural scarring by CMR showed no correlation to PET hibernation. Therefore, cardiac PET-MR might be a suitable tool for a comprehensive assessment of myocardial viability if used to predict response to cardiac reperfusion strategies.
Collapse
Affiliation(s)
- Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Lyngby Lassen
- QIMP Group, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Verena Pichler
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Daniela Senn
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | | | - Richard Nolz
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria.
| |
Collapse
|
15
|
Schwaiger JP, Reinstadler SJ, Tiller C, Holzknecht M, Reindl M, Mayr A, Graziadei I, Müller S, Metzler B, Klug G. Baseline LV ejection fraction by cardiac magnetic resonance and 2D echocardiography after ST-elevation myocardial infarction - influence of infarct location and prognostic impact. Eur Radiol 2019; 30:663-671. [PMID: 31428825 PMCID: PMC6890622 DOI: 10.1007/s00330-019-06316-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/22/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022]
Abstract
Objectives The comparability of left ventricular ejection fraction (LVEF) measurements by cardiac magnetic resonance (CMR) and 2D echocardiography (2DE) early after ST-elevation myocardial infarction (STEMI) remains unclear. Methods In this study, LVEF measured by CMR and 2DE (Simpson’s method) were compared in 221 patients after STEMI treated by primary percutaneous coronary intervention. 2DE image quality was systematically assessed and studies reported by an accredited examiner. Intermodality agreement was assessed by the Bland–Altman method. Major adverse cardiac events (MACE) were defined as the composite of death, myocardial infarction or hospitalisation for heart failure. Patients were followed up for a median of 40.9 months (IQR 28.1–56). Results After non-anterior STEMI, LVEF measurements by 2DE (single and biplane) were consistently underestimated in comparison to CMR (CMR 55.7 ± 9.5% vs. 2DE-4CV 49 ± 8.2% (p = 0.06), 2DE-2CV 52 ± 8% (p < 0.001), 2DE-biplane 53.5 ± 7.1% (p = 0.01)). After anterior STEMI, there was no significant difference in LVEF measurements by 2DE and CMR with acceptable limits of agreement (CMR 49 ± 11% vs. 2DE-4CV 49 ± 8.2% (p = 0.8), 2DE-2CV 49 ± 9.2% (p = 0.9), 2DE-biplane 49.6 ± 8% (p = 0.5)). In total, 15% of patients experienced a MACE during follow-up. In multivariate Cox regression analysis, reduced LVEF (< 52%) as assessed by either 2DE or CMR was predictive of MACE (2DE HR = 2.57 (95% CI 1.1–6.2), p = 0.036; CMR HR = 2.51 (95% CI 1.1–5.7), p = 0.028). Conclusions At baseline after non-anterior STEMI, 2D echocardiography significantly underestimated LVEF in comparison to CMR, whereas after anterior infarction, measurements were within acceptable limits of agreement. Both imaging modalities offered similar prognostic values when a reduced LVEF < 52% was applied. Key Points • After non-anterior STEMI, 2D-echocardiography significantly underestimated LVEF compared with cardiac MRI • An ejection fraction of < 52% in the acute post-infarct period by both 2D echocardiography and CMR offered similar prognostic values
Collapse
Affiliation(s)
- Johannes P Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivo Graziadei
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| |
Collapse
|
16
|
Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schäufele T, Bekeredjian R, Zuern CS, Seizer P, Geisler T, Müller KAL, Krumm P, Nikolaou K, Klug G, Reinstadler S, Pamminger M, Reindl M, Wahl A, Traupe T, Seiler C, Metzler B, Gawaz M, Windecker S, Mahrholdt H. Time-Dependent Myocardial Necrosis in Patients With ST-Segment-Elevation Myocardial Infarction Without Angiographic Collateral Flow Visualized by Cardiac Magnetic Resonance Imaging: Results From the Multicenter STEMI-SCAR Project. J Am Heart Assoc 2019; 8:e012429. [PMID: 31181983 PMCID: PMC6645633 DOI: 10.1161/jaha.119.012429] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
Background Acute complete occlusion of a coronary artery results in progressive ischemia, moving from the endocardium to the epicardium (ie, wavefront). Dependent on time to reperfusion and collateral flow, myocardial infarction ( MI ) will manifest, with transmural MI portending poor prognosis. Late gadolinium enhancement cardiac magnetic resonance imaging can detect MI with high diagnostic accuracy. Primary percutaneous coronary intervention is the preferred reperfusion strategy in patients with ST -segment-elevation MI with <12 hours of symptom onset. We sought to visualize time-dependent necrosis in a population with ST -segment-elevation MI by using late gadolinium enhancement cardiac magnetic resonance imaging (STEMI-SCAR project). Methods and Results ST -segment-elevation MI patients with single-vessel disease, complete occlusion with TIMI (Thrombolysis in Myocardial Infarction) score 0, absence of collateral flow (Rentrop score 0), and symptom onset <12 hours were consecutively enrolled. Using late gadolinium enhancement cardiac magnetic resonance imaging, the area at risk and infarct size, myocardial salvage index, transmurality index, and transmurality grade (0-50%, 51-75%, 76-100%) were determined. In total, 164 patients (aged 54±11 years, 80% male) were included. A receiver operating characteristic curve (area under the curve: 0.81) indicating transmural necrosis revealed the best diagnostic cutoff for a symptom-to-balloon time of 121 minutes: patients with >121 minutes demonstrated increased infarct size, transmurality index, and transmurality grade (all P<0.01) and decreased myocardial salvage index ( P<0.001) versus patients with symptom-to-balloon times ≤121 minutes. Conclusions In MI with no residual antegrade and no collateral flow, immediate reperfusion is vital. A symptom-to-balloon time of >121 minutes causes a high grade of transmural necrosis. In this pure ST -segment-elevation MI population, time to reperfusion to salvage myocardium was less than suggested by current guidelines.
Collapse
Affiliation(s)
- Simon Greulich
- Department of Cardiology and Cardiovascular DiseasesUniversity of TübingenGermany
| | - Agnes Mayr
- Department of RadiologyUniversity of InnsbruckAustria
| | - Steffen Gloekler
- Department of Cardiology, InselspitalBern University HospitalUniversity of BernSwitzerland
- Department of CardiologySchwarzwald‐Baar KlinikumVillingen‐SchwenningenGermany
| | - Andreas Seitz
- Department of CardiologyRobert Bosch Medical CenterStuttgartGermany
| | - Stefan Birkmeier
- Department of CardiologyRobert Bosch Medical CenterStuttgartGermany
| | - Tim Schäufele
- Department of CardiologyRobert Bosch Medical CenterStuttgartGermany
| | | | | | - Peter Seizer
- Department of Cardiology and Cardiovascular DiseasesUniversity of TübingenGermany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular DiseasesUniversity of TübingenGermany
| | - Karin A. L. Müller
- Department of Cardiology and Cardiovascular DiseasesUniversity of TübingenGermany
| | - Patrick Krumm
- Department of RadiologyUniversity of TübingenGermany
| | | | - Gert Klug
- Department of CardiologyUniversity of InnsbruckAustria
| | | | | | - Martin Reindl
- Department of CardiologyUniversity of InnsbruckAustria
| | - Andreas Wahl
- Department of Cardiology, InselspitalBern University HospitalUniversity of BernSwitzerland
| | - Tobias Traupe
- Department of Cardiology, InselspitalBern University HospitalUniversity of BernSwitzerland
| | - Christian Seiler
- Department of Cardiology, InselspitalBern University HospitalUniversity of BernSwitzerland
| | | | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular DiseasesUniversity of TübingenGermany
| | - Stephan Windecker
- Department of Cardiology, InselspitalBern University HospitalUniversity of BernSwitzerland
| | - Heiko Mahrholdt
- Department of CardiologyRobert Bosch Medical CenterStuttgartGermany
| |
Collapse
|
17
|
Future perspectives of nanoparticle-based contrast agents for cardiac magnetic resonance in myocardial infarction. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 17:329-341. [PMID: 30802547 DOI: 10.1016/j.nano.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/11/2019] [Accepted: 02/02/2019] [Indexed: 12/23/2022]
Abstract
Cardiac Magnetic Resonance (CMR), thanks to high spatial resolution and absence of ionizing radiation, has been widely used in myocardial infarction (MI) assessment to evaluate cardiac structure, function, perfusion and viability. Nevertheless, it suffers from limitations in tissue and assessment of myocardial pathophysiological changes subsequent to MI. In this issue, nanoparticle-based contrast agents offer the possibility to track biological processes at cellular and molecular level underlying the various phases of MI, infarct healing and tissue repair. In this paper, first we examine the conventional CMR protocol and its findings in MI patients. Next, we looked at how nanoparticles can help in the imaging of MI and give an overview of the major approaches currently explored. Based on the presentation of successful nanoparticle applications as contrast agents (CAs) in preclinical and clinical models, we discuss promises and outstanding challenges facing the field of CMR in MI, their translational potential and clinical application.
Collapse
|
18
|
Dastidar AG, Harries I, Pontecorboli G, Bruno VD, De Garate E, Moret C, Baritussio A, Johnson TW, McAlindon E, Bucciarelli-Ducci C. Native T1 mapping to detect extent of acute and chronic myocardial infarction: comparison with late gadolinium enhancement technique. Int J Cardiovasc Imaging 2018; 35:517-527. [DOI: 10.1007/s10554-018-1467-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/10/2018] [Indexed: 12/28/2022]
|
19
|
Effect of Erythropoietin Administration on Myocardial Viability and Coronary Microvascular Dysfunction in Anterior Acute Myocardial Infarction: Randomized Controlled Trial in the Japanese Population. Cardiol Ther 2018; 7:151-162. [PMID: 30353280 PMCID: PMC6251819 DOI: 10.1007/s40119-018-0122-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction Cardioprotective effects of erythropoietin (EPO) on infarcted myocardium in acute myocardial infarction (AMI) patients have been inconclusive. This study aimed to assess the effect of EPO administration on coronary microvascular dysfunction (CMD) and myocardial viability in anterior AMI. We also evaluated the serial changes in CMD and cardiac remodeling in these patients. Methods Patients with a successful percutaneous coronary intervention (PCI) for the first anterior AMI were randomly assigned to two groups (EPO and control groups), and given single-dose intravenous administration of recombinant human EPO (12,000 IU) or saline after PCI. Delayed-enhanced cardiac magnetic resonance imaging was performed at 1 week after AMI to assess the average of transmural extent of infarction and infarct size. Coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery was measured by Doppler echocardiography at 1 week, 1 month, and 8 months after AMI. All patients underwent clinical follow-up for the assessment of cardiac remodeling. Results Sixty-one patients (EPO 32, control 29) were eligible for analysis. EPO group (2.4 ± 1.2) had a tendency of smaller transmural extent of infarction than that of control group (2.9 ± 1.1; p = 0.063). CFVR-8 months improved significantly in EPO group (2.9 ± 0.6) compared to control group (2.6 ± 0.5; p = 0.04). Left atrial (LA) volume − 8 months was significantly lower in EPO group (47 ± 11) than those of control group (65 ± 20; p = 0.004). Conclusions A single medium dose of EPO could have a favorable effect on CMD and LA remodeling in the chronic phase of anterior AMI. Trial Registration The institutional ethics committee of Wakayama Medical University, identifier, 1125. Electronic supplementary material The online version of this article (10.1007/s40119-018-0122-1) contains supplementary material, which is available to authorized users.
Collapse
|
20
|
Selvanayagam JB, Nucifora G. Myocardial Deformation Imaging by Feature-Tracking Cardiac Magnetic Resonance in Acute Myocardial Infarction: Do We Need It? Circ Cardiovasc Imaging 2018; 9:CIRCIMAGING.116.005058. [PMID: 27283008 DOI: 10.1161/circimaging.116.005058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Joseph B Selvanayagam
- From the Department of Heart Health, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia (J.S., G.N.); Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia (J.S.); and Flinders University, Adelaide, Australia (J.S.).
| | - Gaetano Nucifora
- From the Department of Heart Health, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia (J.S., G.N.); Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia (J.S.); and Flinders University, Adelaide, Australia (J.S.)
| |
Collapse
|
21
|
Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins! Heart Fail Rev 2018; 22:385-399. [PMID: 28432605 DOI: 10.1007/s10741-017-9609-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.
Collapse
Affiliation(s)
- Ahmed Aljizeeri
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulbaset Sulaiman
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Naji Alhulaimi
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, AB, Canada
| | - Ahmed Alsaileek
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
22
|
Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, Banfi C. Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With STEMI: A Cardiac Magnetic Resonance Study. JACC Cardiovasc Imaging 2018; 12:1007-1017. [PMID: 29680345 DOI: 10.1016/j.jcmg.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to evaluate the correlation between different haptoglobin (Hp) phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR) in consecutive patients after ST-segment elevation myocardial infarction (STEMI). BACKGROUND Hp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE) technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH) in patients with STEMI treated by primary percutaneous coronary intervention (pPCI). METHODS A total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men) were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI. RESULTS CMR showed an area at risk (AAR) involving 26.6 ± 19.1% of left ventricular (LV) mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%) and 12 (8%) patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR) (OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008]) and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]). CONCLUSIONS Hp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.
Collapse
Affiliation(s)
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea I Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital "Policlinico" of Bari, Bari, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Fabio Fazzari
- Department of Cardiology, University Hospital P. Giaccone, Palermo, Italy
| | - Claudio Berzovini
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Annalisa Pasquini
- Department of Cardiology, "La Sapienza" University of Rome, Rome, Italy
| | | | | | | | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois; Edward Hines Jr. VA Hospital, Hines, Illinois
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | |
Collapse
|
23
|
Suranyi P, Elgavish GA, Schoepf UJ, Ruzsics B, Kiss P, van Assen M, Jacobs BE, Brott BC, Elgavish A, Varga-Szemes A. Myocardial tissue characterization by combining late gadolinium enhancement imaging and percent edema mapping: a novel T2 map-based MRI method in canine myocardial infarction. Eur Radiol Exp 2018; 2:6. [PMID: 29708212 PMCID: PMC5909369 DOI: 10.1186/s41747-018-0037-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Assessing the extent of ischemic and reperfusion-associated myocardial injuries remains challenging with current magnetic resonance imaging (MRI) techniques. Our aim was to develop a tissue characterization mapping (TCM) technique by combining late gadolinium enhancement (LGE) with our novel percent edema mapping (PEM) approach to enable the classification of tissue represented by MRI voxels as healthy, myocardial edema (ME), necrosis, myocardial hemorrhage (MH), or scar. Methods Six dogs underwent closed-chest myocardial infarct (MI) generation. Serial MRI scans were performed post-MI on days 3, 4, 6, 14, and 56, including T2 mapping and LGE. Dogs were sacrificed on day 4 (n = 4, acute MI) or day 56 (n = 2, chronic MI). TCMs were generated based on a voxel classification algorithm taking into account signal intensity from LGE and T2-based estimation of ME. TCM-based MI and MH were validated with post mortem triphenyl tetrazolium chloride (TTC) staining. Pearson's correlation and Bland-Altman analyses were performed. Results The MI, ME, and MH measured by TCM were 13.4% [25th-75th percentile 1.6-28.8], 28.1% [2.1-37.5] and 4.3% [1.0-11.3], respectively. TCM measured higher MH and MI compared to TTC (p = 0.0033 and p = 0.0007, respectively). MH size was linearly correlated with MI size by both MRI (r = 0.9528, p < 0.0001) and TTC (r = 0.9625, p < 0.0001). MH quantification demonstrated good agreement between TCM and TTC (r = 0.8766, p < 0.0001, 2.4% overestimation by TCM). A similar correlation was observed for MI size (r = 0.9429, p < 0.0001, 6.1% overestimation by TCM). Conclusions Preliminary results suggest that the TCM method is feasible for the in vivo localization and quantification of various MI-related tissue components.
Collapse
Affiliation(s)
- Pal Suranyi
- 1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 USA
| | - Gabriel A Elgavish
- 2Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005 USA
| | - U Joseph Schoepf
- 1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 USA
| | - Balazs Ruzsics
- 3Department of Cardiology, Royal Liverpool and Broadgreen University Hospital, Thomas Dr, Liverpool, L14 3LB UK
| | - Pal Kiss
- 2Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005 USA
| | - Marly van Assen
- 1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 USA.,4University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Hanzeplein 1, Groningen, 9713GZ The Netherlands
| | - Brian E Jacobs
- 1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 USA
| | - Brigitta C Brott
- 5Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 907, Birmingham, AL 35294-3407 USA
| | - Ada Elgavish
- 6Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005 USA
| | - Akos Varga-Szemes
- 1Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425 USA.,2Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, MCLM 556, Birmingham, AL 35294-0005 USA
| |
Collapse
|
24
|
Patel N, Kolakalapudi P, Arora G. Contrast - in cardiac magnetic resonance imaging. Echocardiography 2018; 35:401-409. [PMID: 29474744 DOI: 10.1111/echo.13845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The utility and role of cardiac magnetic resonance (CMR) as a non-invasive diagnostic imaging modality has been well recognized in the field of cardiovascular disease. Use of late gadolinium enhancement (LGE) has further enhanced CMR's ability to determine structural, functional, and prognostic information in various cardiovascular diseases. The delivery and distribution of gadolinium as an extracellular agent allows the detection of edema, fibrosis, and infiltration in the myocardium. The pattern of LGE in cardiomyopathies enables us to distinguish among various disease processes non-invasively. Additionally, in patients with hypertrophic cardiomyopathy and sudden cardiac death, it helps in decision making in regards to use of implantable cardioverter defibrillator. In the evaluation of cardiac masses, LGE-CMR can often times differentiate between neoplastic and non-neoplastic conditions. In this review, we will discuss the various aspects of gadolinium-based contrast agents, and its application in CMR.
Collapse
Affiliation(s)
- Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pavani Kolakalapudi
- The Heart Center of Northeast Georgia Medical Center, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
25
|
Hwang HY, Yeom SY, Choi JW, Oh SJ, Park EA, Lee W, Kim KB. Cardiac Magnetic Resonance Predictor of Ventricular Function after Surgical Coronary Revascularization. J Korean Med Sci 2017; 32:2009-2015. [PMID: 29115084 PMCID: PMC5680501 DOI: 10.3346/jkms.2017.32.12.2009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/10/2017] [Indexed: 11/20/2022] Open
Abstract
We evaluated echocardiographic changes of left ventricular (LV) function in coronary artery bypass grafting (CABG) patients with LV dysfunction, and examined cardiac magnetic resonance (CMR) parameters associated with improved LV function. Seventy-seven CABG patients presenting with decreased LV ejection fraction (LVEF, ≤ 35%) and who underwent preoperative gadolinium-enhanced CMR were enrolled. A 16-segment model was used to analyze CMR imaging. A viable myocardial segment was defined as ≤ 50% transmural extent of late gadolinium enhancement. Serial echocardiographic examinations were performed preoperatively, pre-discharge (median 6 days), and during postoperative year 1 (median 11 months) in 70 patients. Predictors of absolute increase in LVEF (≥ 5%) and proportional changes in LVEF were analyzed. Serial echocardiography demonstrated that LVEF measured 28.6% ± 5.4% preoperatively, 31.5% ± 8.0% median 6 days, and 42.1% ± 10.5% median 11 months postoperatively. Absolute increase of LVEF was observed in 27 patients at pre-discharge and in 24 patients by median 11 months. Proportional changes in LVEF at postoperative median 6 days and 11 months were 14% ± 28% and 57% ± 45%, respectively. The median number of viable myocardial segments was 14 (range, 9-16) in the 16 segment CMR model. Multivariable models demonstrated that the median number of overall viable myocardial segments (≥ 14) in preoperative CMR was associated with absolute increase (P = 0.046) and proportional changes (P = 0.005) in LVEF. In conclusion, the number of viable myocardial segments (≥ 14) in preoperative CMR predicted LV function improvement after CABG in patients with LV dysfunction.
Collapse
Affiliation(s)
- Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sang Yoon Yeom
- Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Se Jin Oh
- Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ki Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
| |
Collapse
|
26
|
Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, Baggiano A, Fusini L, Muscogiuri G, Lorenzoni V, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Carità P, Verdecchia M, Pica S, Fazzari F, Cosentino N, Marenzi G, Rabbat MG, Agostoni P, Bartorelli AL, Pepi M, Masci PG. Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006428. [PMID: 29146587 DOI: 10.1161/circimaging.117.006428] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. METHODS AND RESULTS Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement. CONCLUSIONS CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment-elevation myocardial infarction.
Collapse
Affiliation(s)
- Gianluca Pontone
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.).
| | - Andrea I Guaricci
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Daniele Andreini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Giovanni Ferro
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Marco Guglielmo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Andrea Baggiano
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Laura Fusini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Giuseppe Muscogiuri
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Valentina Lorenzoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Saima Mushtaq
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Edoardo Conte
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Andrea Annoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Alberto Formenti
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Maria Elisabetta Mancini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Patrizia Carità
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Massimo Verdecchia
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Silvia Pica
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Fabio Fazzari
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Nicola Cosentino
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Giancarlo Marenzi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Mark G Rabbat
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Piergiuseppe Agostoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Antonio L Bartorelli
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Mauro Pepi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Pier Giorgio Masci
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| |
Collapse
|
27
|
Holmes AA, Romero J, Levsky JM, Haramati LB, Phuong N, Rezai-Gharai L, Cohen S, Restrepo L, Ruiz-Guerrero L, Fisher JD, Taub CC, Di Biase L, Garcia MJ. Circumferential strain acquired by CMR early after acute myocardial infarction adds incremental predictive value to late gadolinium enhancement imaging to predict late myocardial remodeling and subsequent risk of sudden cardiac death. J Interv Card Electrophysiol 2017; 50:211-218. [PMID: 29143170 DOI: 10.1007/s10840-017-0296-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Late adverse myocardial remodeling after acute myocardial infarction (AMI) is strongly associated with sudden cardiac death (SCD). Cardiac magnetic resonance (CMR) performed early after AMI can predict late remodeling and SCD risk with moderate accuracy. This study assessed the ability of CMR-measured circumferential strain (CS) to add incremental predictive information to late gadolinium enhancement (LGE). METHODS Patients with an AMI and LVEF < 50% were screened for inclusion. A total of 27 patients, totaling 432 myocardial segments, prospectively underwent CMR 7 ± 5 days after percutaneous coronary intervention (PCI). LGE, microvascular obstruction (MVO), and myocardial CS were measured for each segment. The primary endpoint was late segmental adverse remodeling defined as segmental wall motion score (WMS) > 1 measured by echocardiography 3 months after PCI. RESULTS A total of 141 segments experienced the primary endpoint at 3 months. The mean LGE volume was higher in these segments, but LGE was also present in many segments with normal WMS (40 ± 28 versus 20 ± 26%, p < 0.01). Segments that met the primary endpoint also showed greater impairment of CS. Segments with both LGE > 17% and impaired CS >- 7.2% on CMR were more likely to experience late adverse remodeling (73%) as compared to segments with neither (9%, p < 0.001) or one abnormal parameter (36%, p < 0.001). CS >- 7.2% also added incremental accuracy to LGE > 17% for predicting late adverse remodeling (AUC 0.81 from 0.70, p < 0.001). CONCLUSIONS When performed early after AMI, LGE is a moderate predictor of late remodeling and CS is a powerful predictor of late myocardial remodeling. When combined, they can predict late remodeling, a surrogate of SCD, with high accuracy.
Collapse
Affiliation(s)
- Anthony A Holmes
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.,Leon H. Charney Division of Cardiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Jorge Romero
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Jeffrey M Levsky
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Linda B Haramati
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Newton Phuong
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Leila Rezai-Gharai
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Stuart Cohen
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, North Shore Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Lina Restrepo
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Luis Ruiz-Guerrero
- Division of Cardiology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - John D Fisher
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Cynthia C Taub
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Luigi Di Biase
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Mario J Garcia
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. .,Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
28
|
Redefining viability by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction. Sci Rep 2017; 7:14676. [PMID: 29116176 PMCID: PMC5676975 DOI: 10.1038/s41598-017-15353-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/24/2017] [Indexed: 01/05/2023] Open
Abstract
In chronic myocardial infarction (MI), segments with a transmural extent of infarct (TEI) of ≤50% are defined as being viable. However, in the acute phase of an ST-segment elevation myocardial infarction (STEMI), late gadolinium enhancement (LGE) has been demonstrated to overestimate MI size and TEI. We aimed to identify the optimal cut-off of TEI by cardiovascular magnetic resonance (CMR) for defining viability during the acute phase of an MI, using ≤50% TEI at follow-up as the reference standard. 40 STEMI patients reperfused by primary percutaneous coronary intervention (PPCI) underwent a CMR at 4 ± 2 days and 5 ± 2 months. The large majority of segments with 1–25%TEI and 26–50%TEI that were viable acutely were also viable at follow-up (59/59, 100% and 75/82, 96% viable respectively). 56/84(67%) segments with 51–75%TEI but only 4/63(6%) segments with 76–100%TEI were reclassified as viable at follow-up. TEI on the acute CMR scan had an area-under-the-curve of 0.87 (95% confidence interval of 0.82 to 0.91) and ≤75%TEI had a sensitivity of 98% but a specificity of 66% to predict viability at follow-up. Therefore, the optimal cut-off by CMR during the acute phase of an MI to predict viability was ≤75% TEI and this would have important implications for patients undergoing viability testing prior to revascularization during the acute phase.
Collapse
|
29
|
Kishimoto J, Ohta Y, Kitao S, Watanabe T, Ogawa T. Image quality improvements using adaptive statistical iterative reconstruction for evaluating chronic myocardial infarction using iodine density images with spectral CT. Int J Cardiovasc Imaging 2017; 34:633-639. [DOI: 10.1007/s10554-017-1258-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
|
30
|
Tanabe Y, Kido T, Kurata A, Kouchi T, Fukuyama N, Yokoi T, Uetani T, Yamashita N, Miyagawa M, Mochizuki T. Late iodine enhancement computed tomography with image subtraction for assessment of myocardial infarction. Eur Radiol 2017; 28:1285-1292. [DOI: 10.1007/s00330-017-5048-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/02/2017] [Accepted: 08/22/2017] [Indexed: 01/22/2023]
|
31
|
Kidambi A, Motwani M, Uddin A, Ripley DP, McDiarmid AK, Swoboda PP, Broadbent DA, Musa TA, Erhayiem B, Leader J, Croisille P, Clarysse P, Greenwood JP, Plein S. Myocardial Extracellular Volume Estimation by CMR Predicts Functional Recovery Following Acute MI. JACC Cardiovasc Imaging 2017; 10:989-999. [PMID: 27771398 PMCID: PMC5593809 DOI: 10.1016/j.jcmg.2016.06.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES In the setting of reperfused acute myocardial infarction (AMI), the authors sought to compare prediction of contractile recovery by infarct extracellular volume (ECV), as measured by T1-mapping cardiac magnetic resonance (CMR), with late gadolinium enhancement (LGE) transmural extent. BACKGROUND The transmural extent of myocardial infarction as assessed by LGE CMR is a strong predictor of functional recovery, but accuracy of the technique may be reduced in AMI. ECV mapping by CMR can provide a continuous measure associated with the severity of tissue damage within infarcted myocardium. METHODS Thirty-nine patients underwent acute (day 2) and convalescent (3 months) CMR scans following AMI. Cine imaging, tissue tagging, T2-weighted imaging, modified Look-Locker inversion T1 mapping natively and 15 min post-gadolinium-contrast administration, and LGE imaging were performed. The ability of acute infarct ECV and acute transmural extent of LGE to predict convalescent wall motion, ejection fraction (EF), and strain were compared per-segment and per-patient. RESULTS Per-segment, acute ECV and LGE transmural extent were associated with convalescent wall motion score (p < 0.01; p < 0.01, respectively). ECV had higher accuracy than LGE extent to predict improved wall motion (area under receiver-operating characteristics curve 0.77 vs. 0.66; p = 0.02). Infarct ECV ≤0.5 had sensitivity 81% and specificity 65% for prediction of improvement in segmental function; LGE transmural extent ≤0.5 had sensitivity 61% and specificity 71%. Per-patient, ECV and LGE correlated with convalescent wall motion score (r = 0.45; p < 0.01; r = 0.41; p = 0.02, respectively) and convalescent EF (p < 0.01; p = 0.04). ECV and LGE extent were not significantly correlated (r = 0.34; p = 0.07). In multivariable linear regression analysis, acute infarct ECV was independently associated with convalescent infarct strain and EF (p = 0.03; p = 0.04), whereas LGE was not (p = 0.29; p = 0.24). CONCLUSIONS Acute infarct ECV in reperfused AMI can complement LGE assessment as an additional predictor of regional and global LV functional recovery that is independent of transmural extent of infarction.
Collapse
Affiliation(s)
- Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Manish Motwani
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - David P Ripley
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - David A Broadbent
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom; Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Joshua Leader
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Pierre Croisille
- Université Lyon, INSA Lyon, Université Lyon 1, Université Jean Monnet, CNRS 5220, INSERM 1046, CHU Saint-Etienne, CREATIS, F-69621, Lyon, France
| | - Patrick Clarysse
- Université Lyon, INSA Lyon, Université Lyon 1, Université Jean Monnet, CNRS 5220, INSERM 1046, CHU Saint-Etienne, CREATIS, F-69621, Lyon, France
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
| |
Collapse
|
32
|
Dweck MR, Williams MC, Moss AJ, Newby DE, Fayad ZA. Computed Tomography and Cardiac Magnetic Resonance in Ischemic Heart Disease. J Am Coll Cardiol 2017; 68:2201-2216. [PMID: 27855810 PMCID: PMC5181647 DOI: 10.1016/j.jacc.2016.08.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/01/2016] [Accepted: 08/05/2016] [Indexed: 01/30/2023]
Abstract
Ischemic heart disease is a complex disease process caused by the development of coronary atherosclerosis, with downstream effects on the left ventricular myocardium. It is characterized by a long preclinical phase, abrupt development of myocardial infarction, and more chronic disease states such as stable angina and ischemic cardiomyopathy. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) now allow detailed imaging of each of these different phases of the disease, potentially allowing ischemic heart disease to be tracked during a patient’s lifetime. In particular, CT has emerged as the noninvasive modality of choice for imaging the coronary arteries, whereas CMR offers detailed assessments of myocardial perfusion, viability, and function. The clinical utility of these techniques is increasingly being supported by robust randomized controlled trial data, although the widespread adoption of cardiac CT and CMR will require further evidence of clinical efficacy and cost effectiveness.
Collapse
Affiliation(s)
- Marc R Dweck
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alastair J Moss
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
33
|
Souto ALM, Souto RM, Teixeira ICR, Nacif MS. Myocardial Viability on Cardiac Magnetic Resonance. Arq Bras Cardiol 2017; 108:458-469. [PMID: 28591322 PMCID: PMC5444893 DOI: 10.5935/abc.20170056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022] Open
Abstract
The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability. Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.
Collapse
Affiliation(s)
| | | | | | - Marcelo Souto Nacif
- Universidade Federal Fluminense, Niterói, RJ - Brazil.,Centro de Imagem Complexo Hospitalar de Niterói, Niterói, RJ - Brazil.,Unidade de Radiologia Clínica - Hospital Vivalle - Rede D´Or - São Luiz, São José dos Campo, SP - Brazil
| |
Collapse
|
34
|
Zhang L, Mandry D, Chen B, Huttin O, Hossu G, Wang H, Beaumont M, Girerd N, Felblinger J, Odille F. Impact of microvascular obstruction on left ventricular local remodeling after reperfused myocardial infarction. J Magn Reson Imaging 2017; 47:499-510. [DOI: 10.1002/jmri.25780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/15/2017] [Indexed: 01/17/2023] Open
Affiliation(s)
- Lin Zhang
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- Zhongnan Hospital of Wuhan University, Department of Cardiology; Wuhan China
| | - Damien Mandry
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- CHRU Nancy, Pôle Imagerie; Nancy France
| | - Bailiang Chen
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | | | - Gabriela Hossu
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | - Hairong Wang
- Zhongnan Hospital of Wuhan University, Department of Cardiology; Wuhan China
| | - Marine Beaumont
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | - Nicolas Girerd
- CHRU Nancy, Department of Cardiology; Nancy France
- INSERM, CIC-P 9501; Nancy France
| | - Jacques Felblinger
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- CHRU Nancy, Pôle Imagerie; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | - Freddy Odille
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| |
Collapse
|
35
|
Hassell MECJ, Vlastra W, Robbers L, Hirsch A, Nijveldt R, Tijssen JGP, van Rossum AC, Zijlstra F, Piek JJ, Delewi R. Long-term left ventricular remodelling after revascularisation for ST-segment elevation myocardial infarction as assessed by cardiac magnetic resonance imaging. Open Heart 2017; 4:e000569. [PMID: 28861274 PMCID: PMC5577529 DOI: 10.1136/openhrt-2016-000569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/11/2017] [Accepted: 03/21/2017] [Indexed: 01/08/2023] Open
Abstract
Objective Left ventricular remodelling following a ST-segment elevated myocardial infarction (STEMI) is an adaptive response to maintain the cardiac output despite myocardial tissue loss. Limited studies have evaluated long term ventricular function using cardiac magnetic resonance imaging (CMR) after STEMI. Methods Study population consisted of 155 primary percutaneous coronary intervention treated first STEMI patients. CMR was performed at 4±2 days, 4 months and 24 months follow-up. Patients were treated with beta-blockers, ACE-inhibitors or AT-II- inhibitors, statins and dual antiplatelet according to current international guidelines. Results Mean left ventricular ejection fraction (LVEF) at baseline was 44%±8%. Twenty-one per cent of the study population had an increase of more than 5.0% after 4 months of follow-up and 21% of the cohort had a decrease of more than 5.0%. Patients with long-term LVEF deterioration have significantly larger end-systolic volumes than patients with improvement of LVEF (61±23 mL/m2 compared with 52±21 mL/m2, p=0.02) and less wall thickening in the remote zone. Patients with LVEF improvement had significantly greater improvement in wall thickening in the infarct areas and in the non-infarct or remote zone. Conclusion Contrary to previous studies, we demonstrate that myocardial remodelling after STEMI is a long-term process. Long-term LVEF deterioration is characterised by an increase in end-systolic volume and less wall thickening in the remote zones. Patients with LVEF improvement exhibit an increase in left ventricular wall thickening both in the infarct as well as in the remote zones. Trial registration The HEBE study is registered in The Netherlands Trial Register #NTR166 (www.trialregister.nl) and the International Standard Randomised Controlled Trial, #ISRCTN95796863 (https://c-d-qn9pqajji.sec.amc.nl).
Collapse
Affiliation(s)
- Mariella ECJ Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wieneke Vlastra
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lourens Robbers
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan GP Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| |
Collapse
|
36
|
Mayr A, Klug G, Feistritzer HJ, Reinstadler SJ, Reindl M, Esterhammer R, Feuchtner G, Metzler B, Schocke MF. Myocardial edema in acute myocarditis: relationship of T2 relaxometry and late enhancement burden by using dual-contrast turbo spin-echo MRI. Int J Cardiovasc Imaging 2017; 33:1789-1794. [PMID: 28528429 PMCID: PMC5682853 DOI: 10.1007/s10554-017-1170-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Abstract
To quantify myocardial edema by using a T2 relaxometry approach with a dual-contrast turbo spin-echo (dcTSE) sequence in patients with acute myocarditis regarding focal late gadolinium enhancement (LGE) burden. CMR T2 relaxometry was performed in 39 patients (age 41 ± 19 years; 36% women) with LGE in a typical myocarditis pattern and in ten healthy volunteers (age 46 ± 12; 60% woman). dcTSE sequence (echo time 29 and 75 ms, respectively) was used for T2 mapping, analysis were performed on the basis of region of interest (ROI). Myocardial T2 relaxation times (T2 RT) in patients-ROI with focal LGE were significantly (p < 0.001) higher than T2 RT in patients-ROI without apparent LGE pattern (65 ms (IQR 36-95) vs. 60 ms (IQR 26-88), respectively). T2 RT in healthy volunteers [55 ms (IQR 35-71)] were significantly lower than in patients ROI with or without focal LGE-pattern (p < 0.001, respectively). T2 RT assessed by dcTSE are significantly higher in patients segments with and without focal LGE compared to normal controls, supporting a global myocardial inflammatory process in acute myocarditis. Furthermore, this quantitative T2-mapping approach highlights the potential to identify patients with diffuse myocarditis.
Collapse
Affiliation(s)
- A Mayr
- University Hospital for Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - G Klug
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H J Feistritzer
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - S J Reinstadler
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M Reindl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - R Esterhammer
- University Hospital for Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - G Feuchtner
- University Hospital for Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - B Metzler
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M F Schocke
- University Hospital for Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
37
|
Khan JN, Nazir SA, Singh A, Shetye A, Lai FY, Peebles C, Wong J, Greenwood JP, McCann GP. Relationship of Myocardial Strain and Markers of Myocardial Injury to Predict Segmental Recovery After Acute ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.003457. [PMID: 27283007 DOI: 10.1161/circimaging.115.003457] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Late gadolinium-enhanced cardiovascular magnetic resonance imaging overestimates infarct size and underestimates recovery of dysfunctional segments acutely post ST-segment-elevation myocardial infarction. We assessed whether cardiovascular magnetic resonance imaging-derived segmental myocardial strain and markers of myocardial injury could improve the accuracy of late gadolinium-enhancement in predicting functional recovery after ST-segment-elevation myocardial infarction. METHODS AND RESULTS A total of 164 ST-segment-elevation myocardial infarction patients underwent acute (median 3 days) and follow-up (median 9.4 months) cardiovascular magnetic resonance imaging. Wall-motion scoring, feature tracking-derived circumferential strain (Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular obstruction, intramyocardial hemorrhage, and salvage index (MSI) were assessed in 2624 segments. We used logistic regression analysis to identify markers that predict segmental recovery. At acute CMR 32% of segments were dysfunctional, and at follow-up CMR 19% were dysfunctional. Segmental function at acute imaging and odds ratio (OR) for functional recovery decreased with increasing SEE, although 33% of dysfunctional segments with SEE 76% to 100% improved. SEE was a strong predictor of functional improvement and normalization (area under the curve [AUC], 0.840 [95% confidence interval {CI}, 0.814-0.867]; OR, 0.97 [95% CI, 0.97-0.98] per +1% SEE for improvement and AUC, 0.887 [95% CI, 0.865-0.909]; OR, 0.95 [95% CI, 0.94-0.96] per +1% SEE for normalization). Its predictive accuracy for improvement, as assessed by areas under the receiver operator curves, was similar to that of MSI (AUC, 0.840 [95% CI, 0.809-0.872]; OR, 1.03 [95% CI, 1.02-1.03] per +1% MSI for improvement and AUC, 0.862 [0.832-0.891]; OR, 1.04 [95% CI, 1.03-1.04] per +1% SEE for normalization) and Ecc (AUC, 0.834 [95% CI, 0.807-0.862]; OR, 1.05 [95% CI, 1.03-1.07] per +1% MSI for improvement and AUC, 0.844 [95% CI, 0.818-0.871]; OR, 1.07 [95% CI, 1.05-1.10] per +1% SEE for normalization), and for normalization was greater than the other predictors. MSI and Ecc remained as significant after adjustment for SEE but provided no significant increase in predictive accuracy for improvement and normalization compared with SEE alone. MSI had similar predictive accuracy to SEE for functional recovery but was not assessable in 25% of patients. Microvascular obstruction provided no incremental predictive accuracy above SEE. CONCLUSIONS This multicenter study confirms that SEE is a strong predictor of functional improvement post ST-segment-elevation myocardial infarction, but recovery occurs in a substantial proportion of dysfunctional segments with SEE >75%. Feature tracking-derived Ecc and MSI provide minimal incremental benefit to SEE in predicting segmental recovery. CLINICAL TRIAL REGISTRATION URL: http://www.isrctn.com. Unique identifier: ISRCTN70913605.
Collapse
Affiliation(s)
- Jamal N Khan
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Sheraz A Nazir
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Anvesha Singh
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Abhishek Shetye
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Florence Y Lai
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Charles Peebles
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Joyce Wong
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - John P Greenwood
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Gerry P McCann
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
| |
Collapse
|
38
|
La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
Collapse
Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| |
Collapse
|
39
|
Gropler RJ. Relationship between residual viable myocardium and LV remodeling post-MI: Only part of the story. J Nucl Cardiol 2017; 24:668-671. [PMID: 26888373 DOI: 10.1007/s12350-016-0425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Robert J Gropler
- Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
| |
Collapse
|
40
|
Timmer SAJ, Teunissen PFA, Danad I, Robbers LFHJ, Raijmakers PGHM, Nijveldt R, van Rossum AC, Lammertsma AA, van Royen N, Knaapen P. In vivo assessment of myocardial viability after acute myocardial infarction: A head-to-head comparison of the perfusable tissue index by PET and delayed contrast-enhanced CMR. J Nucl Cardiol 2017; 24:657-667. [PMID: 26843199 PMCID: PMC5413541 DOI: 10.1007/s12350-015-0329-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early recognition of viable myocardium after acute myocardial infarction (AMI) is of clinical relevance, since affected segments have the potential of functional recovery. Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viable myocardium. An alternative parameter for detecting viability is the perfusable tissue index (PTI), derived using [15O]H2O positron emission tomography (PET), which is inversely related to the extent of myocardial scar (non-perfusable tissue). The aim of the present study was to investigate the predictive value of PTI on recovery of LV function as compared to DCE-CMR in patients with AMI, after successful percutaneous coronary intervention (PCI). METHODS Thirty-eight patients with ST elevation myocardial infarction (STEMI) successfully treated by PCI were prospectively recruited. Subjects were examined 1 week and 3 months (mean follow-up time: 97 ± 10 days) after AMI using [15O]H2O PET and DCE-CMR to assess PTI, regional function and scar. Viability was defined as recovery of systolic wall thickening ≥3.0 mm at follow-up by use of CMR. A total of 588 segments were available for serial analysis. RESULTS At baseline, 180 segments were dysfunctional and exhibited DCE. Seventy-three (41%) of these dysfunctional segments showed full recovery during follow-up (viable), whereas 107 (59%) segments remained dysfunctional (nonviable). Baseline PTI of viable segments was 0.94 ± 0.09 and was significantly higher compared to nonviable segments (0.80 ± 0.13, P < .001). The optimal cut-off value for PTI was ≥0.85 with a sensitivity of 85% and specificity of 72%, and an area under the curve (AUC) of 0.82. In comparison, a cut-off value of <32% for the extent of DCE resulted in a sensitivity of 72% and a specificity of 69%, and an AUC of 0.75 (AUC PTI vs DCE P = .14). CONCLUSION Assessment of myocardial viability shortly after reperfused AMI is feasible using PET. PET-derived PTI yields a good predictive value for the recovery of LV function in PCI-treated STEMI patients, in excellent agreement with DCE-CMR.
Collapse
Affiliation(s)
- Stefan A. J. Timmer
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Paul F. A. Teunissen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Lourens F. H. J. Robbers
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Adriaan A. Lammertsma
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 5F013, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
41
|
Khan JN, McCann GP. Cardiovascular magnetic resonance imaging assessment of outcomes in acute myocardial infarction. World J Cardiol 2017; 9:109-133. [PMID: 28289525 PMCID: PMC5329738 DOI: 10.4330/wjc.v9.i2.109] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/02/2016] [Accepted: 01/02/2017] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging uniquely characterizes myocardial and microvascular injury in acute myocardial infarction (AMI), providing powerful surrogate markers of outcomes. The last 10 years have seen an exponential increase in AMI studies utilizing CMR based endpoints. This article provides a contemporary, comprehensive review of the powerful role of CMR imaging in the assessment of outcomes in AMI. The theory, assessment techniques, chronology, importance in predicting left ventricular function and remodelling, and prognostic value of each CMR surrogate marker is described in detail. Major studies illustrating the importance of the markers are summarized, providing an up to date review of the literature base in CMR imaging in AMI.
Collapse
Affiliation(s)
- Jamal N Khan
- Jamal N Khan, Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| | - Gerry P McCann
- Jamal N Khan, Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| |
Collapse
|
42
|
Hammer-Hansen S, Leung SW, Hsu LY, Wilson JR, Taylor J, Greve AM, Thune JJ, Køber L, Kellman P, Arai AE. Early Gadolinium Enhancement for Determination of Area at Risk: A Preclinical Validation Study. JACC Cardiovasc Imaging 2017; 10:130-139. [PMID: 27665165 PMCID: PMC5384795 DOI: 10.1016/j.jcmg.2016.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/14/2016] [Accepted: 04/14/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether early gadolinium enhancement (EGE) by cardiac magnetic resonance (CMR) in a canine model of reperfused myocardial infarction depicts the area at risk (AAR) as determined by microsphere blood flow analysis. BACKGROUND It remains controversial whether only the irreversibly injured myocardium enhances when CMR is performed in the setting of acute myocardial infarction. Recently, EGE has been proposed as a measure of the AAR in acute myocardial infarction because it correlates well with T2-weighted imaging of the AAR, but this still requires pathological validation. METHODS Eleven dogs underwent 2 h of coronary artery occlusion and 48 h of reperfusion before imaging at 1.5-T. EGE imaging was performed 3 min after contrast administration with coverage of the entire left ventricle. Late gadolinium enhancement imaging was performed between 10 and 15 min after contrast injection. AAR was defined as myocardium with blood flow <2 SD from remote myocardium determined by microspheres during occlusion. The size of infarction was determined with triphenyltetrazolium chloride. RESULTS There was no significant difference in the size of enhancement by EGE compared with the size of AAR by microspheres (44.1 ± 15.8% vs. 42.7 ± 9.2%; p = 0.61), with good correlation (r = 0.88; p < 0.001) and good agreement by Bland-Altman analysis (mean bias 1.4 ± 17.4%). There was no difference in the size of enhancement by EGE compared with enhancement on native T1 and T2 maps. The size of EGE was significantly greater than the infarct by triphenyltetrazolium chloride (44.1 ± 15.8% vs. 20.7 ± 14.4%; p < 0.001) and late gadolinium enhancement (44.1 ± 15.8% vs. 23.5 ± 12.7%; p < 0.001). CONCLUSIONS At 3 min post-contrast, EGE correlated well with the AAR by microspheres and CMR and was greater than infarct size. Thus, EGE enhances both reversibly and irreversibly injured myocardium.
Collapse
Affiliation(s)
- Sophia Hammer-Hansen
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Steve W Leung
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Medicine and Radiology, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Li-Yueh Hsu
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Joel R Wilson
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Medicine and Radiology, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California
| | - Joni Taylor
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Anders M Greve
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Jens Jakob Thune
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Peter Kellman
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
| |
Collapse
|
43
|
Wong C, Chen S, Iyngkaran P. Cardiac Imaging in Heart Failure with Comorbidities. Curr Cardiol Rev 2017; 13:63-75. [PMID: 27492227 PMCID: PMC5324322 DOI: 10.2174/1573403x12666160803100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.
Collapse
Affiliation(s)
- Chiew Wong
- Flinders University, NT Medical School, Darwin Australia
| | - Sylvia Chen
- Flinders University, NT Medical School, Darwin Australia
| | | |
Collapse
|
44
|
Zhang JL, Conlin CC, Carlston K, Xie L, Kim D, Morrell G, Morton K, Lee VS. Optimization of saturation-recovery dynamic contrast-enhanced MRI acquisition protocol: monte carlo simulation approach demonstrated with gadolinium MR renography. NMR IN BIOMEDICINE 2016; 29:969-77. [PMID: 27200499 PMCID: PMC5206992 DOI: 10.1002/nbm.3553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/13/2016] [Accepted: 04/11/2016] [Indexed: 05/18/2023]
Abstract
Dynamic contrast-enhanced (DCE) MRI is widely used for the measurement of tissue perfusion and to assess organ function. MR renography, which is acquired using a DCE sequence, can measure renal perfusion, filtration and concentrating ability. Optimization of the DCE acquisition protocol is important for the minimization of the error propagation from the acquired signals to the estimated parameters, thus improving the precision of the parameters. Critical to the optimization of contrast-enhanced T1 -weighted protocols is the balance of the T1 -shortening effect across the range of gadolinium (Gd) contrast concentration in the tissue of interest. In this study, we demonstrate a Monte Carlo simulation approach for the optimization of DCE MRI, in which a saturation-recovery T1 -weighted gradient echo sequence is simulated and the impact of injected dose (D) and time delay (TD, for saturation recovery) is tested. The results show that high D and/or high TD cause saturation of the peak arterial signals and lead to an overestimation of renal plasma flow (RPF) and glomerular filtration rate (GFR). However, the use of low TD (e.g. 100 ms) and low D leads to similar errors in RPF and GFR, because of the Rician bias in the pre-contrast arterial signals. Our patient study including 22 human subjects compared TD values of 100 and 300 ms after the injection of 4 mL of Gd contrast for MR renography. At TD = 100 ms, we computed an RPF value of 157.2 ± 51.7 mL/min and a GFR of 33.3 ± 11.6 mL/min. These results were all significantly higher than the parameter estimates at TD = 300 ms: RPF = 143.4 ± 48.8 mL/min (p = 0.0006) and GFR = 30.2 ± 11.5 mL/min (p = 0.0015). In conclusion, appropriate optimization of the DCE MRI protocol using simulation can effectively improve the precision and, potentially, the accuracy of the measured parameters. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Jeff L. Zhang
- Correspondence to: J. L. Zhang, University of Utah School of Medicine, Department of Radiology, 729 Arapeend Dr., Salt Lake City, UT 84108, USA.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Khurelsukh K, Kim YH, Seon HJ, Song JH, Park SY, Moon SM, Kim SH, Sim DS, Ahn Y. Non-contrast cardiac CT immediately after percutaneous coronary intervention: does it predict the risk of left ventricular remodeling in patients with ST-elevation myocardial infarction? Int J Cardiovasc Imaging 2016; 32 Suppl 1:147-54. [PMID: 27139462 DOI: 10.1007/s10554-016-0900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
To assess the clinical utility of non-contrast cardiac CT (CCT) immediately after successful percutaneous coronary intervention (PCI) for predicting the risk of left ventricle (LV) remodeling in the management of patients with acute myocardial infarction (AMI), 35 patients with AMI underwent non-contrast CCT immediately after PCI. Volume and transmural extent of myocardial delayed enhancement (DE) were assessed on non-contrast CCT. Serial echocardiography and serologic biomarkers were evaluated at baseline and at 2 and 12 months after AMI. Based on an increase in left ventricular end-diastolic volume (LVEDV) ≥20 % at 2 months, patients were classified into two groups: LV remodeling (group 1, n = 14) and no LV remodeling (group 2, n = 21). Clinical characteristics, imaging parameters, and serologic biomarkers were compared between the two groups. Higher incidence of hypertension, longer time to reperfusion, and higher Killip classification at admission were observed for group 1 than for group 2, but these differences were not statistically significant (P > 0.05). Greater volume and transmural extent of DE on non-contrast CCT and poorer resolution of ST-segment elevation on ECG were observed in group 1 compared to group 2, but these results were not statistically significant (P > 0.05). Measurement of biochemical markers showed that probrain natriuretic peptide (proBNP), initial high sensitivity C reactive protein (hs-CRP), and maximum troponin T level were significantly higher in group 1 than in group 2 (P < 0.05) at 2 months. Based on the trend of greater volume and transmural extent of DE in group 1 compared to group 2, non-contrast CCT immediately after PCI, in combination with serologic biomarkers (proBNP, hs-CRP, and troponin T) might be useful for managing patients with AMI.
Collapse
Affiliation(s)
- Khulan Khurelsukh
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea.
| | - Hyun Ju Seon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Jang Hyun Song
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Seo Yeon Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Sung Min Moon
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Soo Hyun Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-Gu, Gwangju, 61469, South Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| |
Collapse
|
46
|
|
47
|
Mazumder R, Choi S, Clymer BD, White RD, Kolipaka A. Diffusion Tensor Imaging of Healthy and Infarcted Porcine Hearts: Study on the Impact of Formalin Fixation. J Med Imaging Radiat Sci 2016; 47:74-85. [PMID: 26989451 PMCID: PMC4790101 DOI: 10.1016/j.jmir.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Due to complexities of in-vivo cardiac diffusion tensor imaging (DTI), ex-vivo formalin-fixed specimens are used to investigate cardiac remodeling in diseases, and reported results have shown conflicting trends. This study investigates the impact of formalin-fixation on diffusion properties and optimizes tracking parameters based on controls to understand remodeling in myocardial-infarction (MI). METHODS DTI was performed on 4 healthy (controls) and 4 MI induced formalin-fixed (PoMI) ex-vivo porcine hearts. Controls were scanned pre-fixation (PrCtrl) and re-scanned (PoCtrl) after formalin-fixation. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were estimated in all hearts. Tracking parameters (FA, tract termination angle (TTA), fiber-length) were optimized in controls and then used to investigate structural remodeling in PoMI hearts. RESULTS Fixation increased ADC and decreased FA. PoMI showed increased ADC but decreased FA in infarcted zone compared to remote zone. TTA showed sharp increase in slope from 5°-10°, which flattened after 25° in all groups. Mean fiber-length for different tracking length range showed that PoCtrl had shorter fibers compared to PrCtrl. Fibers around infarction were shorter in length and disarrayed compared to PoCtrl group. CONCLUSION Formalin-fixation affects diffusion properties and hence DTI parametric trends observed in pathology may be influenced by the fixation process which can cause contradictory findings.
Collapse
Affiliation(s)
- Ria Mazumder
- Department of Electrical and Computer Engineering, 205
Dreese Laboratories, 2015 Neil Avenue, The Ohio State University, Columbus, Ohio
43210, USA
| | - Seongjin Choi
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| | - Bradley D. Clymer
- Department of Electrical and Computer Engineering, 205
Dreese Laboratories, 2015 Neil Avenue, The Ohio State University, Columbus, Ohio
43210, USA
| | - Richard D. White
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
- Department of Internal Medicine-Division of Cardiovascular
Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| | - Arunark Kolipaka
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
- Department of Internal Medicine-Division of Cardiovascular
Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| |
Collapse
|
48
|
Tsadok Y, Friedman Z, Haluska BA, Hoffmann R, Adam D. Myocardial strain assessment by cine cardiac magnetic resonance imaging using non-rigid registration. Magn Reson Imaging 2015; 34:381-90. [PMID: 26723847 DOI: 10.1016/j.mri.2015.12.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/20/2015] [Indexed: 11/25/2022]
Abstract
AIMS To evaluate a novel post-processing method for assessment of longitudinal mid-myocardial strain in standard cine cardiac magnetic resonance (CMR) imaging sequences. METHODS AND RESULTS Cine CMR imaging and tagged cardiac magnetic resonance imaging (TMRI) were performed in 15 patients with acute myocardial infarction (AMI) and 15 healthy volunteers served as control group. A second group of 37 post-AMI patients underwent both cine CMR and late gadolinium enhancement (LGE) CMR exams. Speckle tracking echocardiography (STE) was performed in 36 of these patients. Cine CMR, TMRI and STE were analyzed to obtain longitudinal strain. LGE-CMR datasets were analyzed to evaluate scar extent. Comparison of peak systolic strain (PSS) measured from CMR and TMRI yielded a strong correlation (r=0.86, p<0.001). PSS measured from CMR and STE correlated well (r=0.75, p<0.001). A cutoff longitudinal PSS value of -13.14% differentiated non-infarction from any infarcted myocardium, with a sensitivity of 93% and a specificity of 89% (area under curve (AUC) 0.95). PSS value of -9.39% differentiated non-transmural from transmural infarcted myocardium, with a sensitivity of 75% and a specificity of 67% (AUC 0.78). CONCLUSION The present study showed a novel off-line post-processing method for segmental longitudinal strain analysis in mid-myocardium layer based on cine CMR data. The method was found to be highly correlated with strain measurements obtained by TMRI and STE. This tool allows accurate discrimination between different transmurality states of myocardial infarction.
Collapse
Affiliation(s)
- Yossi Tsadok
- Faculty of Biomedical Engineering, Technion-IIT Technion City, Haifa, Israel.
| | - Zvi Friedman
- General Electric Healthcare, Ultrasound, Tirat HaCarmel, Israel
| | - Brian A Haluska
- Cardiovascular Imaging Research Centre, University of Queensland, Brisbane, Australia
| | - Rainer Hoffmann
- Medical Clinic I, University Hospital RWTH Aachen, Aachen, Germany
| | - Dan Adam
- Faculty of Biomedical Engineering, Technion-IIT Technion City, Haifa, Israel
| |
Collapse
|
49
|
Klug G, Reinstadler SJ, Feistritzer HJ, Kremser C, Schwaiger JP, Reindl M, Mair J, Müller S, Mayr A, Franz WM, Metzler B. Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging. Eur Radiol 2015; 26:1999-2008. [PMID: 26385805 DOI: 10.1007/s00330-015-4022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/02/2015] [Accepted: 09/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Phase-contrast CMR (PC-CMR) might provide a fast and robust non-invasive determination of left ventricular function in patients after ST-segment elevation myocardial infarction (STEMI). METHODS Cine sequences in the left-ventricular (LV) short-axis and free-breathing, retrospectively gated PC-CMR were performed in 90 patients with first acute STEMI and 15 healthy volunteers. Inter- and intra-observer agreement was determined. The correlations of clinical variables (age, gender, ejection fraction, NT pro-brain natriuretic peptide [NT-proBNP] with cardiac index (CI) were calculated. RESULTS For CI, there was a strong agreement of cine CMR with PC-CMR in healthy volunteers (r: 0.82, mean difference: -0.14 l/min/m(2), error ± 23 %). Agreement was lower in STEMI patients (r: 0.61, mean difference: -0.17 l/min/m(2), error ± 32 %). In STEMI patients, CI measured with PC-CMR showed lower intra-observer (1 % vs. 9 %) and similar inter-observer variability (9 % vs. 12 %) compared to cine CMR. CI was significantly correlated with age, ejection fraction and NT-proBNP values in STEMI patients. DISCUSSION The agreement of PC-CMR and cine CMR for the determination of CI is lower in STEMI patients than in healthy volunteers. After acute STEMI, CI measured with PC-CMR decreases with age, LV ejection fraction and higher NT-proBNP. KEY POINTS • Cine CMR and PC-CMR correlate well in healthy volunteers. • Agreement is lower in STEMI patients. • Cardiac Output should be measured with one method longitudinally. • Cardiac output decreases with age after myocardial infarction.
Collapse
Affiliation(s)
- Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes P Schwaiger
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Johannes Mair
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvana Müller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang-Michael Franz
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| |
Collapse
|
50
|
Watabe H, Sato A, Nishina H, Hoshi T, Sugano A, Kakefuda Y, Takaiwa Y, Aihara H, Fumikura Y, Noguchi Y, Aonuma K. Enhancement patterns detected by multidetector computed tomography are associated with microvascular obstruction and left ventricular remodelling in patients with acute myocardial infarction. Eur Heart J 2015; 37:684-92. [PMID: 26385959 DOI: 10.1093/eurheartj/ehv467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/20/2015] [Indexed: 12/22/2022] Open
Abstract
AIMS This study evaluated the clinical value of myocardial contrast-delayed enhancement (DE) with multidetector computed tomography (MDCT) for detecting microvascular obstruction (MVO) and left ventricular (LV) remodelling revealed by DE magnetic resonance imaging after acute myocardial infarction (AMI). METHODS AND RESULTS In 92 patients with first AMI, MDCT without iodine reinjection was performed immediately following successful percutaneous coronary intervention (PCI). Delayed-enhancement magnetic resonance imaging performed in the acute and chronic phases was used to detect MVO and LV remodelling (any increase in LV end-systolic volume at 6 months after infarction compared with baseline). Patients were divided into two groups according to the presence (n = 33) or absence (n = 59) of heterogeneous enhancement (HE). Heterogeneous enhancement was defined as concomitant presence of hyper- and hypoenhancement within the infarcted myocardium on MDCT. Microvascular obstruction and LV remodelling were detected in 49 (53%) and 29 (32%) patients, respectively. In a multivariable analysis, HE and a relative CT density >2.20 were significant independent predictors for MVO [odds ratio (OR) 13.5; 95% confidence interval (CI), 2.15-84.9; P = 0.005 and OR 12.0; 95% CI, 2.94-49.2; P < 0.001, respectively). The presence of HE and relative CT density >2.20 showed a high positive predictive value of 93%, and the absence of these two findings yielded a high negative predictive value of 90% for the predictive value of MVO. Heterogeneous enhancement was significantly associated with LV remodelling (OR 6.75; 95% CI, 1.56-29.29; P = 0.011). CONCLUSION Heterogeneous enhancement detected by MDCT immediately after primary PCI may provide promising information for predicting MVO and LV remodelling in patients with AMI.
Collapse
Affiliation(s)
- Hiroaki Watabe
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tomoya Hoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Akinori Sugano
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuki Kakefuda
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yui Takaiwa
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hideaki Aihara
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuko Fumikura
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| |
Collapse
|