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Shang Y, Zhang Y, Leng W, Lei X, Chen L, Zhou X, Liang Z, Wang J. Assessment of right ventricular function using cardiovascular magnetic resonance in patients with type 2 diabetes mellitus. Quant Imaging Med Surg 2022; 12:1539-1548. [PMID: 35111646 DOI: 10.21037/qims-21-376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
Background Accurate evaluation of right ventricular (RV) function is always difficult due to its irregular shape and movement. Many indices have been proposed to assess RV function, but none have been universally accepted. This study evaluated RV function in type 2 diabetes mellitus (T2DM) patients using long-axis strain (LAS) and other traditional indices. Methods Fifty-seven patients with T2DM and 39 healthy controls were prospectively enrolled. Four-chamber cardiovascular magnetic resonance (CMR) and RV short-axis cine images were obtained from all participants to measure the tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (EF), peak longitudinal strain (PLS) and four LAS indices. The inter-and intraobserver variabilities were also calculated. Results Compared with healthy controls, T2DM was associated with a decreased LAS (apex/lateral wall) (-17.4%±4.2% vs. control, -19.7%±3.7%, P=0.008) and LAS (apex/middle point) (-17.5%±4.5% vs. control, -19.5%±3.9%, P=0.026), but both groups had a similar LAS (RV/lateral wall) and LAS (RV/middle point) (all P>0.05). After adjustments for age and body mass index, a significant difference was observed only for LAS (apex/lateral wall) (P=0.028). There were no significant differences in the TAPSE, RVEF and PLS (all P>0.05). LAS (apex/lateral wall) correlated with the TAPSE (r=-0.723, P<0.001), RVEF (r=-0.270, P=0.008) and PLS (r=0.210, P=0.040). The inter- and intraobserver variability of the LAS (apex/lateral wall) were lower than the other three LAS indices. Conclusions Compared with traditional RV function indices, such as the TAPSE, RVEF and PLS, LAS is easy to obtain and shows high repeatability. LAS (apex/lateral wall) may provide a more sensitive T2DM-related RV dysfunction index.
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Affiliation(s)
- Yongning Shang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yulin Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weiling Leng
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaotian Lei
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Liu Chen
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | | | - Ziwen Liang
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Chen R, Xu C, Dong Z, Liu Y, Du X. DeepCQ: Deep multi-task conditional quantification network for estimation of left ventricle parameters. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 184:105288. [PMID: 31901611 DOI: 10.1016/j.cmpb.2019.105288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Automatic cardiac left ventricle (LV) quantification plays an important role in assessing cardiac function. Although many advanced methods have been put forward to quantify related LV parameters, automatic cardiac LV quantification is still a challenge task due to the anatomy construction complexity of heart. METHODS In this work, we propose a novel deep multi-task conditional quantification learning model (DeepCQ) which contains Segmentation module, Quantification encoder, and Dynamic analysis module. Besides, we also use task uncertainty loss function to update the parameters of the network in training. RESULTS The proposed framework is validated on the dataset from Left Ventricle Full Quantification Challenge MICCAI 2018 (https://lvquan18.github.io/). The experimental results show that DeepCQ outperforms the other advanced methods. CONCLUSIONS It illustrates that our method has a great potential in comprehensive cardiac function assessment and could play an auxiliary role in clinicians' diagnosis.
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Affiliation(s)
- Ruifeng Chen
- School of Computer Science and Technology, Anhui University, Anhui, China
| | - Chenchu Xu
- Department of Medical Imaging, Western University, London, Canada.
| | - Zhangfu Dong
- School of Computer Science and Technology, Anhui University, Anhui, China
| | - Yueguo Liu
- School of Computer Science and Technology, Anhui University, Anhui, China
| | - Xiuquan Du
- Key Laboratory of Intelligent Computing and Signal Processing, Ministry of Education, Anhui University, Anhui, China; School of Computer Science and Technology, Anhui University, Anhui, China.
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3
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Yi JE, Park J, Lee HJ, Shin DG, Kim Y, Kim M, Kwon K, Pyun WB, Kim YJ, Joung B. Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study. PLoS One 2018; 13:e0208100. [PMID: 30485353 PMCID: PMC6261623 DOI: 10.1371/journal.pone.0208100] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction The presence of late gadolinium enhancement (LGE) at the right ventricular insertion point (RVIP) on cardiac magnetic resonance (CMR) is generally believed to be nonspecific, but the clinical implication of this unique LGE pattern in patients with non-ischemic dilated cardiomyopathy (NICM) has not been elucidated. Objectives We investigated the prognostic significance of RVIP-LGE in NICM patients. Methods A total of 360 consecutive NICM patients referred for CMR (102 with no LGE, 50 with RVIP-LGE, 121 with left ventricular [LV]-LGE, and 87 with both an LV and RVIP-LGE) were studied. The primary endpoint was a composite of the all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events. Results During a mean follow-up of 45.2 ± 36.5 months, 149 (41.4%) patients (22 [21.6%] no LGE vs. 16 [32.0%] RVIP-LGE vs. 62 [51.2%] LV-LGE vs. 49 [56.3%] both LV and RVIP-LGE, P < 0.0001) reached the primary endpoint. A Kaplan Meier curve demonstrated that RVIP-LGE patients had an intermediate trend of an event free survival rate for the composite endpoint (log-rank P < 0.0001). In a multivariable Cox regression model, LV-LGE (P = 0.008) and both LV and RVIP-LGE (P = 0.003) were significantly associated with a worse outcome, whereas RVIP-LGE was not (P = 0.101). In addition, RVIP-LGE patients (n = 32) had a more favorable outcome compared to LV-LGE patients (n = 32) even after matching the extent of the LGE (median 3.4% [interquartile range, 3.1–3.8], 8 [25.0%] RVIP-LGE vs. 20 [62.5%] LV-LGE, P = 0.002). Conclusions LGE confined to the RVIP among NICM patients did not significantly increase the risk of adverse cardiac events, and also showed a better outcome than the same extent of LGE located in the LV. Identification of this unique LGE distribution may help refine the current risk stratification.
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Affiliation(s)
- Jeong-Eun Yi
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Geum Shin
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Minsuk Kim
- Department of Pharmacology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kihwan Kwon
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail: (BYJ); (YJK)
| | - Boyoung Joung
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: (BYJ); (YJK)
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Liu X, Hou JL, Yang ZG, Xia CC, Xie LJ, Ye PF, Peng WL, Li L, Yang MX, Guo YK. Native T 1 mapping for characterization of acute and chronic myocardial infarction in swine: Comparison with contrast-enhanced MRI. J Magn Reson Imaging 2017; 47:1406-1414. [PMID: 29044903 DOI: 10.1002/jmri.25871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/23/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Both acute and chronic myocardial infarction (AMI and CMI, respectively) exhibit delayed enhancement; however, clinical decision-making processes frequently require the differentiation of these two types of myocardial injury. PURPOSE To investigate the reliability of AMI and CMI characterization using native T1 mapping and its feasibility for discriminating AMI from CMI. STUDY TYPE Case-control. ANIMAL MODEL The study cohort comprised 12 AMI (mean post-MI, 3.75 ± 1.29 days) and 15 CMI (mean post-MI, 39.53 ± 6.10 days) Bama mini-pigs. FIELD STRENGTH/SEQUENCE Balanced steady-state free precession (bSSFP), segmented-turbo-FLASH-PSIR, and modified Look-Locker inversion recovery (MOLLI) sequences at 3.0T. ASSESSMENT The infarct sizes were compared on matching short-axis slices of late-gadolinium-enhanced (LGE) images and T1 maps by two experienced radiologists. STATISTICAL TESTS The infarct sizes were compared on matching short-axis slices of LGE images and T1 maps, and agreement was determined using linear regression and Bland-Altman analyses. The native T1 values were compared between AMI and CMI models (independent sample t-test). The intraclass correlation coefficient was used to assess inter- and intraobserver variability. RESULTS Measured infarct sizes did not differ between native T1 mapping and LGE images (AMI: P = 0.913; CMI: P = 0.233), and good agreement was observed between the two techniques (AMI: bias, -3.38 ± 19.38%; R2 = 0.96; CMI: bias, -10.55 ± 10.90%; R2 = 0.90). However, the native infarction myocardium T1 values and the T1 signal intensity ratio of infarct and remote myocardium (T1 SI ratio) did not differ significantly between AMI and CMI (P = 0.173). DATA CONCLUSION Noncontrast native T1 mapping can accurately determine acute and chronic infarct areas as well as conventional LGE imaging; however, it cannot distinguish acute from chronic MI. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1406-1414.
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Affiliation(s)
- Xi Liu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jiang-Long Hou
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Peng-Fei Ye
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Wan-Lin Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Lei Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Meng-Xi Yang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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Arenja N, Riffel JH, Halder M, Djiokou CN, Fritz T, Andre F, aus dem Siepen F, Zelniker T, Meder B, Kayvanpour E, Korosoglou G, Katus HA, Buss SJ. The prognostic value of right ventricular long axis strain in non-ischaemic dilated cardiomyopathies using standard cardiac magnetic resonance imaging. Eur Radiol 2017; 27:3913-3923. [DOI: 10.1007/s00330-016-4729-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/19/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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Arenja N, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Zelniker T, Kristen AV, Korosoglou G, Katus HA, Buss SJ. Right ventricular long axis strain—validation of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging. Eur J Radiol 2016; 85:1322-8. [DOI: 10.1016/j.ejrad.2016.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/22/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022]
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Association of cardiovascular disease risk factors with left ventricular mass, biventricular function, and the presence of silent myocardial infarction on cardiac MRI in an asymptomatic population. Int J Cardiovasc Imaging 2016; 32 Suppl 1:173-81. [PMID: 27209284 DOI: 10.1007/s10554-016-0885-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 01/04/2023]
Abstract
The purposes of this study were to evaluate the relationship between risk factors for cardiovascular disease (CVD) and cardiac mass and function on cardiac magnetic resonance imaging (MRI), and to investigate possible risk factors for silent myocardial infarction (SMI) in an asymptomatic Asian population. We included 647 asymptomatic subjects (485 males, mean age 54.8 ± 6.7 years; 162 females, mean age 55.2 ± 7.6 years) who underwent 1.5-T cardiac MRI during a health checkup. The association between biventricular functional parameters as evaluated on MRI and CVD risk factors was examined using multivariable regression and analysis of variance. The left ventricular mass-to-volume ratios were positively related to body mass index (β = 0.153, p < 0.001), systolic (β = 0.165, p = 0.001) and diastolic (β = 0.147, p = 0.002) blood pressure, triglyceride levels (β = 0.197, p = 0.006), and C-reactive protein levels (β = 0.130, p < 0.001), and were negatively related to estimated glomerular filtration rates (β = -0.076, p = 0.025). No significant relationship was present between ventricular parameters and the presence of SMI after adjusting for confounders. The prevalence (6.9 %, 7/101) of SMI in diabetics was significantly greater than that in non-diabetics patients (0.9 %, 5/546; confidence interval 1.739-12.848; p < 0.001). Traditional CVD risk factors are associated with ventricular mass, geometry and function in asymptomatic subjects. Silent MI may not independently influence ventricular mass and function and diabetes mellitus may contribute to the development of SMI.
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Okur A, Kantarcı M, Kızrak Y, Yıldız S, Pirimoğlu B, Karaca L, Oğul H, Sevimli S. Quantitative evaluation of ischemic myocardial scar tissue by unenhanced T1 mapping using 3.0 Tesla MR scanner. Diagn Interv Radiol 2015; 20:407-13. [PMID: 25010366 DOI: 10.5152/dir.2014.13520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed to use a noninvasive method for quantifying T1 values of chronic myocardial infarction scar by cardiac magnetic resonance imaging (MRI), and determine its diagnostic performance. MATERIALS AND METHODS We performed cardiac MRI on 29 consecutive patients with known coronary artery disease (CAD) on 3.0 Tesla MRI scanner. An unenhanced T1 mapping technique was used to calculate T1 relaxation time of myocardial scar tissue, and its diagnostic performance was evaluated. Chronic scar tissue was identified by delayed contrast-enhancement (DE) MRI and T2-weighted images. Sensitivity, specificity, and accuracy values were calculated for T1 mapping using DE images as the gold standard. RESULTS Four hundred and forty-two segments were analyzed in 26 patients. While myocardial chronic scar was demonstrated in 45 segments on DE images, T1 mapping MRI showed a chronic scar area in 54 segments. T1 relaxation time was higher in chronic scar tissue, compared with remote areas (1314±98 ms vs. 1099±90 ms, P < 0.001). Therefore, increased T1 values were shown in areas of myocardium colocalized with areas of DE and normal signal on T2-weighted images. There was a significant correlation between T1 mapping and DE images in evaluation of myocardial wall injury extent (P < 0.05). We calculated sensitivity, specificity, and accuracy as 95.5%, 97%, and 96%, respectively. CONCLUSION The results of the present study reveal that T1 mapping MRI combined with T2-weighted images might be a feasible imaging modality for detecting chronic myocardial infarction scar tissue.
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Affiliation(s)
- Aylin Okur
- Department of Radiology, Bozok University, School of Medicine, Yozgat, Turkey; Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey.
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O'Hare M, Murphy K, Mookadam F, Sharma A, Lee H. Cardio-oncology Part II: the monitoring, prevention, detection and treatment of chemotherapeutic cardiac toxicity. Expert Rev Cardiovasc Ther 2015; 13:519-27. [PMID: 25864865 DOI: 10.1586/14779072.2015.1027686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer treatment has advanced in recent years with new drugs, complex regimes and multiple modalities of treatment; which has improved survival of cancer patients. Cardiotoxicity from chemotherapy is an emerging, important issue. Currently, echocardiographic evaluation of ejection fraction is the most commonly employed diagnostic tool for detecting chemotherapy-induced cardiotoxicity. However, novel echocardiographic techniques assessing myocardial mechanics using strain imaging can detect earlier changes. New imaging techniques and biomarkers can risk stratify patients to identify those requiring closer monitoring. Cardiologists collaborating with oncologists can detect and treat cardiovascular chemotherapeutic complications earlier, reducing morbidity and mortality. While cardiac MRI and multigated acquisition nuclear scanning are alternatives, echocardiography has become the mainstream for assessing cardiac function due to its portability, efficiency and low cost. Current recommendations regarding cardiac monitoring of cancer patients are based on expert consensus opinion. There is a need for prospective controlled trials to support specific guidelines.
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Affiliation(s)
- Meabh O'Hare
- From the Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Doesch C, Dierks DM, Haghi D, Schimpf R, Kuschyk J, Suselbeck T, Schoenberg SO, Borggrefe M, Papavassiliu T. Right ventricular dysfunction, late gadolinium enhancement, and female gender predict poor outcome in patients with dilated cardiomyopathy. Int J Cardiol 2014; 177:429-35. [PMID: 25304065 DOI: 10.1016/j.ijcard.2014.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 07/31/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
Abstract
AIMS Dilated cardiomyopathy (DCM) shows a variable disease course and is associated with significant morbidity and mortality. So far, left ventricular function (LVF) is the major determinant for risk stratification. However, since it has shown to be a poor guide to individual outcome, we studied the prognostic value of cardiovascular magnetic resonance imaging (CMR) parameters, late gadolinium enhancement (LGE) and epicardial adipose tissue (EAT). METHODS AND RESULTS 140 patients with DCM underwent late gadolinium enhancement (LGE) CMR. During a median follow-up of 3 years, 22 patients (16%) died and another 51 (36%) were hospitalized due to congestive heart failure (CHF). Female gender and right ventricular ejection fraction (RV-EF) below the median of 38% were independent predictors of all-cause mortality in multivariable analysis. In patients who were hospitalized due to CHF, RV-EF below the median of 38% was the only independent predictor in multivariable analysis. When patients where further stratified according to systolic LV-EF, the prognostic value of RV-EF to predict mortality and cardiac morbidity remained unchanged. Looking at DCM patients who died during follow-up compared to those who were hospitalized due to CHF, the former presented with a higher prevalence of LGE as well as reduced indexed EAT. CONCLUSION Female gender, RV-EF and the presence of LGE are of prognostic importance in patients with DCM. Therefore, the present study underlines the role of CMR as an important tool for risk stratification in patients with DCM.
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Affiliation(s)
- Christina Doesch
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
| | - Désirée-Marie Dierks
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Dariusch Haghi
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Rainer Schimpf
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Jürgen Kuschyk
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Tim Suselbeck
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine, Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
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Kerkhove D, Fontaine C, Droogmans S, De Greve J, Tanaka K, Van De Veire N, Van Camp G. How to monitor cardiac toxicity of chemotherapy: time is muscle! Heart 2013; 100:1208-17. [DOI: 10.1136/heartjnl-2013-303815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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13
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Multiacquisition T1-mapping MRI during tidal respiration for quantification of myocardial T1 in swine with heart failure. AJR Am J Roentgenol 2013; 201:W563-70. [PMID: 24059393 DOI: 10.2214/ajr.12.8659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate a free-breathing pulse sequence to quantify myocardial T1 changes in a swine model of tachycardia-induced heart failure. MATERIALS AND METHODS Yorkshire swine were implanted with pacemakers and were ventricularly paced at 200 beats/min to induce heart failure. Animals were scanned twice with a 1.5-T MRI scanner, once at baseline and once at heart failure. A T1-mapping sequence was performed during tidal respiration before and 5 minutes after the administration of a gadolinium-chelate contrast agent. T1-mapping values were compared between the baseline and heart failure scans. The percentage of fibrosis of heart failure myocardial tissue was compared with similar left ventricular tissue from control animals using trichrome blue histologic analysis. RESULTS In the study cohort, differences were found between the baseline and heart failure T1-mapping values before the administration of contrast agent (960 ± 96 and 726 ± 94 ms, respectively; p = 0.02) and after contrast agent administration (546 ± 180 and 300 ± 171 ms, respectively; p = 0.005). The animals with heart failure also had a difference histologically in the percentage of myocardial collagen compared with tissue from healthy control animals (control, 5.4% ± 1.0%; heart failure, 9.4% ± 1.6%; p < 0.001). CONCLUSION The proposed T1-mapping technique can quantify diffuse myocardial changes associated with heart failure without the use of a contrast agent and without breath-holding. These T1 changes appear to be associated with increases in the percentage of myocardial collagen that in this study were not detected by traditional myocardial delayed enhancement imaging. T1 mapping may be a useful technique for detecting early but clinically significant myocardial fibrosis.
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Kitabata H, Kubo T, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Kashiwagi M, Ozaki Y, Shiono Y, Shimamura K, Orii M, Hirata K, Tanaka A, Imanishi T, Akasaka T. Prognostic Value of Microvascular Resistance Index Immediately After Primary Percutaneous Coronary Intervention on Left Ventricular Remodeling in Patients With Reperfused Anterior Acute ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2013; 6:1046-54. [DOI: 10.1016/j.jcin.2013.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/03/2013] [Accepted: 05/09/2013] [Indexed: 11/28/2022]
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Correlation between clinical presentation and delayed-enhancement MRI pattern in myocarditis. Radiol Med 2012; 117:1309-19. [PMID: 22327917 DOI: 10.1007/s11547-012-0790-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 06/10/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The exact incidence of myocarditis is unknown, as the diagnosis is frequently delayed or missed. Clinical presentation and disease course are extremely variable, as there may be acute onset with acute coronary syndrome, or cardiogenic shock, or progressive heart failure or arrhythmias. The purpose of this study was to identify prognostic factors on magnetic resonance imaging (MRI) performed in patients with bioptically proven myocarditis at presentation and after 6 months. MATERIALS AND METHODS Fifty-six consecutive patients with different presentations of myocarditis (20 with acute coronary syndrome, 20 with heart failure, 16 with arrhythmias) were enrolled. All patients underwent B-mode echocardiography (echo) and tissue Doppler imaging, coronarography, ventriculography, endomyocardial biopsy and contrast-enhanced MRI examination, as well as clinical and echo follow-up at 6 months. RESULTS At 6-month follow-up, patients were divided in two groups according to values of end-systolic volume and ejection fraction: patients with negative remodelling and those with positive remodelling. Late enhancement was found to be an independent predictor of negative remodelling. CONCLUSIONS Contrast-enhanced MRI is useful both in the diagnosis and as a prognostic indicator in the clinical suspicion of myocarditis.
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16
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Affiliation(s)
- Anthony Martin Gerdes
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, 1100 E 21st Street, Sioux Falls, SD 57105, USA.
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17
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Ozdogan O, Yuksel A, Gurgun C, Kayikcioglu M, Yavuzgil O, Cinar CS. Assessment of cardiac remodeling in asymptomatic mitral regurgitation for surgery timing: a comparative study of echocardiography and magnetic resonance imaging. Cardiovasc Ultrasound 2010; 8:32. [PMID: 20704764 PMCID: PMC2929214 DOI: 10.1186/1476-7120-8-32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 08/13/2010] [Indexed: 12/04/2022] Open
Abstract
Background Early surgery is recommended for asymptomatic severe mitral regurgitation (MR), because of increased postoperative left ventricular (LV) dysfunction in patients with late surgery. On the other hand, recent reports emphasized a "watchful waiting" process for the determination of the proper time of mitral valve surgery. In our study, we compared magnetic resonance imaging (MRI) and transthoracic echocardiography to evaluate the LV and left atrial (LA) remodeling; for better definitions of patients that may benefit from early valve surgery. Methods Twenty-one patients with moderate to severe asymptomatic MR were evaluated by echocardiography and MRI. LA and LV ejection fractions (EFs) were calculated by echocardiography and MRI. Pulmonary veins (PVs) were measured from vein orifices in diastole and systole from the tangential of an imaginary circle that completed LA wall. Right upper PV indices were calculated with the formula; (Right upper PV diastolic diameter- Right upper PV systolic diameter)/Right upper PV diastolic diameter. Results In 9 patients there were mismatches between echocardiography and MRI measurements of LV EF. LV EFs were calculated ≥60% by echocardiography, meanwhile < 60% by MRI in these 9 patients. Severity of MR evaluated by effective regurgitant orifice area (EROA) didn't differ with preserved and depressed EFs by MRI (p > 0.05). However, both right upper PV indices (0.16 ± 0.06 vs. 0.24 ± 0.08, p: 0.024) and LA EFs (0.19 ± 0.09 vs. 0.33 ± 0.14, p: 0.025) were significantly decreased in patients with depressed EFs when compared to patients with normal EFs. Conclusions MRI might be preferred when small changes in functional parameters like LV EF, LA EF, and PV index are of clinical importance to disease management like asymptomatic MR patients that we follow up for appropriate surgery timing.
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Affiliation(s)
- Oner Ozdogan
- Tepecik Training and Research Hospital, Cardiology Department, Izmir, Turkey.
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18
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Walker J, Bhullar N, Fallah-Rad N, Lytwyn M, Golian M, Fang T, Summers AR, Singal PK, Barac I, Kirkpatrick ID, Jassal DS. Role of three-dimensional echocardiography in breast cancer: comparison with two-dimensional echocardiography, multiple-gated acquisition scans, and cardiac magnetic resonance imaging. J Clin Oncol 2010; 28:3429-36. [PMID: 20530277 DOI: 10.1200/jco.2009.26.7294] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In patients with breast cancer, the administration of doxorubicin and trastuzumab is associated with an increased risk of cardiotoxicity. Although multiple-gated acquisition (MUGA) scans and two-dimensional transthoracic echocardiography (TTE) are conventional methods for baseline and serial assessment of left ventricular ejection fraction (LVEF) in these patients, little is known about the use of real-time three-dimensional TTE (RT3D TTE) in this clinical setting. The aim of this study was to assess the accuracy of MUGA, 2D TTE, and RT3D TTE for determining LVEF in comparison to cardiac magnetic resonance imaging (CMR). METHODS Between 2007 and 2009 inclusive, 50 female patients with human epidermal growth factor receptor 2-positive breast cancer received adjuvant trastuzumab after doxorubicin. Serial MUGA, 2D TTE, RT3D TTE, and CMR were performed at baseline, 6, and 12 months after the initiation of trastuzumab. RESULTS A comparison of left ventricular end diastolic volume (LVEDV) demonstrated a modest correlation between 2D TTE and CMR (r = 0.64 at baseline; r = 0.69 at 12 months, respectively). A comparison of LVEDV between RT3D TTE and CMR demonstrated a stronger correlation (r = 0.87 at baseline; r = 0.95 at 12 months, respectively). Although 2D TTE demonstrated a weak correlation with CMR for LVEF assessment (r = 0.31 at baseline, r = 0.42 at 12 months, respectively), both RT3D TTE and MUGA showed a strong correlation when compared with CMR (r = 0.91 at baseline; r = 0.90 at 12 months, respectively). CONCLUSION As compared with conventional MUGA, RT3D TTE is a feasible, accurate, and reproducible alternate imaging modality for the serial monitoring of LVEF in patients with breast cancer.
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Affiliation(s)
- Jonathan Walker
- Institute of Cardiovascular Sciences, Cardiology Division, St Boniface General Hospital, University of Manitoba, Canada
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19
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Different substrates of non-sustained ventricular tachycardia in post-infarction patients with and without left ventricular dilatation. J Card Fail 2009; 16:61-8. [PMID: 20123320 DOI: 10.1016/j.cardfail.2009.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 06/10/2009] [Accepted: 09/04/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND We investigated the relationship between nonsustained ventricular tachycardia (NSVT) and left ventricular (LV) dilatation, function, remodeling, and scar tissue extent in patients with previous myocardial infarction (MI). METHODS AND RESULTS Eighty-two patients (ages 64+/-10 years) with first previous MI were referred for 24-hour electrocardiogram recording and cine and delayed enhancement (DE) cardiac magnetic resonance (CMR). LV volumes, ejection fraction, systolic wall thickening, sphericity index, and core and peri-infarctual areas of scar tissue by CMR were evaluated. LV dilatation was observed in 39 patients. Episodes of NSVT were recorded in 32 patients: 23 with LV dilatation and 9 without. In the entire population, NSVT was related to ejection fraction, LV volumes, LV mass, and sphericity index; end-systolic volume (P=.001) resulted in the only independent predictor at multivariate analysis. In patients without LV dilatation, the occurrence of NSVT was only positively related with percentage of contracting segments with DE (P=.008). Conversely, in patients with LV dilatation, increase in LV mass (P=.020) and end-systolic volume (P=.038) were independent predictors of NSVT. CONCLUSIONS Necrotic and viable myocardium coexistence within the same wall segments predicted occurrence of NSVT in patients without LV dilatation, whereas LV mass and end-systolic volume were predictors of NSVT in those with LV dilatation.
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20
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Reichek N, Devereux RB, Rocha RA, Hilkert R, Hall D, Purkayastha D, Pitt B. Magnetic resonance imaging left ventricular mass reduction with fixed-dose angiotensin-converting enzyme inhibitor-based regimens in patients with high-risk hypertension. Hypertension 2009; 54:731-7. [PMID: 19687350 DOI: 10.1161/hypertensionaha.109.130641] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Left ventricular hypertrophy, a major cardiovascular risk factor for morbidity and mortality, is commonly caused by arterial hypertension. The renin-angiotensin-aldosterone system may contribute to the pathogenesis of left ventricular hypertrophy. The Assessment of Lotrel in Left Ventricular Hypertrophy and Hypertension Study compared a single-pill combination of amlodipine/benazepril at doses 5.0/20.0 mg, 5.0/40.0 mg, and 10.0/40.0 mg with hydrochlorothiazide/benazepril at doses 12.5/20.0 mg, 12.5/40.0 mg, and 25.0/40.0 mg on the reduction of left ventricular mass index measured by cardiac MRI in stage 2 hypertensive patients over 52 weeks of treatment in a randomized clinical trial. A total of 125 male and female patients, > or =55 years of age, with echocardiographic left ventricular hypertrophy and high-risk hypertension defined as blood pressure > or =160/100 mm Hg or current antihypertensive treatment were enrolled. After 52 weeks of treatment, left ventricular mass index was significantly reduced from baseline with amlodipine/benazepril (mean: 10.16 g/m(2)) or hydrochlorothiazide/benazepril (mean: 6.74 g/m(2); both P<0.0001), with a mean difference between treatment groups of 3.36 g/m(2) (P=0.16). No significant treatment differences were observed in subgroups defined by age, male gender, race, diabetes status, or dose level. However, in female patients, left ventricular mass index reduction was greater with amlodipine/benazepril (P=0.02). Both treatments were well tolerated.
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Affiliation(s)
- Nathaniel Reichek
- Research Department, St Francis Hospital, 100 Port Washington Blvd., Roslyn, NY 11576, USA.
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21
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Wadhwa D, Fallah-Rad N, Grenier D, Krahn M, Fang T, Ahmadie R, Walker JR, Lister D, Arora RC, Barac I, Morris A, Jassal DS. Trastuzumab mediated cardiotoxicity in the setting of adjuvant chemotherapy for breast cancer: a retrospective study. Breast Cancer Res Treat 2008; 117:357-64. [PMID: 19082707 DOI: 10.1007/s10549-008-0260-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Accepted: 11/20/2008] [Indexed: 11/25/2022]
Abstract
Background The incidence and management of trastuzumab-mediated cardiotoxicity outside of clinical trials has not been well described. Objective and methods The aim of the study was to retrospectively evaluate the incidence of cardiac dysfunction, characterize its natural history, and identify the degree of reversibility using cardiac MRI, in a population of HER-2 positive breast cancer patients receiving trastuzumab in the adjuvant setting. Results Out of 152 patients (mean age 52 +/- 10 years), 36 (24%) developed trastuzumab mediated cardiomyopathy, the majority asymptomatic. Factors that predicted the development of trastuzumab mediated cardiac dysfunction were a pre-existing history of hypertension, smoking history, and a family history of coronary artery disease. Within 3 months of treatment with trastuzumab, there was a difference in LVEF between the normal cohort and those patients who developed LV systolic dysfunction (61 +/- 5% vs. 51 +/- 8%, P < 0.01). During the 6-month-followup, 34/36 patients demonstrated subepicardial linear delayed enhancement of the lateral wall of the left ventricle on cardiac MRI, suggesting trastuzumab induced myocarditis. Conclusion Approximately 1 in 4 women may develop LV systolic dysfunction after treatment with adjuvant trastuzumab, necessitating careful patient selection and close serial monitoring using noninvasive cardiac imaging.
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Affiliation(s)
- Deepa Wadhwa
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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22
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Sironi AM, Pingitore A, Ghione S, De Marchi D, Scattini B, Positano V, Muscelli E, Ciociaro D, Lombardi M, Ferrannini E, Gastaldelli A. Early Hypertension Is Associated With Reduced Regional Cardiac Function, Insulin Resistance, Epicardial, and Visceral Fat. Hypertension 2008; 51:282-8. [DOI: 10.1161/hypertensionaha.107.098640] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mild-to-moderate hypertension is often associated with insulin resistance and visceral adiposity. Whether these metabolic abnormalities have an independent impact on regional cardiac function is not known. The goal of this study was to investigate the effects of increased blood pressure, insulin resistance, and ectopic fat accumulation on the changes in peak systolic circumferential strain. Thirty-five male subjects (age: 47±1 years; body mass index: 28.4±0.6 kg
.
m
−2
; mean±SEM) included 13 with normal blood pressure (BP: 113±5/67±2 mm Hg), 13 with prehypertension (BP: 130±1/76±2 mm Hg), and 9 newly diagnosed with essential hypertension (BP: 150±2/94±2 mm Hg) who underwent cardiac magnetic resonance tissue tagging (MRI) and MRI quantitation of abdominal visceral and epicardial fat. Glucose tolerance, on oral glucose tolerance test, and insulin resistance were assessed along with the serum lipid profile. All of the subjects had normal glucose tolerance, left- and right-ventricular volumes, and ejection fraction. Across the BP groups, left ventricular mass tended to increase, and circumferential shortening was progressively reduced at basal, midheart, and apical segments (on average, from −17.0±0.5% in normal blood pressure to −15.2±0.7% in prehypertension to −13.6±0.8% in those newly diagnosed with essential hypertension;
P
=0.004). Reduced circumferential strain was significantly associated with raised BP independent of age (
r
=0.41;
P
=0.01) and with epicardial and visceral fat, serum triglycerides, and insulin resistance independent of age and BP. In conclusion, regional left ventricular function is already reduced at the early stages of hypertension despite the normal global cardiac function. Insulin resistance, dyslipidemia, and ectopic fat accumulation are associated with reduced regional systolic function.
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Affiliation(s)
- Anna Maria Sironi
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Alessandro Pingitore
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Sergio Ghione
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Daniele De Marchi
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Barbara Scattini
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Vincenzo Positano
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Elza Muscelli
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Demetrio Ciociaro
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Massimo Lombardi
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Ele Ferrannini
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
| | - Amalia Gastaldelli
- From the Metabolism and MRI Laboratory (A.M.S., A.P., S.G., D.D.M., B.S., V.P., D.C., M.L., E.F., A.G.), Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, Pisa, Italy; and the Department of Internal Medicine (E.M., E.F.), University of Pisa School of Medicine, Pisa, Italy
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Calore C, Cacciavillani L, Boffa GM, Silva C, Tiso E, Marra MP, Bacchiega E, Corbetti F, Iliceto S. Contrast-enhanced cardiovascular magnetic resonance in primary and ischemic dilated cardiomyopathy. J Cardiovasc Med (Hagerstown) 2008; 8:821-9. [PMID: 17885521 DOI: 10.2459/jcm.0b013e3280101e3c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Differentiation between primary dilated cardiomyopathy and ischemic cardiomyopathy has an important clinical significance. Contrast-enhanced cardiovascular magnetic resonance can play a role in this task, identifying myocardial scarring or fibrosis as presence of delayed enhancement. The aim of the present study was to evaluate the diagnostic potential of contrast-enhanced cardiovascular magnetic resonance in differentiating dilated cardiomyopathy from ischemic cardiomyopathy. METHODS Contrast-enhanced cardiovascular magnetic resonance was performed in 100 patients with left ventricular dilatation and reduced systolic function: 24 had normal coronary arteries (dilated cardiomyopathy group) and 76 had significant coronary artery disease (ischemic cardiomyopathy group), with or without previous myocardial infarction. RESULTS In the dilated cardiomyopathy group, only seven (29%) patients showed delayed enhancement and its pattern was characterized by mid-wall, patchy or diffuse location. All patients with ischemic cardiomyopathy and prior myocardial infarction (54 subjects) showed delayed enhancement with subendocardial (n = 4) or transmural (n = 50) extension. Among the 22 patients with ischemic cardiomyopathy but without previous myocardial infarction, 13 (59%) showed either subendocardial (n = 4) or transmural (n = 9) delayed enhancement. CONCLUSIONS Patterns of delayed enhancement are different in dilated cardiomyopathy and ischemic cardiomyopathy, reflecting the presence of scarring or various degrees of fibrosis in left ventricular myocardium. The presence of subendocardial or transmural delayed enhancement at contrast-enhanced cardiovascular magnetic resonance allowed distinction between dilated cardiomyopathy and ischemic cardiomyopathy with high sensitivity (88%) and specificity (100%). Integration of cardiovascular magnetic resonance results with angiographic information can be useful in the identification of pathogenic mechanisms underlying left ventricular dysfunction.
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Affiliation(s)
- Chiara Calore
- Department of Cardiac, Thoracic and Vascular Sciences of the University of Padua, Padua, Italy.
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24
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Pedersen F, Mehlsen J, Raymond I, Atar D, Skjoldborg US, Hildebrandt PR. Evaluation of dyspnoea in a sample of elderly subjects recruited from general practice. Int J Clin Pract 2007; 61:1481-91. [PMID: 17686092 DOI: 10.1111/j.1742-1241.2007.01428.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objectives of this study were to investigate the cause of dyspnoea in a sample of elderly individuals and to assess the diagnostic yield of a three-step examination algorithm for the evaluation of dyspnoea paired with a cost analysis. A total of 152 subjects were examined. A predefined diagnostic approach in three steps was carried out to find the cause of dyspnoea. Step 1 included lung spirometry and ECG; step 2 included lung diffusion capacity, echocardiography, haemoglobin and thyroid function; and step 3 included cardiac magnetic resonance imaging, chest radiography and exercise test. Of 129 subjects with dyspnoea, 68 (53%) had signs of lung disease, 27 (21%) had heart disease, a total of 43 (33%) were obese, 20 (16%) were obese without other causes of dyspnoea and five (4%) had general physical deconditioning. Twelve per cent had none of the above-mentioned potential causes of dyspnoea. Steps 1, 1 + 2 and 1 + 2 + 3 revealed a cause of dyspnoea in 39%, 63%, and 73% of subjects respectively. The cost per diagnosed case at steps 2 and 3 was twice and 3.5 times the cost per diagnosed case at step 1. In this sample of elderly subjects, a potential cause of dyspnoea was identified in most cases, the most frequent being lung disease followed by heart disease and obesity. These data shed light on the diagnostic yield that can be expected from a relatively simple diagnostic approach, including the most frequent recommended initial screening tests. As expected, the incremental nature of this algorithm translated into incremental costs per diagnosis achieved.
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Affiliation(s)
- F Pedersen
- Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark.
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25
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Klecha A, Kawecka-Jaszcz K, Bacior B, Kubinyi A, Pasowicz M, Klimeczek P, Banyś R. Physical training in patients with chronic heart failure of ischemic origin: effect on exercise capacity and left ventricular remodeling. ACTA ACUST UNITED AC 2007; 14:85-91. [PMID: 17301632 DOI: 10.1097/hjr.0b013e3280114f12] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical training is a well-known complementary treatment for chronic heart failure (CHF); however, many aspects require further studies. One of them is the impact on remodeling of the left ventricle (LV). The purpose of this study was to evaluate the effect of 6 months of training on LV, exercise capacity and safety issues in patients with ischemic CHF. METHODS Fifty patients (mean age 60.1+/-9.2 years) with ischemic CHF, New York Heart Association (NYHA) classification class II and III and left ventricular ejection fraction (LVEF) <or=35% were randomized into groups: undergoing 6-month training (25 patients) and not trained (25 patients). In both groups at baseline and at 6 months a cardiopulmonary exercise test and magnetic resonance imaging (MRI) with evaluation of LV were performed. Training was limited by the achievement of 80% of the predicted heart rate at VO2peak achieved at the baseline cardiopulmonary exercise test. RESULTS All patients completed the 6-month observation. No serious adverse events were found in either group. Exercise capacity improved only in the trained group (VO2peak increased by 31%). At 6 months in the trained group there was a tendency towards an improvement in some LV parameters: ejection fraction, end-diastolic volume and wall motion score index (WMSI), whereas an opposite trend was seen in the controls (P<0.05, P<0.05 and P<0.01 for comparison of LVEFs, end-diastolic volumes and WMSIs, respectively). CONCLUSIONS Six-month training in ischemic CHF patients is a safe modality. Training improves exercise capacity. There was no negative impact on LV morphology, and a trend towards improvement of functional parameters on MRI may suggest an anti-remodeling effect of training in patients with ischemic CHF.
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Affiliation(s)
- Artur Klecha
- I Cardiac Department, Jagiellonian University Medical College, Kraków, Poland.
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26
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Jörgensen K, Müller MF, Nel J, Upton RN, Houltz E, Ricksten SE. Reduced intrathoracic blood volume and left and right ventricular dimensions in patients with severe emphysema: an MRI study. Chest 2007; 131:1050-7. [PMID: 17426209 DOI: 10.1378/chest.06-2245] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Left ventricular (LV) filling is impaired in patients with severe emphysema manifesting in small end-diastolic dimensions. We hypothesized that the hyperinflated lungs of these patients with high intrinsic positive end-expiratory pressure will decrease intrathoracic blood volume (ITBV) and ventricular preload. We therefore measured ITBV, and LV and right ventricular (RV) dimensions and function using MRI techniques in patients with severe emphysema. METHODS Patients with severe emphysema (n = 13) and matched healthy volunteers (n = 11) were included. The magnetic resonance (MR) examination consisted of three parts: (1) evaluation of RV and LV dimensions and function and interventricular septum curvature using cine MRI; (2) quantification of aortic flow using MR phase velocity mapping; and (3) calculation of the cardiopulmonary peak transit time (PTT) from the pulmonary artery to the ascending aorta using contrast-enhanced, time-resolved, two-dimensional MR angiography. RESULTS There were no differences between the groups regarding age, height, or weight. In the emphysema patients, ITBV index (- 35%), LV end-diastolic volume index (LVEDVI) [- 21%], RV end-diastolic volume index (- 20%), cardiac index (- 22%), and stroke volume index (SVI) [- 40%] were lower compared to control subjects. LV and RV end-systolic volumes, LV wall mass, septal curvature, and PTT did not differ between the groups. LVEDVI (r = 0.83) as well as SVI (r = 0.82) correlated closely to ITBV index. SVI correlated closely to LVEDVI (r = 0.84). CONCLUSIONS LV and RV performance is impaired in patients with severe emphysema because of small end-diastolic dimensions. One possible explanation for the decreased biventricular preload in these patients is intrathoracic hypovolemia caused by hyperinflated lungs.
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Affiliation(s)
- Kirsten Jörgensen
- Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
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27
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Miguel-Dasit A, Martí-Bonmatí L, Sanfeliu P, Aleixandre R. Cardiac MR Imaging: Balanced Publication by Radiologists and Cardiologists. Radiology 2007; 242:410-6. [PMID: 17255412 DOI: 10.1148/radiol.2422060189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the number of articles on cardiac magnetic resonance (MR) imaging written by authors from radiology and cardiology departments and published in Medline-indexed journals from 1999 to 2004 and the relationship between the author's specialty and various parameters. MATERIALS AND METHODS Specific search profiles were devised to retrieve items from the Medline database. Eight hundred seven articles were included in the study. Relationships between the author's specialty (radiology or cardiology) and several evaluated parameters were analyzed and compared by using chi(2) statistics. RESULTS Four hundred eight (50.5%) of 807 publications were from cardiologists, and 399 (49.5%) of 807 were from radiologists. Articles most commonly originated from the United States (n = 270, 53% from radiologists) and Germany (n = 178, 66% from radiologists). Developing techniques (n = 248, 64% from radiologists, P < .001) was the most frequent topic. Results of clinical trials, controlled clinical trials, and randomized controlled trials were published mainly by cardiologists (67%, P = .03; 70%, P = .2; 86%, P = .008, respectively). A majority of articles were published in cardiology journals (n = 269, 83% from cardiologists, P < .001) and radiology journals (n = 249, 82% from radiologists, P < .001). CONCLUSION The number of publications on cardiac MR imaging written by radiologists and that written by cardiologists was essentially the same.
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Bengel FM. Positron emission tomography and magnetic resonance imaging in heart failure. J Nucl Cardiol 2006; 13:145-9. [PMID: 16580947 DOI: 10.1007/bf02971235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Frank M Bengel
- Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21287, USA.
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29
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Rochitte CE, Tassi EM, Shiozaki AA. The emerging role of MRI in the diagnosis and management of cardiomyopathies. Curr Cardiol Rep 2006; 8:44-52. [PMID: 16507236 DOI: 10.1007/s11886-006-0010-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as an important tool for the evaluation of cardiomyopathies, providing highly accurate information on the macroscopic changes of cardiac morphology, function, and tissue composition. For myocardial tissue characterization, the technique of myocardial delayed enhancement is a potentially promising tool for diagnosis, management, and prognosis. Several CMR approaches are now available to better diagnose and prognosticate dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular disease, myocarditis, and other cardiomyopathies.
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30
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Smerup M, Funder J, Nyboe C, Høyer C, Pedersen TF, Ribe L, Ringgaard S, Kim WY, Pedersen EM, Andersen NT, Nielsen SL, Hasenkam JM. Strut chordal-sparing mitral valve replacement preserves long-term left ventricular shape and function in pigs. J Thorac Cardiovasc Surg 2005; 130:1675-82. [PMID: 16308015 DOI: 10.1016/j.jtcvs.2005.07.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2005] [Revised: 06/23/2005] [Accepted: 07/11/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitral valve replacement with preservation of the entire subvalvular apparatus entails superior postoperative left ventricular function compared with other techniques. However, this option is often not possible because of valve pathology. We hypothesized that preservation of only 4 mitral valve secondary ("strut") chordae would be functionally and geometrically equivalent to total valve preservation in the long-term setting. In a porcine mitral valve replacement model we investigated the long-term effects of 3 surgical techniques on left ventricular function and geometry: (1) total preservation of the native valve, (2) strut chordal preservation, and (3) total excision of the subvalvular apparatus. METHODS Forty 60-kg pigs were randomized to 1 of the 3 techniques. Global and regional left ventricular function and dimensions were assessed with cardiovascular magnetic resonance and conductance catheter 90 days after mitral valve replacement. Groups were compared by multivariate analysis of variance. RESULTS There was no overall difference between groups 1 and 2. Group 3 animals had (1) greater base-apex diastolic and systolic lengths, and smaller short-axis diameters, and (2) lower sphericity indices, and greater base-apex and short-axis fractional shortening than groups 1 and 2. Regional analysis showed slimming and elongation to occur primarily in the basal left ventricular segments. Left ventricular contractility and hemodynamic parameters did not differ between groups. CONCLUSIONS Strut chordal preservation was equivalent to total valve preservation during mitral valve replacement, whereas total chordal resection caused significant left ventricular slimming with compensatory increases in fractional shortening. Therefore, to preserve left ventricular geometry, special attention must be paid to maintain the valvular-ventricular continuity through the strut chordae during mitral valve replacement. This concept may have important therapeutic implications for chordal-sparing mitral valve replacement.
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Affiliation(s)
- Morten Smerup
- Department of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, Denmark.
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31
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Westenberg JJM, van der Geest RJ, Lamb HJ, Versteegh MIM, Braun J, Doornbos J, de Roos A, van der Wall EE, Dion RAE, Reiber JHC, Bax JJ. MRI to Evaluate Left Atrial and Ventricular Reverse Remodeling After Restrictive Mitral Annuloplasty in Dilated Cardiomyopathy. Circulation 2005; 112:I437-42. [PMID: 16159859 DOI: 10.1161/circulationaha.104.525659] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Data on reverse remodeling of the left atrium (LA) and left ventricle (LV) after restrictive annuloplasty in patients with dilated cardiomyopathy are scarce, and follow-up studies are performed with echocardiography.
Methods and Results—
Twenty patients with dilated cardiomyopathy and severe mitral regurgitation selected for restrictive mitral annuloplasty underwent serial MRI studies (within 1 week before surgery, and 2 months [n =18] and 1 year [n =13] after surgery). Early mortality was 10%; all patients were free from endocarditis and thromboembolism. New York Heart Association class improved from 3.2±0.4 to 1.2±0.9. Only 1 patient developed recurrent severe mitral regurgitation during follow-up and it was re-repaired. LA end-systolic volumes decreased significantly over time (from 165±48 mL to 109±23 mL to 111±28 mL;
P
<0.01), as did LA end-diastolic volumes (from 92±32 mL to 71±22 mL to 75±17 mL;
P
=0.01). LV end-diastolic volumes decreased significantly (from 244±56 mL to 184±54 mL to 195±67 mL;
P
<0.01), whereas end-systolic volumes did not change significantly. LV ejection fraction increased significantly (from 35±8% to 46±13% to 46±15%;
P
<0.01) and LV mass decreased significantly (from 150±43 grams to 132±39 grams to 136±33 grams;
P
=0.02).
Conclusion—
Restrictive annuloplasty in patients with dilated cardiomyopathy yielded excellent clinical results associated with significant LA and LV reverse remodeling over time as demonstrated by MRI.
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Affiliation(s)
- Jos J M Westenberg
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Pedersen F, Raymond I, Mehlsen J, Atar D, Hildebrandt PR. Prevalence of diastolic dysfunction as a possible cause of dyspnea in the elderly. Am J Med 2005; 118:25-31. [PMID: 15639206 DOI: 10.1016/j.amjmed.2004.07.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Symptoms in patients with heart failure and preserved left ventricular ejection fraction may be caused by isolated diastolic dysfunction. The purpose of this study was to assess the prevalence of diastolic dysfunction as a potential cause of dyspnea in a sample of elderly subjects, as well as of isolated diastolic dysfunction as a potential cause of dyspnea in a subgroup with a preserved left ventricular ejection fraction and normal lung function. METHODS A total of 152 subjects with dyspnea underwent echocardiography, electrocardiography, and lung function testing. Subjects with normal lung function test results (n = 60) underwent cardiac magnetic resonance imaging, chest radiography, bicycle exercise tests, and blood tests. Left ventricular diastolic function was assessed by a variety of echocardiographic/Doppler techniques. RESULTS Of 129 subjects with dyspnea, 81 (63%) had signs of lung disease or 'obvious' cardiac disease. In the remaining 48 subjects, 32 (67%) had a potential cardiac/noncardiac cause of dyspnea. In all subjects with dyspnea, 1% to 11% had diastolic dysfunction, and in the 48 remaining subjects, 0% to 10% had isolated diastolic dysfunction, depending on the definition used. CONCLUSION The frequency of diastolic dysfunction was low in the sample of elderly subjects with dyspnea as well as in the subgroup of persons with no signs of lung disease, left ventricular systolic dysfunction, atrial fibrillation, or valvular heart disease. Diastolic dysfunction was infrequent as a possible cause of dyspnea, and coexisting potential causes of dyspnea were often present.
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Affiliation(s)
- Frants Pedersen
- Frederiksberg University Hospital, Department of Cardiology and Endocrinology, Nordre Fasanvej 57, DK-2000 Frederiksberg-Copenhagen, Denmark.
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33
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Fuchs E, Müller MF, Oswald H, Thöny H, Mohacsi P, Hess OM. Cardiac rotation and relaxation in patients with chronic heart failure. Eur J Heart Fail 2004; 6:715-22. [PMID: 15542406 DOI: 10.1016/j.ejheart.2003.12.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2003] [Revised: 09/13/2003] [Accepted: 12/23/2003] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The normal left ventricle shows a systolic wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex. PURPOSE The aim of the present study was (1) to assess left ventricular (LV) contraction and relaxation in patients with chronic heart failure (CHF), and (2) to evaluate the effect of medical therapy on LV contraction-relaxation behavior. METHODS Magnetic resonance was used to examine LV motion by labeling specific LV regions in three planes (myocardial tagging). Twenty-three subjects were included, nine healthy controls and 14 CHF patients. Cardiac motion was determined from the deformation of a rectangular grid in a basal and apical plane. CHF patients were put on triple therapy with ACE-inhibitors, beta-blockers and spironolactone. Follow-up examination (n=9) was performed after 6 months. RESULTS In controls, systolic rotation was -9.5+/-2 degrees at the base and +3.3+/-1 degrees at the apex. In CHF patients, rotation was reduced both at the base (-3.4+/-2 degrees , P<0.01) and the apex (+0.9+/-3 degrees , P<0.05). Similarly, regional ejection fraction (REF) was reduced in CHF patients both at the base and the apex. Medical therapy was associated with an improvement in REF, but systolic rotation improved only at the base (-4.6+/-2 degrees , P<0.05). CONCLUSIONS Systolic wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex is maintained in CHF although reduced. Heart failure treatment is associated with an improvement in REF, whereas rotation improved only at the base, but not at the apex. Thus, there is an uncoupling between regional shortening and rotation in CHF patients.
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Affiliation(s)
- Esther Fuchs
- Swiss Cardiovascular Center and Institute of Diagnostic Radiology, Debis Systemhaus Health Care Services, University Hospital, Freiburgstrasse, Bern CH-3010, Switzerland
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Khoury VK, Haluska B, Fathi R, Marwick TH. Effects of revascularisation and contractile reserve on left ventricular remodelling in patients with impaired left ventricular function. Int J Cardiol 2004; 93:55-61. [PMID: 14729436 DOI: 10.1016/s0167-5273(03)00109-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to define the influence of revascularisation and contractile reserve on left ventricular (LV) remodelling in patients with LV dysfunction after myocardial infarction. Revascularisation of viable myocardium is associated with improved regional function, but the effect on remodelling is undefined. METHODS We studied 70 patients with coronary artery disease and LV dysfunction, 31 of whom underwent revascularisation. A standard dobutamine stress echocardiogram (DbE) was carried out. All patients underwent standard medical treatment; the decision to revascularise was made clinically, independent of this study. LV volumes and ejection fraction were measured by 3D echocardiography at baseline and after an average of 40 weeks. RESULTS There was no significant difference in baseline ejection fraction or volumes between patients who underwent revascularisation and the remainder. Compared to medically treated patients, revascularised patients had significant improvements in ejection fraction and end-systolic volume in follow-up. The impact of baseline variables on remodelling was assessed by dividing patients into tertiles of LV ejection fraction and volumes. Revascularised patients in the lowest tertile of ejection fraction at baseline (<38%) had a significant improvement in end-systolic volume and ejection fraction, larger than obtained in medically treated patients with low ejection fraction. Revascularised patients with an ejection fraction >38% did not show significant improvement in volumes compared to baseline. Revascularised patients in the largest tertiles of end-systolic (>88 ml) or end-diastolic volume (>149 ml) at baseline had a significant improvement in end-systolic volume. CONCLUSION Remodeling appears to occur independent of the presence of regional contractile reserve but does correlate with the volume response to low-dose dobutamine.
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Affiliation(s)
- Vincent K Khoury
- Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia
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35
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Abstract
In cardiac imaging, acquisition speed is of primary importance. While improved performance has mainly been achieved through improvements in gradient hardware in the past, further developments along this direction are limited due to physiological constraints such as the risk of peripheral nerve stimulation. With the introduction of parallel imaging, alternative means for increasing acquisition speed have become available. Using information from multiple receiver coils, images can be reconstructed from a sparsely sampled set of data. In practice, parallel imaging allows for 2- to 3-fold acceleration of the imaging process in typical cardiac applications. Further increases in acquisition speed are, however, difficult to achieve for current clinical field strengths and typical field of views. To address the limited gain in acquisition speed achievable with parallel imaging, a new set of methods has been proposed to take into account the similarity of image information at different time points during a dynamic series. Using these methods, 5- to 8-fold acceleration can be achieved in cardiac imaging. It is the purpose of this paper to review cardiac applications of reduced data acquisition methods with focus on parallel imaging and the recently developed k-t BLAST and k-t SENSE techniques.
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Affiliation(s)
- Sebastian Kozerke
- Institute for Biomedical Engineering, University of Zurich and Swiss Federal Institute of Technology (ETH), Gloriastrasse 35, 8092 Zurich, Switzerland.
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36
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McCrohon JA, Moon JCC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJS, Pennell DJ. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 2003; 108:54-9. [PMID: 12821550 DOI: 10.1161/01.cir.0000078641.19365.4c] [Citation(s) in RCA: 802] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Heart failure treatment depends partly on the underlying cause of the disease. We evaluated cardiovascular magnetic resonance (CMR) for the problem of differentiating dilated cardiomyopathy (DCM) from left ventricular (LV) dysfunction caused by coronary artery disease (CAD). METHODS AND RESULTS Late gadolinium enhancement with CMR was performed in 90 patients with heart failure and LV systolic dysfunction (63 patients with DCM and unobstructed coronary arteries and 27 with significant CAD at angiography). We also studied 15 control subjects with no coronary risk factors and/or unobstructed coronary arteries. None (0%) of the control subjects had myocardial gadolinium enhancement; however, all patients (100%) with LV dysfunction and CAD had enhancement, which was subendocardial or transmural. In patients with DCM, there were 3 findings: no enhancement (59%); myocardial enhancement indistinguishable from the patients with CAD (13%); and patchy or longitudinal striae of midwall enhancement clearly different from the distribution in patients with CAD (28%). CONCLUSIONS Gadolinium CMR is a powerful technique to distinguish DCM from LV dysfunction related to CAD and yields new insights in DCM. These data suggest that using the coronary angiogram as the arbiter for the presence of LV dysfunction caused by CAD could have lead to an incorrect assignment of DCM cause in 13% of patients, possibly because of coronary recanalization after infarction. The midwall myocardial enhancement in patients with DCM is similar to the fibrosis found at autopsy; it has not previously been visualized in vivo and warrants further investigation. CMR may become a useful alternative to routine coronary angiography in the diagnostic workup of DCM.
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Affiliation(s)
- J A McCrohon
- Center for Advanced MR in Cardiology, Royal Brompton Hospital, London, UK
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37
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Galasko GIW, Lahiri A. The non-invasive assessment of hibernating myocardium in ischaemic cardiomyopathy--a myriad of techniques. Eur J Heart Fail 2003; 5:217-27. [PMID: 12798818 DOI: 10.1016/s1388-9842(03)00008-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Heart failure is placing an ever-increasing burden on society. Many subjects with heart failure and underlying coronary artery disease have a significant amount of akinetic but viable myocardium that is able to contract should myocardial perfusion improve (hibernating myocardium). Non-randomised studies have shown prognostic benefit in subjects with hibernating myocardium undergoing revascularisation. Several non-invasive techniques have been developed to assess the presence or absence of hibernating myocardium. This review will examine the epidemiology and underlying pathogenesis of hibernating myocardium; evaluate the non-invasive techniques for diagnosing hibernating myocardium, and look at therapeutic intervention in subjects with hibernating myocardium.
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Affiliation(s)
- Gavin I W Galasko
- Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
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38
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Rerkpattanapipat P, Mazur W, Link KM, Hundley WG. Assessment of cardiac function with MR imaging. Magn Reson Imaging Clin N Am 2003; 11:67-80. [PMID: 12797511 DOI: 10.1016/s1064-9689(02)00021-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A variety of black or white blood imaging techniques are available for assessing global and regional LV and RV function during cardiovascular MR imaging examinations. In addition to providing information about LV function at rest, these techniques provide diagnostic and prognostic information regarding myocardial ischemia and viability during MR imaging stress tests.
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Affiliation(s)
- Pairoj Rerkpattanapipat
- Cardiology Section, Wake Forest University School of Medicine, The Bowman Gray Campus, Winston-Salem, NC 27157-1045, USA
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