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Di Lisi D, Macaione F, Damiani F, Ganci L, Mirabella M, Madaudo C, Galassi AR, Novo G. What happened to the left ventricular non-compaction cardiomyopathy? to be or not to be: This is the question. Curr Probl Cardiol 2024; 49:102787. [PMID: 39137881 DOI: 10.1016/j.cpcardiol.2024.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
For several years, left ventricular non-compaction (LVNC) was considered as a true cardiomyopathy and several definitions have followed one another. Particularly, LVNC was characterized by prominent left ventricular trabeculae separated from deep intertrabecular recesses. Several echocardiographic criteria and cardiac magnetic resonance imaging (CMR) criteria have been used to diagnose LVNC, leading to overestimate the diagnosis of LVNC in patients with other diseases and/or physiological conditions. Left ventricular hypertrabeculation (LVH) can be present in several cardiac diseases and physiological conditions: heart failure with reduced ejection fraction, thalassemia and other hematological diseases, pregnancy, athlete's heart. Thus, the presence of LVH does not necessarily indicate the presence of an LVNC. In addition, the great heterogeneity of clinical manifestations has raised concerns regarding the existence of a true LVNC as a cardiomyopathy. In fact, LVNC ranges from genetic to acquired and even transient conditions, isolated forms or forms associated with other cardiomyopathies, congenital heart diseases or syndromes with a very different prognosis. Thus, considering LVH as a manifestation of various diseases and physiological conditions, the recent 2023 ESC guidelines on cardiomyopathies did not include LVNC among cardiomyopathies, but they suggested using the term "LVH" rather than LVNC, to describe this phenotype especially when it is transient or of adult-onset. In this review, we aimed to make an excursion on LVNC, from its initial description to the present day, to understand why current guidelines decided to consider LVH as a phenotypic trait rather than a distinct cardiomyopathy.
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Affiliation(s)
- Daniela Di Lisi
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Francesca Macaione
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Damiani
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Luca Ganci
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Marco Mirabella
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Cristina Madaudo
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Alfredo Ruggero Galassi
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
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Tseng WC, Chiu SN, Juang JMJ, Chen WP, Lee NC, Wu MH. Genophenotypic correlates and long-term outcome prognosticators of left ventricular non-compaction in children. J Formos Med Assoc 2024:S0929-6646(24)00452-2. [PMID: 39332976 DOI: 10.1016/j.jfma.2024.09.032] [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: 06/21/2024] [Revised: 08/05/2024] [Accepted: 09/22/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND To investigate the outcomes, clinical prognosticators, and genetic profiles of pediatric left ventricular non-compaction (LVNC). METHODS All subjects were <18 years old, diagnosed with LVNC between January 2008 and December 2020. Whole-exome sequencing was undertaken. The primary endpoint was composite outcome, including death, heart transplant, and left ventricular assist device implantation. RESULTS Thirty-three patients were enrolled, males predominating (57.6%). Median age at diagnosis was 0.33 (0.1-7.2) years. Family history was documented in four (12.1%). Five (15.2%) had sustained arrhythmias. Mean follow-up period was 9.5 years, and 5- and 10-year event-free survival were 84.8% and 66.9%, respectively. Seven died of heart failure, four received heart transplants, and one required left ventricular assist device placement. Log of baseline NT-proBNP (adjusted odds ratio [aOR] = 4.4, p = 0.012) and lack of improvement in NT-proBNP (aOR = 41.2, p = 0.033) impacted the primary outcome most significantly. Eighteen out of 25 genetic testing (72%) revealed chromosomal anomalies, or pathogenic or likely pathogenic variants. Three genetic variants (PLEKHM2 p.G419R, RYR2 p.V2571A, and SCN5A p.M1676I) were significantly associated with the primary outcome (p = 1.52 × 10-6). CONCLUSIONS Pediatric LVNC is a rare disorder with variable genetic underpinnings. Baseline NT-proBNP values and lack of improvement in NT-proBNP levels were important predictors of poor long-term outcomes. Pathogenic genetic variants or chromosomal anomalies are not unusual.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Jyh-Ming Jimmy Juang
- Department of Heart failure Center and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Pin Chen
- Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan
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Visoiu IS, Jensen B, Rimbas RC, Mihaila-Baldea S, Nicula AI, Vinereanu D. How the trabecular layer impacts on left ventricular function. J Cardiol 2024:S0914-5087(24)00168-0. [PMID: 39214511 DOI: 10.1016/j.jjcc.2024.08.008] [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: 06/01/2024] [Revised: 08/11/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
The ventricular trabecular layer is crucial in embryonic life. In adults, the proportion of trabecular-to-compact myocardium varies substantially between individuals, within individuals over time, and yet exhibits almost no correlation to pump function since most individuals with excessive trabeculation are asymptomatic. The question of how functional is the myocardium of the trabecular layer, relative to the myocardium of the compact layer, has been difficult to answer but it is often assumed to be inferior. An answer is now emerging from recent advances and it can improve our understanding of how the trabecular layer impacts on pathogenicity. This narrative review concerns natural variation in trabeculation, tissue organization, transcriptomics, immunohistochemistry, vascularization, electrical propagation, diastolic function and compliance, systolic function, and ejection fraction. There are no overt transcriptional differences in the adult stage, and the myocardium is equally equipped with sarcomeric proteins, mitochondria, and vascular supply. The similar structural features are consistent with myocardium with a similar stroke work per gram tissue, along with a high ejection fraction of the trabecular layer. In conclusion, the myocardium of the trabecular and compact layers is highly similar and this offers a logical explanation for the reproducible observations that most individuals with excessive trabeculation are asymptomatic.
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Affiliation(s)
- Ionela Simona Visoiu
- Department of Cardiology and Cardiovascular Surgery, SEARCH-VASC Center of Excellence, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Roxana Cristina Rimbas
- Department of Cardiology and Cardiovascular Surgery, SEARCH-VASC Center of Excellence, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Sorina Mihaila-Baldea
- Department of Cardiology and Cardiovascular Surgery, SEARCH-VASC Center of Excellence, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Alina Ioana Nicula
- Department of Radiology, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Dragos Vinereanu
- Department of Cardiology and Cardiovascular Surgery, SEARCH-VASC Center of Excellence, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
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Møller ELR, Hauge MG, Pham MHC, Damm P, Kofoed KF, Fuchs A, Kühl JT, Sigvardsen PE, Ersbøll AS, Johansen M, Nordestgaard BG, Køber LV, Gustafsson F, Linde JJ. Aortic dimensions in women with previous pre-eclampsia. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00343-5. [PMID: 38866633 DOI: 10.1016/j.jcct.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Pre-eclampsia is a pregnancy related disorder associated with hypertension and vascular inflammation, factors that are also involved in the pathological pathway of aortic dilatation and aneurysm development. It is, however, unknown if younger women with previous pre-eclampsia have increased aortic dimensions. We tested the hypothesis that previous pre-eclampsia is associated with increased aortic dimensions in younger women. METHODS The study was a cross-sectional cohort study of women with previous pre-eclampsia, aged 40-55, from the PRECIOUS population matched by age and parity with women from the general population. Using contrast-enhanced CT, aortic diameters were measured in the aortic root, ascending aorta, descending aorta, at the level of the diaphragm, suprarenal aorta, and infrarenal aorta. RESULTS 1355 women (684 with previous pre-eclampsia and 671 from the general population), with a mean (standard deviation) age of 46.9 (4.4) were included. The pre-eclampsia group had larger mean (standard deviation) aortic diameters (mm) in all measured segments from the ascending to the infrarenal aorta (ascending: 33.4 (4.0) vs. 31.4 (3.7), descending: 23.9 (2.1) vs. 23.3 (2.0), diaphragm: 20.8 (1.8) vs. 20.4 (1.8), suprarenal: 22.9 (1.9) vs. 22.0 (2.0), infrarenal: 19.3 (1.6) vs. 18.6 (1.7), p < 0.001 for all, also after adjustment for age, height, parity, menopause, dyslipidemia, smoking and chronic hypertension. Guideline-defined ascending aortic aneurysms were found in 8 vs 2 women (p = 0.12). CONCLUSIONS Women with previous pre-eclampsia have larger aortic dimensions compared with women from the general population. Pre-eclampsia was found to be an independent risk factor associated with a larger aortic diameter.
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Affiliation(s)
- Emma L R Møller
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria G Hauge
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael H C Pham
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen, University Hospital, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne S Ersbøll
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Shi RY, Wu R, Ran J, Tang LL, Wesemann L, Hu J, Du L, Zhang WJ, Xu JR, Zhou Y, Zhao L, Pu J, Wu LM. Fractal analysis of left ventricular trabeculae in post-STEMI: from acute to chronic phase. Insights Imaging 2024; 15:75. [PMID: 38499900 PMCID: PMC10948656 DOI: 10.1186/s13244-024-01641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE The temporal evolution of ventricular trabecular complexity and its correlation with major adverse cardiovascular events (MACE) remain indeterminate in patients presenting with acute ST elevation myocardial infarction (STEMI). METHODS This retrospective analysis enrolled patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI, possessing cardiac magnetic resonance (CMR) data in the acute (within 7 days), subacute (1 month after pPCI), and chronic phases (6 months after pPCI) from January 2015 to January 2020 at the three participating sites. Fractal dimensions (FD) were measured for the global, infarct, and remote regions of left ventricular trabeculae during each phase. The potential association of FD with MACE was analyzed using multivariate Cox regression. RESULTS Among the 200 analyzed patients (182 men; median age, 61 years; age range, 50-66 years), 37 (18.5%) encountered MACE during a median follow-up of 31.2 months. FD exhibited a gradual decrement (global FD at acute, subacute, and chronic phases: 1.253 ± 0.049, 1.239 ± 0.046, 1.230 ± 0.045, p < 0.0001), with a more pronounced decrease observed in patients subsequently experiencing MACE (p < 0.001). The global FD at the subacute phase correlated with MACE (hazard ratio 0.89 (0.82, 0.97), p = 0.01), and a global FD value below 1.26 was associated with a heightened risk. CONCLUSION In patients post-STEMI, the global FD, serving as an indicator of left ventricular trabeculae complexity, independently demonstrated an association with subsequent major adverse cardiovascular events, beyond factors encompassing left ventricular ejection fraction, indexed left ventricular end-diastolic volume, infarct size, heart rate, NYHA class, and post-pPCI TIMI flow. CRITICAL RELEVANCE STATEMENT In patients who have had an ST-segment elevation myocardial infarction, global fractal dimension, as a measure of left ventricular trabeculae complexity, provided independent association with subsequent major adverse cardiovascular event. KEY POINTS • Global and regional FD decreased after STEMI, and more so in patients with subsequent MACE. • Lower global FD at the subacute phase and Δglobal FD from acute to subacute phase were associated with subsequent MACE besides clinical and CMR factors. • Global FD at the subacute phase independently correlated with MACE and global FD value below 1.26 was associated with higher risk.
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Affiliation(s)
- Ruo-Yang Shi
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
- Jiading Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Wu
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - Jinjun Ran
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lang-Lang Tang
- Department of Radiology, Longyan First Hospital of Fujian Medical University, Long Yan, Fu Jian, China
| | - Luke Wesemann
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Liang Du
- Shanghai Robotics Institute, Shanghai University, Shanghai, China
| | - Wei-Jun Zhang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Rong Xu
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - Yan Zhou
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China
| | - Lei Zhao
- Department of Radiology, An Zhen Hospital, Capital Medical University, No. 2 Anzhen Road, Beijing, 100029, China.
| | - Jun Pu
- Department of Cardiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China.
| | - Lian-Ming Wu
- Department of Radiology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, 200127, China.
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Kock TO, Børresen MF, Sillesen AS, Vøgg RO, Norsk JB, Pærregaard MM, Vejlstrup NG, Christensen AH, Iversen KK, Bundgaard H, Axelsson Raja A. Left Ventricular Noncompaction in Childhood: Echocardiographic Follow-Up and Prevalence in First-Degree Relatives. JACC. ADVANCES 2024; 3:100829. [PMID: 38938835 PMCID: PMC11198491 DOI: 10.1016/j.jacadv.2024.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 06/29/2024]
Abstract
Background Left ventricular noncompaction (LVNC) is characterized by excessive trabeculations of the left ventricular (LV) wall. Objectives The authors aimed to examine changes in LV function and morphology in 2 to 4-year-old children with and without LVNC at birth and to describe the prevalence of LVNC in first-degree relatives. Methods Echocardiograms in children with and without LVNC (matched 1:4) were performed at 2 to 4 years and in first-degree relatives. LVNC was blindly assessed and defined as a ratio of non-compact to compact myocardium of ≥2 in ≥1 LV segment. Trabeculations were expressed as a percentage of the number of segments with LVNC out of the total number of segments. Results In total, 14 (median age 3 years, 71% male) of 16 children with LVNC at birth and 56 children without (median age 4 years, 71% male), 37 first-degree relatives of children with LVNC (median age 31 years, 46% male) and 146 first-degree relatives of children without (median age 33 years, 50% male) were included. In children with LVNC, trabeculation (8% vs 13%, P = 0.81) and LV ejection fraction (50% vs 49%, P = 0.91) were unchanged from birth to follow-up but LV ejection fraction was lower compared to children without LVNC (49% vs 60%, P < 0.001). In relatives of children with LVNC, 11 of 37 (30%) fulfilled LVNC criteria compared to no relatives to children without LVNC (P < 0.001). Conclusions At 2 to 4 years, children with LVNC diagnosed at birth had reduced systolic function compared to children without but did not have progression of LV dysfunction or extent of trabeculations. In first-degree relatives to children with LVNC, 30% fulfilled criteria.
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Affiliation(s)
- Thilde O. Kock
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marie F. Børresen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ruth O.B. Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob B. Norsk
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria M. Pærregaard
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels G. Vejlstrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alex H. Christensen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper K. Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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7
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Monda E, De Michele G, Diana G, Verrillo F, Rubino M, Cirillo A, Fusco A, Amodio F, Caiazza M, Dongiglio F, Palmiero G, Buono P, Russo MG, Limongelli G. Left Ventricular Non-Compaction in Children: Aetiology and Diagnostic Criteria. Diagnostics (Basel) 2024; 14:115. [PMID: 38201424 PMCID: PMC10871098 DOI: 10.3390/diagnostics14010115] [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: 11/13/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Left ventricular non-compaction (LVNC) is a heterogeneous myocardial disorder characterized by prominent trabeculae protruding into the left ventricular lumen and deep intertrabecular recesses. LVNC can manifest in isolation or alongside other heart muscle diseases. Its occurrence among children is rising due to advancements in imaging techniques. The origins of LVNC are diverse, involving both genetic and acquired forms. The clinical manifestation varies greatly, with some cases presenting no symptoms, while others typically manifesting with heart failure, systemic embolism, and arrhythmias. Diagnosis mainly relies on assessing heart structure using imaging tools like echocardiography and cardiac magnetic resonance. However, the absence of a universally agreed-upon standard and limitations in diagnostic criteria have led to ongoing debates in the scientific community regarding the most reliable methods. Further research is crucial to enhance the diagnosis of LVNC, particularly in early life stages.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
- Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
| | - Gianantonio De Michele
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Federica Amodio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Pietro Buono
- Department of Maternal and Child Health, General Directorate for Health, 80131 Naples, Italy
| | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
- Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
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8
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Zhang TY, An DA, Zhou H, Ni Z, Wang Q, Chen B, Lu R, Huang J, Zhou Y, Hu J, Kim DH, Wilson M, Mou S, Wu LM. Fractal analysis: Left ventricular trabecular complexity cardiac MRI adds independent risks for heart failure with preserved ejection fraction in participants with end-stage renal disease. Int J Cardiol 2023; 391:131334. [PMID: 37696365 DOI: 10.1016/j.ijcard.2023.131334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To measure left ventricular (LV) trabecular complexity by fractal dimension (FD) in patients with end-stage renal disease (ESRD), and assess whether FD was an independent risk factor for heart failure with preserved ejection fraction (HFpEF), or a significant predictor for adverse outcome in this population. METHODS The study retrospectively enrolled 104 participants with ESRD who underwent 3.0 T cardiac magnetic resonance imaging (MRI) from June 2018 to November 2020. LV trabeculation was quantified with fractal analysis of short-axis cine slices to estimate the FD. Logistic regression analyses were used to evaluate FD and cardiac MRI parameters and to find independent risk predictors. Cox proportional hazard regression was used to investigate the association between FD and MACE. RESULTS LV FD was higher in in the HFpEF group than those in the non-HFpEF group, with the greatest difference near the base of the ventricle. Age, minimum left atrial volume index, and LV mean basal FD were independent predictors for HFpEF in patients with ESRD. Combining the mean basal FD with typical predictive factors resulted in a C-index (0.902 vs 0.921), which was not significantly higher. Same improvements were found for net reclassification improvement [0.642; 95% confidence interval (CI), 0.254-1.029] and integrated discrimination index (0.026; 95% CI, 0.008-0.061). Participants with a LV global FD above the cutoff value (1.278) had higher risks of MACE in ESRD patients. CONCLUSIONS LV trabecular complexity measured by FD was an independent risk factor for HFpEF, and a significant predictor for MACE among patients with ESRD.
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Affiliation(s)
- Tian-Yi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Hang Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Zhaohui Ni
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Qin Wang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Binghua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Renhua Lu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiaying Huang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yin Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Doo Hee Kim
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Molly Wilson
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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9
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Møller MB, Hasbak P, Linde JJ, Sigvardsen PE, Køber LV, Kofoed KF. Quantification of myocardial blood flow using dynamic myocardial CT perfusion compared with 82Rb PET. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00093-X. [PMID: 37024395 DOI: 10.1016/j.jcct.2023.03.007] [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: 08/24/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Absolute measures of myocardial blood flow (MBF) obtained with dynamic myocardial CT perfusion (DM-CTP) are underestimated when compared with reference standards. This is to some extent explained by incomplete extraction of iodinated contrast agent (iCA) to the myocardial tissue. We aimed to establish an extraction function for iCA, use the function to calculate MBFCT and to compare this with MBF measured with 82Rb positron emission tomography (PET). MATERIALS AND METHODS Healthy individuals without coronary artery disease (CAD) were examined with 82Rb PET and DM-CTP. The factors a and β of the generalized Renkin-Crone model were estimated using a non-linear least squares model. The factors providing the best fit for the data were subsequently used to calculate MBFCT. RESULTS Of consecutive 91 individuals examined, 79 were eligible for analysis. The factors a and β providing the best fit of the nonlinear least-squares model to the data were a = 0.614 and β = 0.218 (R-squared = 0.81). Conversion of the CT inflow parameter (K1) values using the derived extraction function resulted in a significant correlation between MBF measured during stress using CT and PET (P = 0.039). CONCLUSION In healthy individuals, flow estimates obtained with dynamic myocardial CT perfusion during stress were, after conversion to MBF using the extraction of iodinated CT contrast agent, correlated with absolute MBF quantified with 82Rb PET.
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Affiliation(s)
- Mathias B Møller
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Philip Hasbak
- Department of Nuclear Medicine, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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10
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Petersen SE, Jensen B, Aung N, Friedrich MG, McMahon CJ, Mohiddin SA, Pignatelli RH, Ricci F, Anderson RH, Bluemke DA. Excessive Trabeculation of the Left Ventricle: JACC: Cardiovascular Imaging Expert Panel Paper. JACC Cardiovasc Imaging 2023; 16:408-425. [PMID: 36764891 PMCID: PMC9988693 DOI: 10.1016/j.jcmg.2022.12.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
Excessive trabeculation, often referred to as "noncompacted" myocardium, has been described at all ages, from the fetus to the adult. Current evidence for myocardial development, however, does not support the formation of compact myocardium from noncompacted myocardium, nor the arrest of this process to result in so-called noncompaction. Excessive trabeculation is frequently observed by imaging studies in healthy individuals, as well as in association with pregnancy, athletic activity, and with cardiac diseases of inherited, acquired, developmental, or congenital origins. Adults with incidentally noted excessive trabeculation frequently require no further follow-up based on trabecular pattern alone. Patients with cardiomyopathy and excessive trabeculation are managed by cardiovascular symptoms rather than the trabecular pattern. To date, the prognostic role of excessive trabeculation in adults has not been shown to be independent of other myocardial disease. In neonates and children with excessive trabeculation and normal or abnormal function, clinical caution seems warranted because of the reported association with genetic and neuromuscular disorders. This report summarizes the evidence concerning the etiology, pathophysiology, and clinical relevance of excessive trabeculation. Gaps in current knowledge of the clinical relevance of excessive trabeculation are indicated, with priorities suggested for future research and improved diagnosis in adults and children.
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Affiliation(s)
- Steffen E Petersen
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom.
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nay Aung
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Matthias G Friedrich
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Saidi A Mohiddin
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Ricardo H Pignatelli
- Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging, and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle, United Kingdom
| | - David A Bluemke
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
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11
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Jensen B, Petersen SE, Coolen BF. Myocardial perfusion in excessively trabeculated hearts: Insights from imaging and histological studies. J Cardiol 2022; 81:499-507. [PMID: 36481300 DOI: 10.1016/j.jjcc.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
In gestation, the coronary circulation develops initially in the compact layer and it expands only in fetal development to the trabeculations. Conflicting data have been published as to whether the trabecular layer is hypoperfused relative to the compact wall after birth. If so, this could explain the poor pump function in patients with left ventricular excessive trabeculation, or so-called noncompaction. Here, we review direct and indirect assessments of myocardial perfusion in normal and excessively trabeculated hearts by in vivo imaging by magnetic resonance imaging (MRI), positron emission tomography (PET)/single photon emission computed tomography (SPECT), and echocardiography in addition to histology, injections of labelled microspheres in animals, and electrocardiography. In MRI, PET/SPECT, and echocardiography, flow of blood or myocardial uptake of blood-borne tracer molecules are measured. The imaged trabecular layer comprises trabeculations and blood-filled intertrabecular spaces whereas the compact layer comprises tissue only, and spatio-temporal resolution likely affects measurements of myocardial perfusion differently in the two layers. Overall, studies measuring myocardial uptake of tracers (PET/SPECT) suggest trabecular hypoperfusion. Studies measuring the quantity of blood (echocardiography and MRI) suggest trabecular hyperperfusion. These conflicting results are reconciled if the low uptake from intertrabecular spaces in PET/SPECT and the high signal from intertrabecular spaces in MRI and echocardiography are considered opposite biases. Histology on human hearts reveal a similar capillary density of trabecular and compact myocardium. Injections of labelled microspheres in animals reveal a similar perfusion of trabecular and compact myocardium. In conclusion, trabecular and compact muscle are likely equally perfused in normal hearts and most cases of excessive trabeculation.
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12
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Schiebel K, Finsterer J, Lazarevic P, Stöllberger C. Stroke and embolism in patients with left ventricular hypertrabeculation/noncompaction. J Stroke Cerebrovasc Dis 2022; 31:106623. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022] Open
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13
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Børresen MF, Blixenkrone-Møller E, Kock TO, Sillesen AS, Vøgg ROB, Pihl CA, Norsk JB, Vejlstrup NG, Christensen AH, Iversen KK, Bundgaard H, Axelsson Raja A. Prevalence of Left Ventricular Noncompaction in Newborns. Circ Cardiovasc Imaging 2022; 15:e014159. [PMID: 35727876 DOI: 10.1161/circimaging.121.014159] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular noncompaction (LVNC) is characterized by excessive trabeculations of the LV and may be associated with reduced systolic function or severe adverse outcomes. Several aspects remain to be elucidated; there is controversy to whether LVNC cardiomyopathy is a distinct cardiomyopathy caused by failure of the spongy fetal myocardium to condense during fetal development or acquired later in life as a morphological trait associated with other types of cardiomyopathy; the prevalence in unselected populations is unknown and the distinction between normal variation and pathology remains to be defined. In this study, we aimed to determine the prevalence of LVNC and the association to LV systolic function in a large, population-based cohort of neonates. In addition, we assessed the normal ratio of noncompact to compact (NC:C) myocardium in 150 healthy neonates. METHODS Echocardiographic data were prospectively collected in the population study Copenhagen Baby Heart Study. The ratio of NC:C was measured in 12 ventricular segments. LVNC was defined as NC:C ≥2 in at least one segment. Neonates with LVNC were matched 1:10 to controls on sex, gestational age, and weight and age at the examination day. RESULTS In total, 25 590 neonates (52% males, median age 11 [interquartile range, 7-15] days) underwent echocardiography. Among 21 133 with satisfactory visualization of ventricular segments, we identified a prevalence of LVNC of 0.076% (95% CI, 0.047-0.123). LV ejection fraction was lower in neonates with LVNC compared with matched controls (median 49.5 versus 59.0%; P<0.0001). In neonates with otherwise healthy hearts, the median NC:C ratio ranged from 0.0 to 0.7 and the 99th percentiles from 1.0 to 1.9 for each of the 12 segments. CONCLUSIONS The prevalence of LVNC based on neonatal echocardiography was 0.076%. LVNC was associated with lower LV systolic function. The findings in normal newborns support the cutoff NC:C ≥2 as an appropriate diagnostic criterion. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02753348.
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Affiliation(s)
- Marie F Børresen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Elisabeth Blixenkrone-Møller
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Thilde O Kock
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Christian A Pihl
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.).,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (C.A.P., N.G.V., H.B., A.A.R.)
| | - Jakob B Norsk
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Niels G Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (C.A.P., N.G.V., H.B., A.A.R.)
| | - Alex H Christensen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Kasper K Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.)
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (C.A.P., N.G.V., H.B., A.A.R.)
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., A.H.C., K.K.I., A.A.R.).,Department of Clinical Medicine, University of Copenhagen, Denmark (M.F.B., E.B.-M., T.O.K., A.-S.S., R.O.B.V., C.A.P., J.B.N., N.G.V., A.H.C., K.K.I., H.B., A.A.R.).,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (C.A.P., N.G.V., H.B., A.A.R.)
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14
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Early Coronary Atherosclerosis in Women With Previous Preeclampsia. J Am Coll Cardiol 2022; 79:2310-2321. [DOI: 10.1016/j.jacc.2022.03.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022]
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15
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Casas G, Rodríguez-Palomares JF. Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis. J Clin Med 2022; 11:578. [PMID: 35160031 PMCID: PMC8836975 DOI: 10.3390/jcm11030578] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies.
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Affiliation(s)
- Guillem Casas
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - José F. Rodríguez-Palomares
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
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16
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Kaltoft M, Sigvardsen PE, Afzal S, Langsted A, Fuchs A, Kühl JT, Køber L, Kamstrup PR, Kofoed KF, Nordestgaard BG. Elevated lipoprotein(a) in mitral and aortic valve calcification and disease: The Copenhagen General Population Study. Atherosclerosis 2021; 349:166-174. [PMID: 34903381 DOI: 10.1016/j.atherosclerosis.2021.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/25/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS We tested the hypotheses (i) that elevated lipoprotein(a) is causally associated with both mitral and aortic valve calcification and disease, and (ii) that aortic valve calcification mediates the effect of elevated lipoprotein(a) on aortic valve stenosis. METHODS From the Copenhagen General Population study, we included 12,006 individuals who underwent cardiac computed tomography to measure mitral and aortic valve calcification and 85,884 to examine risk of heart valve disease. Participants had information on plasma lipoprotein(a) and genetic instruments associated with plasma lipoprotein(a) to investigate potential causality. RESULTS At age 70-79 years, 29% and 54% had mitral and aortic valve calcification, respectively. For 10-fold higher lipoprotein(a) levels, multifactorially adjusted odds ratios for mitral and aortic valve calcification were 1.26 (95% confidence interval: 1.13-1.41) and 1.62 (1.48-1.77). For mitral and aortic valve stenosis, corresponding hazard ratios were 0.93 (95%CI:0.40-2.15, 19 events) and 1.54 (1.38-1.71, 1158 events), respectively. For ≤23 versus ≥36 kringle IV type 2 number of repeats, the age and sex adjusted odds ratios for mitral and aortic valve calcification were 1.53 (1.18-1.99) and 2.23 (1.81-2.76). For carriers versus non-carriers of LPA rs10455872, odds ratios for mitral and aortic valve calcification were 1.33 (1.13-1.57) and 1.86 (1.64-2.13). For aortic valve stenosis, 31% (95%CI:16%-76%) of the effect of lipoprotein(a) was mediated through calcification. CONCLUSIONS Elevated lipoprotein(a) was genetically and observationally associated with mitral and aortic valve calcification and aortic valve stenosis. Aortic valve calcification mediated 31% of the effect of elevated lipoprotein(a) on aortic valve stenosis.
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Affiliation(s)
- Morten Kaltoft
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anne Langsted
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lars Køber
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
| | - Klaus F Kofoed
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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17
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Høgh J, Pham MHC, Knudsen AD, Thudium RF, Gelpi M, Sigvardsen PE, Fuchs A, Kühl JT, Afzal S, Nordestgaard BG, Benfield T, Køber L, Gerstoft J, Kofoed KF, Nielsen SD. HIV infection is associated with thoracic and abdominal aortic aneurysms: a prospective matched cohort study. Eur Heart J 2021; 42:2924-2931. [PMID: 34240121 DOI: 10.1093/eurheartj/ehab348] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Little is known about the prevalence of aortic aneurysms among people living with HIV (PLWH). We investigated whether HIV status is independently associated with having aortic aneurysms. Furthermore, we determined risk factors associated with aortic aneurysms in PLWH. METHODS AND RESULTS PLWH aged ≥40 years (n = 594) were recruited from the Copenhagen Comorbidity in HIV Infection study and matched for age and sex with uninfected controls (n = 1188) from the Copenhagen General Population Study. Aortic dimensions were assessed using contrast enhanced computed tomography. Aortic aneurysms were defined according to the European Society of Cardiology guidelines, i.e. an aortic dilation of ≥50% or an infrarenal aortic diameter of ≥30 mm. Among PLWH and uninfected controls, the median (interquartile range) age was 52 (47-60) and 52 (48-61) and 88% and 90% were male, respectively. We found 46 aneurysms in 42 (7.1%) PLWH and 31 aneurysms in 29 (2.4%) uninfected controls (P < 0.001). PLWH had a significantly higher prevalence of ascending aortic aneurysms and infrarenal aortic aneurysms. In an adjusted model, HIV was independently associated with aortic aneurysms (adjusted odds ratio; 4.51 [95% confidence interval 2.56-8.08], P < 0.001). Within PLWH, obesity and hepatitis B co-infection were associated with aortic aneurysms. CONCLUSION PLWH had four-fold higher odds of aortic aneurysms compared to uninfected controls, and HIV status was independently associated with aortic aneurysms. Among PLWH, age, obesity and hepatitis B co-infection were associated with higher odds of aortic aneurysms. Our findings suggest that increased attention to aortic aneurysms in PLWH may be beneficial.
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Affiliation(s)
- Julie Høgh
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Michael Huy Cuong Pham
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Rebekka Faber Thudium
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark
| | - Per Ejlstrup Sigvardsen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Shoaib Afzal
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Børge Grønne Nordestgaard
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Amager Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark.,Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Esther Møllers Vej 6, 2100 Kbh Ø, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Kbh N, Copenhagen, Denmark
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18
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Stöllberger C, Finsterer J. Correlation between pathoanatomic findings, imaging modalities, and genetic findings in patients with left ventricular hypertrabeculation/noncompaction. Expert Rev Cardiovasc Ther 2021; 19:595-606. [PMID: 34053374 DOI: 10.1080/14779072.2021.1937128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Left ventricular hypertrabeculation, also named 'noncompaction' (LVHT) is a cardiac abnormality which is detected by pathoanatomic investigation or during cardiac surgery. Imaging techniques visualize LVHT by ventriculography, echocardiography, cardiac magnetic resonance imaging (CMRI) and computed tomography (CT).Areas covered: We aimed to assess 1) how often the definition of LVHT was validated against a criterion standard, 2) if inter- and intra-observer agreement was assessed, and 3) how often LVHT was associated with genetic diseases. A literature search disclosed 58 cases whose hearts were investigated pathoanatomically and by ≥1 imaging technique. Echocardiography was most frequently (95%) compared with pathoanatomy, followed by cMRI (31%), ventriculography (7%) and CT (5%). Intra- and inter-observer agreement was more frequently assessed for cMRI definitions and yielded more consistent results than for echocardiographic definitions. Since genetic findings were only reported from 4 of the 58 cases, no association with imaging findings could be carried out.Expert opinion: Correlation between pathoanatomic investigations with imaging techniques will hopefully contribute to reliable and uniformly accepted definitions of LVHT. Most probably, the echocardiographic definition of LVHT will be a synthesis of the currently used definitions, integrating short axis and four-chamber views. A refinement of cMRI definitions, considering pathoanatomic and echocardiographic investigations, seems necessary to avoid overdiagnosis.
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19
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Ramchand J, Podugu P, Obuchowski N, Harb SC, Chetrit M, Milinovich A, Griffin B, Burrell LM, Wilson Tang WH, Kwon DH, Flamm SD. Novel Approach to Risk Stratification in Left Ventricular Non-Compaction Using A Combined Cardiac Imaging and Plasma Biomarker Approach. J Am Heart Assoc 2021; 10:e019209. [PMID: 33834849 PMCID: PMC8174181 DOI: 10.1161/jaha.120.019209] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Left ventricular non‐compaction remains a poorly described entity, which has led to challenges of overdiagnosis. We aimed to evaluate if the presence of a thin compacted myocardial layer portends poorer outcomes in individuals meeting cardiac magnetic resonance criteria for left ventricular non‐compaction . Methods and Results This was an observational, retrospective cohort study involving individuals selected from the Cleveland Clinic Foundation cardiac magnetic resonance database (N=26 531). Between 2000 and 2018, 328 individuals ≥12 years, with left ventricular non‐compaction or excessive trabeculations based on the cardiac magnetic resonance Petersen criteria were included. The cohort comprised 42% women, mean age 43 years. We assessed the predictive ability of myocardial thinning for the primary composite end point of major adverse cardiac events (composite of all‐cause mortality, heart failure hospitalization, left ventricular assist device implantation/heart transplant, ventricular tachycardia, or ischemic stroke). At mean follow‐up of 3.1 years, major adverse cardiac events occurred in 102 (31%) patients. After adjusting for comorbidities, the risk of major adverse cardiac events was nearly doubled in the presence of significant compacted myocardial thinning (hazard ratio [HR], 1.88 [95% CI, 1.18‒3.00]; P=0.016), tripled in the presence of elevated plasma B‐type natriuretic peptide (HR, 3.29 [95% CI, 1.52‒7.11]; P=0.006), and increased by 5% for every 10‐unit increase in left ventricular end‐systolic volume (HR, 1.01 [95% CI, 1.00‒1.01]; P=0.041). Conclusions The risk of adverse clinical events is increased in the presence of significant compacted myocardial thinning, an elevated B‐type natriuretic peptide or increased left ventricular dimensions. The combination of these markers may enhance risk assessment to minimize left ventricular non‐compaction overdiagnosis whilst facilitating appropriate diagnoses in those with true disease.
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Affiliation(s)
- Jay Ramchand
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Imaging InstituteCleveland Clinic Cleveland OH.,Department of Medicine Austin HealthThe University of Melbourne Victoria Australia
| | - Pooja Podugu
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Nancy Obuchowski
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Imaging InstituteCleveland Clinic Cleveland OH
| | - Serge C Harb
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Imaging InstituteCleveland Clinic Cleveland OH
| | - Michael Chetrit
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Imaging InstituteCleveland Clinic Cleveland OH
| | - Alex Milinovich
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Brian Griffin
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Louise M Burrell
- Department of Medicine Austin HealthThe University of Melbourne Victoria Australia
| | - W H Wilson Tang
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Deborah H Kwon
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Imaging InstituteCleveland Clinic Cleveland OH
| | - Scott D Flamm
- Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Imaging InstituteCleveland Clinic Cleveland OH
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20
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Jensen B, Christoffels VM, Moorman AFM. An Appreciation of Anatomy in the Molecular World. J Cardiovasc Dev Dis 2020; 7:E44. [PMID: 33076272 PMCID: PMC7712948 DOI: 10.3390/jcdd7040044] [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: 09/25/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Robert H. Anderson is one of the most important and accomplished cardiac anatomists of the last decades, having made major contributions to our understanding of the anatomy of normal hearts and the pathologies of acquired and congenital heart diseases. While cardiac anatomy as a research discipline has become largely subservient to molecular biology, anatomists like Professor Anderson demonstrate anatomy has much to offer. Here, we provide cases of early anatomical insights on the heart that were rediscovered, and expanded on, by molecular techniques: migration of neural crest cells to the heart was deduced from histological observations (1908) and independently shown again with experimental interventions; pharyngeal mesoderm is added to the embryonic heart (1973) in what is now defined as the molecularly distinguishable second heart field; chambers develop from the heart tube as regional pouches in what is now considered the ballooning model by the molecular identification of regional differentiation and proliferation. The anatomical discovery of the conduction system by Purkinje, His, Tawara, Keith, and Flack is a special case because the main findings were never neglected in later molecular studies. Professor Anderson has successfully demonstrated that sound knowledge of anatomy is indispensable for proper understanding of cardiac development.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ Amsterdam, The Netherlands; (V.M.C.); (A.F.M.M.)
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