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Iqbal MK, Ambreen A, Mujahid M, Zarlashat Y, Abid M, Yasin A, Ullah MN, Shahzad R, Harlina PW, Khan SU, Alissa M, Algopishi UB, Almubarak HA. Cardiomegaly: Navigating the uncharted territories of heart failure - A multimodal radiological journey through advanced imaging, pathophysiological landscapes, and innovative therapeutic frontiers. Curr Probl Cardiol 2024; 49:102748. [PMID: 39009253 DOI: 10.1016/j.cpcardiol.2024.102748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
Cardiomegaly is among the disorders categorized by a structural enlargement of the heart by any of the situations including pregnancy, resulting in damage to heart muscles and causing trouble in normal heart functioning. Cardiomegaly can be defined in terms of dilatation with an enlarged heart and decreased left or biventricular contraction. The genetic origin of cardiomegaly is becoming more evident due to extensive genomic research opening up new avenues to ensure the use of precision medicine. Cardiomegaly is usually assessed by using an array of radiological modalities, including computed tomography (CT) scans, chest X-rays, and MRIs. These imaging techniques have provided an important opportunity for the physiology and anatomy of the heart. This review aims to highlight the complexity of cardiomegaly, highlighting the contribution of both ecological and genetic variables to its progression. Moreover, we further highlight the worth of precise clinical diagnosis, which comprises blood biomarkers and electrocardiograms (EKG ECG), demonstrating the significance of distinguishing between numerous basic causes. Finally, the analysis highlights the extensive variation of treatment lines, such as lifestyle modifications, prescription drugs, surgery, and implantable devices, although highlighting the critical need for individualized and personalized care.
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Affiliation(s)
- Muhammad Khalid Iqbal
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, Dalian Medical University Liaoning Provence China; Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Alia Ambreen
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Muhammad Mujahid
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Yusra Zarlashat
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Muhammad Abid
- Academy of Integrative Medicine, Dalian Medical University, Dalian 116044, China
| | - Ayesha Yasin
- Department of Pathology and Forensic Medicine, Dalian Medical University Liaoning Provence, China
| | | | - Raheel Shahzad
- Research Center for Genetic Engineering, National Research and Innovation Agency (BRIN), KST-Cibinong, JI Raya Bogor KM46, Cibinong 16911, Indonesia
| | - Putri Widyanti Harlina
- Department of Food Industrial Technology, Faculty of Agro-Industrial Technology, Universitas Padjadjaran, 45363 Bandung, Indonesia
| | - Shahid Ullah Khan
- Integrative Science Center of Germplasm Creation in Western China (CHONGQING) Science City and Southwest University, College of Agronomy and Biotechnology, Southwest University, Chongqing, 400715, China; Women Medical and Dental College, Khyber Medical University, Peshawar, KPK, 22020, Pakistan.
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | - Hassan Ali Almubarak
- Division of Radiology, Department of Medicine, College of Medicine and Surgery, King Khalid University, Abha, Saudi Arabia
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2
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Petkovic A, Menkovic N, Petrovic O, Bilbija I, Nisevic M, Radovanovic NN, Stanisavljevic D, Putnik S, Maksimovic R, Ivanovic B. Imaging in Infective Endocarditis-Current Opinions and Trends in Cardiac Computed Tomography. Diagnostics (Basel) 2024; 14:1355. [PMID: 39001245 PMCID: PMC11241025 DOI: 10.3390/diagnostics14131355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Infective endocarditis is a rare disease with an increasing incidence and an unaltered high mortality rate, despite medical development. Imaging plays an integrative part in the diagnosis of infective endocarditis, with echocardiography as the initial diagnostic test. Research data in the utility of cardiac computed tomography (CCT) in the diagnostic algorithm of IE are rising, which indicates its importance in detection of IE-related lesion along with the exclusion of coronary artery disease. The latest 2023 European Society of Cardiology Guidelines in the management of IE classified CCT as class of recommendation I and level of evidence B in detection of both valvular and paravalvular lesions in native and prosthetic valve endocarditis. This review article provides a comprehensive and contemporary review of the role of CCT in the diagnosis of IE, the optimization of acquisition protocols, the morphology characteristics of IE-related lesions, the published data of the diagnostic performance of CCT in comparison to echocardiography as the state-of-art method, as well as the limitations and future possibilities.
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Affiliation(s)
- Ana Petkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nemanja Menkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
| | - Ilija Bilbija
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Nisevic
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nikola N. Radovanovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Pacemaker Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Svetozar Putnik
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Branislava Ivanovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
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3
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Gaibazzi N, Cortigiani L, Rigo F, Porter TR, Guerra E, Ciampi Q. Reversible ischaemia and outcome after adjustment for coronary artery disease severity: a multicentre stress-echocardiography registry. Eur Heart J Cardiovasc Imaging 2024; 25:510-519. [PMID: 37950913 DOI: 10.1093/ehjci/jead304] [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: 07/12/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023] Open
Abstract
AIMS To assess the potential association of reversible ischaemia and Doppler coronary flow velocity reserve in the left anterior descending coronary artery (CFVR-LAD) during stress echocardiography (SE) with all-cause mortality and non-fatal myocardial infarction (MI), after correction for anatomic coronary artery disease (CAD) burden and other significant clinical variables. METHODS AND RESULTS We selected 3191 patients (mean age 66 ± 12 years) from our multicentre SE registry, who underwent both high-dose dipyridamole SE (comprehensive of CFVR-LAD measurement) and coronary angiography within 2 months. All-cause mortality and non-fatal MI were the primary end points. The association of the primary end point with ischaemia severity and CFVR-LAD was assessed, after multivariable adjustment for all other significant clinical and imaging variables, including anatomic CAD severity by the modified Duke Prognostic Index. The primary end point occurred in 767 (24%) patients (death in 409 and non-fatal MI in 375 patients) during a median follow-up of 42 months. Multivariable Cox regression analyses indicated that, among other significant variables, anatomic CAD severity, reversible ischaemia, and CFVR-LAD were all independently associated with the primary end point; reversible ischaemia was also associated with subsequent MI, while CFVR-LAD with mortality, independent of anatomic CAD severity. CONCLUSION Our study suggests that reversible ischaemia by wall motion assessment and CFVR-LAD on dipyridamole SE are independently associated with dismal outcome in patients with suspected or known stable CAD, even after accounting for angiographic anatomic CAD severity and also independently from which coronary artery is diseased.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | | | - Fausto Rigo
- Division of Cardiology, Villa Salus Hospital Foundation/IRCCS San Camillo Venice, Italy
| | - Thomas R Porter
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Emiliano Guerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
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Almeida AG, Grapsa J, Gimelli A, Bucciarelli-Ducci C, Gerber B, Ajmone-Marsan N, Bernard A, Donal E, Dweck MR, Haugaa KH, Hristova K, Maceira A, Mandoli GE, Mulvagh S, Morrone D, Plonska-Gosciniak E, Sade LE, Shivalkar B, Schulz-Menger J, Shaw L, Sitges M, von Kemp B, Pinto FJ, Edvardsen T, Petersen SE, Cosyns B. Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:e116-e136. [PMID: 38198766 DOI: 10.1093/ehjci/jeae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Cardiovascular diseases (CVD) represent an important cause of mortality and morbidity in women. It is now recognized that there are sex differences regarding the prevalence and the clinical significance of the traditional cardiovascular (CV) risk factors as well as the pathology underlying a range of CVDs. Unfortunately, women have been under-represented in most CVD imaging studies and trials regarding diagnosis, prognosis, and therapeutics. There is therefore a clear need for further investigation of how CVD affects women along their life span. Multimodality CV imaging plays a key role in the diagnosis of CVD in women as well as in prognosis, decision-making, and monitoring of therapeutics and interventions. However, multimodality imaging in women requires specific consideration given the differences in CVD between the sexes. These differences relate to physiological changes that only women experience (e.g. pregnancy and menopause) as well as variation in the underlying pathophysiology of CVD and also differences in the prevalence of certain conditions such as connective tissue disorders, Takotsubo, and spontaneous coronary artery dissection, which are all more common in women. This scientific statement on CV multimodality in women, an initiative of the European Association of Cardiovascular Imaging of the European Society of Cardiology, reviews the role of multimodality CV imaging in the diagnosis, management, and risk stratification of CVD, as well as highlights important gaps in our knowledge that require further investigation.
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Affiliation(s)
- Ana G Almeida
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Julia Grapsa
- Cardiology Department, Guys and St Thomas NHS Trust, London, UK
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, UCLouvain, Brussels, Belgium
- Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Nina Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Bernard
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
- Service de Cardiologie, CHRU de Tours, Tours, France
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI-UMR 1099, University of Rennes, Rennes, France
| | - Marc R Dweck
- Centre for Cardiovascular Science, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Krassimira Hristova
- Center for Cardiovascular Diseases, Faculty of Medicine, Sofia University, Sofia, Bulgaria
| | - Alicia Maceira
- Ascires Biomedical Group, Valencia, Spain
- Department of Medicine, Health Sciences School, UCH-CEU University, Valencia, Spain
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Doralisa Morrone
- Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leyla Elif Sade
- Cardiology Department, University of Baskent, Ankara, Turkey
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jeanette Schulz-Menger
- Charité ECRC Medical Faculty of the Humboldt University Berlin and Helios-Clinics, Berlin, Germany
- DZHK, Partner site Berlin, Berlin, Germany
| | - Leslee Shaw
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERCV, Barcelona, Spain
| | - Berlinde von Kemp
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
| | - Fausto J Pinto
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
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5
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Kadoglou NPE, Papadopoulos CΗ, Khattab E, Velidakis N, Lambropoulos S. The diagnostic value of stress echocardiography with limited myocardial ischemia in high-risk patients. Hellenic J Cardiol 2024:S1109-9666(23)00233-6. [PMID: 38182003 DOI: 10.1016/j.hjc.2023.12.007] [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: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The diagnostic value of limited myocardial ischemia in DSE is not well known. OBJECTIVES We investigated whether myocardial ischemia during dobutamine stress echocardiography (DSE) in 1 apical segment of any of the ventricular walls of the left ventricle relates to the anatomical and functional stenosis of the suppling coronary artery. METHODS Our observational, prospective study enrolled 212 patients, symptomatic or asymptomatic, with newly diagnosed limited myocardial ischemia on DSE. Almost 25% of them had already known CAD, while the rest were divided into low-risk and high-risk groups, integrating 1-2 and ≥3 classical cardiovascular risk factors, respectively. After DSE, all patients underwent invasive coronary angiography (ICA) and were followed up for one year. In coronary arteries distributing ischemic area, the calculated stenosis ≥50% and FFR<0.8 were considered anatomically and functionally significant, respectively. In the latter cases, the patients underwent coronary revascularization. RESULTS Significant anatomical and functional stenosis of the supplying coronary artery was common among patients with already known CAD (62.5% and 44.5%, respectively) or those without CAD but a high-risk profile (60.2% and 25.6%, respectively). In logistic regression analysis, CAD revascularization was independently determined by an already known CAD, diabetes mellitus, and high-risk profile. During follow-up, 24 patients experienced ACS or new angina episodes, which were associated with diabetes and smoking in univariate analysis. CONCLUSION Limited myocardial ischemia may implicate significant anatomical and functional coronary stenosis among individuals with a history of CAD or those without known CAD but a high-risk profile. The prognostic value of our findings requires further investigation.
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Affiliation(s)
| | | | - Elina Khattab
- Medical School, University of Cyprus, Nicosia, Cyprus
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6
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Székely A, Steding-Ehrenborg K, Ryd D, Hedeer F, Valind K, Akil S, Hindorf C, Hedström E, Erlinge D, Arheden H, Engblom H. Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome: A cardiac positron emission tomography study. Clin Physiol Funct Imaging 2024; 44:89-99. [PMID: 37642142 DOI: 10.1111/cpf.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty-six patients [median age 69 (range 46-86) years, 24 females] planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac 13 N-NH3 positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusionmin ) at stress and rest and lowest myocardial perfusion reserve (MPRmin ) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%-100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusionmin at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPRmin . Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS.
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Affiliation(s)
- Anna Székely
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kristian Valind
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahnaz Akil
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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7
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Sade LE, Joshi SS, Cameli M, Cosyns B, Delgado V, Donal E, Edvardsen T, Carvalho RF, Manka R, Podlesnikar T, Popescu BA, Hanzevacki JS, Sitges M, Dweck MR. Current clinical use of speckle-tracking strain imaging: insights from a worldwide survey from the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2023; 24:1583-1592. [PMID: 37463125 DOI: 10.1093/ehjci/jead170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Speckle-tracking echocardiography (STE) strain imaging has been a major advancement in myocardial function quantification. We aimed to explore current worldwide clinical application of STE. METHODS AND RESULTS Access, feasibility, access, and clinical implementation of STE were investigated with a worldwide open-access online survey of the European Association of Cardiovascular Imaging. Participants (429 respondents and 77 countries) from tertiary centres (46%), private clinics, or public hospitals (54%) using different vendors for data acquisition and analysis were represented. Despite almost universal access (98%) to STE, only 39% of the participants performed and reported STE results frequently (>50%). Incomplete training and time constraints were the main reasons for not using STE more regularly. STE was mainly used to assess the LV (99%) and less frequently the right ventricular (57%) and the left atrial (46%) function. Cardiotoxicity (88%) and cardiac amyloidosis (87%) were the most frequent reasons for the clinical use of LV STE. Left atrial STE was used most frequently for the diagnosis of diastolic dysfunction and right ventricular STE for the assessment of right ventricle (RV) function in pulmonary hypertension (51%). Frequency of STE use, adherence to optimal techniques, and clinical appropriateness of STE differed according to training experience and across vendors. Key suggestions outlined by respondents to increase the clinical use of STE included improved reproducibility (48%) and standardization of strain values across vendors (42%). CONCLUSION Although STE is now readily available, it is underutilized in the majority of centres. Structured training, improved reproducibility, and inter-vendor standardization may increase its uptake.
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Affiliation(s)
- Leyla Elif Sade
- Department of Cardiology, University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Lothrop Street, Ste E354.2, Pittsburgh, PA, 15232, USA
| | - Shruti S Joshi
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Matteo Cameli
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Victoria Delgado
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Norway
| | - Ricardo Fontes Carvalho
- Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
- Centro de Investigação Cardiovascular (UniC@RISE), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | | | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBER, Centro de Investigación Biomédica en Red, Spain
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, Chancellor's Building, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
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8
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Nabeta T, Meucci MC, Westenberg JJM, Reiber JH, Knuuti J, van der Bijl P, Marsan NA, Bax JJ. Prognostic implications of left ventricular inward displacement assessed by cardiac magnetic resonance imaging in patients with myocardial infarction. Int J Cardiovasc Imaging 2023; 39:1525-1533. [PMID: 37249652 PMCID: PMC10427538 DOI: 10.1007/s10554-023-02861-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 05/31/2023]
Abstract
Risk stratification of patients with ischemic heart disease (IHD) still depends mainly on the left ventricular ejection fraction (LVEF). LV inward displacement (InD) is a novel parameter of LV systolic function, derived from feature tracking cardiac magnetic resonance (CMR) imaging. We aimed to investigate the prognostic impact of InD in patients with IHD and prior myocardial infarction. A total of 111 patients (mean age 57 ± 10, 86% male) with a history of myocardial infarction who underwent CMR were included. LV InD was quantified by measuring the displacement of endocardially tracked points towards the centreline of the LV during systole with feature tracking CMR. The endpoint was a composite of all-cause mortality, heart failure hospitalization and arrhythmic events. During a median follow-up of 142 (IQR 107-159) months, 31 (27.9%) combined events occurred. Kaplan-Meier analysis demonstrated that patients with LV InD below the study population median value (23.0%) had a significantly lower event-free survival (P < 0.001). LV InD remained independently associated with outcomes (HR 0.90, 95% CI 0.84-0.98, P = 0.010) on multivariate Cox regression analysis. InD also provided incremental prognostic value to LVEF, LV global radial strain and CMR scar burden. LV InD, measured with feature tracking CMR, was independently associated with outcomes in patients with IHD and prior myocardial infarction. LV InD also provided incremental prognostic value, in addition to LVEF and LV global radial strain. LV InD holds promise as a pragmatic imaging biomarker for post-infarct risk stratification.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Johan Hc Reiber
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Medis Medical Imaging Systems, Schuttersveld 9, Leiden, 2316 XG, The Netherlands
| | - Juhani Knuuti
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
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9
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Zampella E, Assante R, Acampa W. Myocardial perfusion reserve by CZT cameras: A journey inside coronary microvascular circulation. Is it time to leave yet? J Nucl Cardiol 2023; 30:1668-1670. [PMID: 37311913 DOI: 10.1007/s12350-023-03313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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10
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Abstract
Approach to imaging ischemia in women Coronary artery disease in women tends to have a worse short- and long-term prognosis relative to men and remains the leading cause of mortality worldwide. Both clinical symptoms and diagnostic approach remain challenging in women due to lesser likelihood of women presenting with classic anginal symptoms on one hand and underperformance of conventional exercise treadmill testing in women on the other. Moreover, a higher proportion of women with signs and symptoms suggestive of ischemia are more likely to have nonobstructive coronary artery disease (CAD) that requires additional imaging and therapeutic considerations. New imaging techniques such as coronary computed tomography (CT) angiography, CT myocardial perfusion imaging, CT functional flow reserve assessment, and cardiac magnetic resonance imaging carry substantially better sensitivity and specificity for the detection of ischemia and coronary artery disease in women. Familiarity with various clinical subtypes of ischemic heart disease in women and with the major advantages and disadvantages of advanced imaging tests to ensure the decision to select one modality over another is one of the keys to successful diagnosis of CAD in women. This review compares the 2 major types of ischemic heart disease in women - obstructive and nonobstructive, while focusing on sex-specific elements of its pathophysiology.
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11
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Ricci F, Khanji MY, Bisaccia G, Cipriani A, Di Cesare A, Ceriello L, Mantini C, Zimarino M, Fedorowski A, Gallina S, Petersen SE, Bucciarelli-Ducci C. Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:662-673. [PMID: 37285143 PMCID: PMC10248816 DOI: 10.1001/jamacardio.2023.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Importance The clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown. Objective To provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain. Data Sources PubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021. Study Selection Selected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included. Data Extraction and Synthesis This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Main Outcomes and Measures Diagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death. Results A total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%. Conclusion and Relevance In this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, Barts Biomedical Research Centre, National Institute for Health and Care Research, Queen Mary University London, Charterhouse Square, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Rimini Hospital, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Steffen E. Petersen
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
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12
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Zampella E, Mannarino T, D'Antonio A, Assante R, Gaudieri V, Buongiorno P, Panico M, Cantoni V, Green R, Nappi C, Arumugam P, Petretta M, Cuocolo A, Acampa W. Prediction of outcome by 82Rb PET/CT in patients with ischemia and nonobstructive coronary arteries. J Nucl Cardiol 2023; 30:1110-1117. [PMID: 36352083 DOI: 10.1007/s12350-022-03144-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The purpose of this study was to assess the prognostic value of cardiac 82Rb positron emission tomography (PET)/computed tomography (CT) imaging in patients with myocardial ischemia of nonobstructive coronary arteries (INOCA). METHODS We retrospectively evaluated 311 INOCA patients who underwent rest stress 82Rb PET/CT. Cardiac end points were cardiac death, myocardial infarction, or late coronary revascularization. A parametric survival model was also used to identify how the variables influenced time to event. RESULTS During a median follow-up of 37 months (range 6-108), 23 (7%) cardiac events occurred. In patients with events total perfusion defect (TPD) was higher and myocardial flow reserve (MFR) lower compared to those without events (both P < .001). At multivariable Cox analysis, increased TPD (i.e., ≥ 5%) and reduced MFR (i.e., < 2) were predictors of events (both P < .001). At Weibull survival analysis, the highest probability of cardiac events and risk acceleration were observed in patients with both increased TPD and reduced MFR. Annualized event rate was higher in patients with reduced MFR compared to those with preserved MFR (P < .001). CONCLUSION In patients with INOCA, the combined evaluation of myocardial perfusion and coronary vascular function by 82Rb PET/CT is able to identify those at higher risk of cardiac events.
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Affiliation(s)
- Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | | | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
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13
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Khoche S, Ellis J, Poorsattar SP, Kothari P, Oliver A, Whyte A, Maus TM. The Year in Perioperative Echocardiography: Selected Highlights From 2022. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00260-4. [PMID: 37208207 DOI: 10.1053/j.jvca.2023.04.023] [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: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
THIS SPECIAL article is part of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the Editorial Board for the opportunity to continue this series, which focuses on the past year's research highlights that pertain to perioperative echocardiography in relation to cardiothoracic and vascular anesthesia. The major selected themes for 2022 include (1) updates on mitral valve assessments and interventions, (2) training and simulation updates, (3) outcomes and complications of transesophageal echocardiography, and (4) point-of-care cardiac ultrasound. The themes selected for this special article are just a sample of the advances in perioperative echocardiography during 2022. An appreciation and understanding of these highlights will help to ensure and improve the perioperative outcomes for patients with cardiovascular disease undergoing cardiac surgery.
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Affiliation(s)
- Swapnil Khoche
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California
| | - Jon Ellis
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California
| | - Sophia P Poorsattar
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Perin Kothari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ashley Oliver
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Alice Whyte
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy M Maus
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California.
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14
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Entezarmahdi SM, Faghihi R, Yazdi M, Shahamiri N, Geramifar P, Haghighatafshar M. QCard-NM: Developing a semiautomatic segmentation method for quantitative analysis of the right ventricle in non-gated myocardial perfusion SPECT imaging. EJNMMI Phys 2023; 10:21. [PMID: 36959409 PMCID: PMC10036722 DOI: 10.1186/s40658-023-00539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Recent studies have shown that the right ventricular (RV) quantitative analysis in myocardial perfusion imaging (MPI) SPECT can be beneficial in the diagnosis of many cardiopulmonary diseases. This study proposes a new algorithm for right ventricular 3D segmentation and quantification. METHODS The proposed Quantitative Cardiac analysis in Nuclear Medicine imaging (QCard-NM) algorithm provides RV myocardial surface estimation and creates myocardial contour using an iterative 3D model fitting method. The founded contour is then used for quantitative RV analysis. The proposed method was assessed using various patient datasets and digital phantoms. First, the physician's manually drawn contours were compared to the QCard-NM RV segmentation using the Dice similarity coefficient (DSC). Second, using repeated MPI scans, the QCard-NM's repeatability was evaluated and compared with the QPS (quantitative perfusion SPECT) algorithm. Third, the bias of the calculated RV cavity volume was analyzed using 31 digital phantoms using the QCard-NM and QPS algorithms. Fourth, the ability of QCard-NM analysis to diagnose coronary artery diseases was assessed in 60 patients referred for both MPI and coronary angiography. RESULTS The average DSC value was 0.83 in the first dataset. In the second dataset, the coefficient of repeatability of the calculated RV volume between two repeated scans was 13.57 and 43.41 ml for the QCard-NM and QPS, respectively. In the phantom study, the mean absolute percentage errors for the calculated cavity volume were 22.6% and 42.2% for the QCard-NM and QPS, respectively. RV quantitative analysis using QCard-NM in detecting patients with severe left coronary system stenosis and/or three-vessel diseases achieved a fair performance with the area under the ROC curve of 0.77. CONCLUSION A novel model-based iterative method for RV segmentation task in non-gated MPI SPECT is proposed. The precision, accuracy, and consistency of the proposed method are demonstrated by various validation techniques. We believe this preliminary study could lead to developing a framework for improving the diagnosis of cardiopulmonary diseases using RV quantitative analysis in MPI SPECT.
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Affiliation(s)
- Seyed Mohammad Entezarmahdi
- Nuclear Engineering Department, Shiraz University, Shiraz, Iran
- Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Faghihi
- Nuclear Engineering Department, Shiraz University, Shiraz, Iran.
| | - Mehran Yazdi
- School of Electrical and Computer Engineering, Shiraz University, Shiraz, Iran
| | - Negar Shahamiri
- Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Computer Science and Engineering and IT, Shiraz University, Shiraz, Iran
| | - Parham Geramifar
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Haghighatafshar
- Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Nuclear Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Mingrone G, Astarita A, Colomba A, Catarinella C, Cesareo M, Airale L, Paladino A, Leone D, Vallelonga F, Bringhen S, Gay F, Veglio F, Milan A. Patients with Very High Risk of Cardiovascular Adverse Events during Carfilzomib Therapy: Prevention and Management of Events in a Single Center Experience. Cancers (Basel) 2023; 15:cancers15041149. [PMID: 36831492 PMCID: PMC9953901 DOI: 10.3390/cancers15041149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Carfilzomib (CFZ) improves the prognosis of multiple myeloma (MM) patients but has shown cardiovascular toxicity. The risk stratification of cardiovascular adverse events (CVAEs) now seems well established, while little is known about the course and management of patients with a high-cardiovascular-risk profile or experiencing CVAEs during therapy. Therefore, we aimed to describe our experience in decision making to support health professionals in selecting the best management strategies to prevent and treat CVAEs. A total of 194 patients with indication to CFZ underwent baseline evaluation of CVAEs risk and were prospectively followed. We propose a novel approach, which includes advanced cardiac imaging testing for patients at high baseline CV risk to rule out clinical conditions that could contraindicate starting CFZ. After baseline evaluation, 19 (9.8%) patients were found at high risk of CVAEs: 13 (6.7%) patients underwent advanced cardiac testing and 3 (1.5%) could not receive CFZ due to CV contraindications. A total of 178 (91.7%) patients started CFZ: 82 (46%) experienced arterial-hypertension-related events and 37 (20.8%) major CVAEs; 19 (10.7%) patients had to discontinue or modify the CFZ dosing regimen. Along with baseline risk stratification, subsequent cardiovascular clinical events and diagnostic follow-up both provided critical data to help identify conditions that could contraindicate the anticancer therapy.
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Affiliation(s)
- Giulia Mingrone
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Anna Astarita
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Anna Colomba
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Cinzia Catarinella
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Marco Cesareo
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Lorenzo Airale
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Arianna Paladino
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Dario Leone
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Fabrizio Vallelonga
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Sara Bringhen
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Division of Hematology, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Francesca Gay
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Division of Hematology, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10124 Turin, Italy
| | - Franco Veglio
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
| | - Alberto Milan
- Hypertension Unit, Department of Medical Sciences, Division of Internal Medicine, AO “Città della Salute e della Scienza” University Hospital, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-011-633-6952
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16
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Counseller Q, Aboelkassem Y. Recent technologies in cardiac imaging. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:984492. [PMID: 36704232 PMCID: PMC9872125 DOI: 10.3389/fmedt.2022.984492] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiac imaging allows physicians to view the structure and function of the heart to detect various heart abnormalities, ranging from inefficiencies in contraction, regulation of volumetric input and output of blood, deficits in valve function and structure, accumulation of plaque in arteries, and more. Commonly used cardiovascular imaging techniques include x-ray, computed tomography (CT), magnetic resonance imaging (MRI), echocardiogram, and positron emission tomography (PET)/single-photon emission computed tomography (SPECT). More recently, even more tools are at our disposal for investigating the heart's physiology, performance, structure, and function due to technological advancements. This review study summarizes cardiac imaging techniques with a particular interest in MRI and CT, noting each tool's origin, benefits, downfalls, clinical application, and advancement of cardiac imaging in the near future.
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Affiliation(s)
- Quinn Counseller
- College of Health Sciences, University of Michigan, Flint, MI, United States
| | - Yasser Aboelkassem
- College of Innovation and Technology, University of Michigan, Flint, MI, United States,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States,Correspondence: Yasser Aboelkassem
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17
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43:4229-4361. [PMID: 36017568 DOI: 10.1093/eurheartj/ehac244] [Citation(s) in RCA: 715] [Impact Index Per Article: 357.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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18
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Edvardsen T, Donal E, Muraru D, Gimelli A, Fontes-Carvalho R, Maurer G, Petersen SE, Cosyns B. The year 2021 in the European Heart Journal—Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2022; 23:1576-1583. [DOI: 10.1093/ehjci/jeac210] [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: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The European Heart Journal—Cardiovascular Imaging was introduced in 2012 and has during these 10 years become one of the leading multimodality cardiovascular imaging journals. The journal is currently ranked as Number 19 among all cardiovascular journals. It has an impressive impact factor of 9.130 and our journal is well established as one of the top cardiovascular journals. The most important studies published in our Journal in 2021 will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet , Sognsvannsveien 20, Postbox 4950 Nydalen, NO-0424 Oslo , Norway
- Institute for Clinical Medicine, University of Oslo , Sognsvannsveien 20, NO-0424 Oslo , Norway
| | - Erwan Donal
- Department of Cardiology and CIC-IT1414, CHU Rennes, Inserm, LTSI-UMR 1099, University Rennes-1, Rennes F-35000 , France
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Piazzale Brescia 20, 20149 Milan , Italy
- Department of Medicine and Surgery, University of Milano-Bicocca , Via Cadore 48, 20900 Monza , Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana G. Monasterio , Via Giuseppe Moruzzi, 1, 56124 Pisa PI , Italy
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, R. Dr. Francisco Sá Carneiro 4400-129 , 4430-999 Vila Nova de Gaia , Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Alameda Prof. Hernâni Monteiro 4200-319 Porto , Portugal
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna , Wahringer Gurtel 18-20, 1090 Vienna , Austria
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust , West Smithfield, London EC1A 7BE , UK
- William Harvey Research Institute, Queen Mary University of London , Charterhouse Square, London EC1M 6BQ , UK
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel , 1090 Jette, Brussels , Belgium
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Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, Boriani G, Cardinale D, Cordoba R, Cosyns B, Cutter DJ, de Azambuja E, de Boer RA, Dent SF, Farmakis D, Gevaert SA, Gorog DA, Herrmann J, Lenihan D, Moslehi J, Moura B, Salinger SS, Stephens R, Suter TM, Szmit S, Tamargo J, Thavendiranathan P, Tocchetti CG, van der Meer P, van der Pal HJH. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging 2022; 23:e333-e465. [PMID: 36017575 DOI: 10.1093/ehjci/jeac106] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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20
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Mikail N, Rossi A, Bengs S, Haider A, Stähli BE, Portmann A, Imperiale A, Treyer V, Meisel A, Pazhenkottil AP, Messerli M, Regitz-Zagrosek V, Kaufmann PA, Buechel RR, Gebhard C. Imaging of heart disease in women: review and case presentation. Eur J Nucl Med Mol Imaging 2022; 50:130-159. [PMID: 35974185 PMCID: PMC9668806 DOI: 10.1007/s00259-022-05914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging - Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, Strasbourg, France.,Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin, Berlin, Berlin, Germany.,University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland. .,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review. J Clin Med 2022; 11:jcm11164680. [PMID: 36012918 PMCID: PMC9410297 DOI: 10.3390/jcm11164680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing “idiopathic” ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.
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22
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Bullock-Palmer RP, Peix A, Aggarwal NR. Nuclear Cardiology in Women and Underrepresented Minority Populations. Curr Cardiol Rep 2022; 24:553-566. [PMID: 35262873 DOI: 10.1007/s11886-022-01673-w] [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] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW To outline sex-specific features of coronary artery disease (CAD) that should be considered in the assessment of women, including those from ethnic minority populations with suspected stable ischemic heart disease (IHD). Second, to determine the latest nuclear imaging tools available to assess microvascular CAD. RECENT FINDINGS Latest studies indicate that women are more likely to have ischemia with no obstructive coronary arteries (INOCA) and paradoxically have worse outcomes. Therefore, the evaluation of women with suspected IHD should include assessing microvascular and epicardial coronary circulation. The prevalence of CAD is increasing in younger women due to the increased cardiovascular disease (CVD) risk burden. CAD is often underrecognized in these patients. There is increasing recognition that INOCA is not benign and should be accurately diagnosed and managed. Nuclear imaging assesses the full spectrum of CAD from microvascular CAD to multivessel obstructive epicardial CAD. Further research on myocardial blood flow (MBF) assessment with PET MPI is needed.
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Affiliation(s)
- Renee P Bullock-Palmer
- Department of Cardiology, Deborah Heart and Lung Center, Trenton Road, Browns Mills, NJ, 08015, USA.
| | - Amalia Peix
- Institute of Cardiology and Cardiovascular Surgery, La Habana, Havana, Cuba
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, 55902, USA
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23
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Porro B, Eligini S, Conte E, Cosentino N, Capra N, Cavalca V, Banfi C. An Optimized MRM-Based Workflow of the l-Arginine/Nitric Oxide Pathway Metabolites Revealed Disease- and Sex-Related Differences in the Cardiovascular Field. Int J Mol Sci 2022; 23:ijms23031136. [PMID: 35163055 PMCID: PMC8835333 DOI: 10.3390/ijms23031136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
Clinical data indicate that low circulating l-homoarginine (HArg) concentrations are associated with cardiovascular (CV) disease, CV mortality, and all-cause mortality. A high number of LC-based analytical methods for the quantification of HArg, in combination with the l-arginine (Arg)-related pathway metabolites, have been reported. However, these methods usually consider a limited panel of analytes. Thus, in order to achieve a comprehensive picture of the Arg metabolism, we described an improved targeted metabolomic approach based on a multiple reaction monitoring (MRM) mass spectrometry method for the simultaneous quantification of the Arg/nitric oxide (NO) pathway metabolites. This methodology was then employed to quantify the plasma concentrations of these analytes in a cohort of individuals with different grades/types of coronary artery disease (CAD) in order to increase knowledge about the role of HArg and its associated metabolites in the CV field. Our results showed that the MRM method here implemented is suitable for the simultaneous assessment of a wide panel of amino acids involved in the Arg/NO metabolic pathway in plasma samples from patients with CV disease. Further, our findings highlighted an impairment of the Arg/NO metabolic pathway, and suggest a sex-dependent regulation of this metabolic route.
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