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Zheng Y, Liu X, Yang K, Chen X, Wang J, Zhao K, Dong W, Yin G, Yu S, Yang S, Lu M, Su G, Zhao S. Cardiac MRI feature-tracking-derived torsion mechanics in systolic and diastolic dysfunction in systemic light-chain cardiac amyloidosis. Clin Radiol 2024; 79:e692-e701. [PMID: 38388253 DOI: 10.1016/j.crad.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 02/24/2024]
Abstract
AIM To describe the myocardial torsion mechanics in cardiac amyloidosis (CA), and evaluate the correlations between left ventricle (LV) torsion mechanics and conventional parameters using cardiac magnetic resonance imaging feature tracking (CMR-FT). MATERIALS AND METHODS One hundred and thirty-nine patients with light-chain CA (AL-CA) were divided into three groups: group 1 with preserved systolic function (LV ejection fraction [LVEF] ≥50%, n=55), group 2 with mildly reduced systolic function (40% ≤ LVEF <50%, n=51), and group 3 with reduced systolic function (LVEF <40%, n=33), and compared with age- and gender-matched healthy controls (n=26). All patients underwent cine imaging and late gadolinium-enhancement (LGE). Cine images were analysed offline using CMR-FT to estimate torsion parameters. RESULTS Global torsion, base-mid torsion, and peak diastolic torsion rate (diasTR) were significantly impaired in patients with preserved systolic function (p<0.05 for all), whereas mid-apex torsion and peak systolic torsion rate (sysTR) were preserved (p>0.05 for both) compared with healthy controls. In patients with mildly reduced systolic function, global torsion and base-mid torsion were lower compared to those with preserved systolic function (p<0.05 for both), while mid-apex torsion, sysTR, and diasTR were preserved (p>0.05 for all). In patients with reduced systolic function, only sysTR was significantly worse compared with mildly reduced systolic function (p<0.05). At multivariable analysis, right ventricle (RV) end-systolic volume RVESV index and NYHA class were independently related to global torsion, whereas LVEF was independently related to sysTR. RV ejection fraction (RVEF) was independently related to diasTR. LV global torsion performed well (AUC 0.71; 95% confidence interval [CI]: 0.61, 0.77) in discriminating transmural from non-transmural LGE in AL-CA patients. CONCLUSION LV torsion mechanics derived by CMR-FT could help to monitor LV systolic and diastolic function in AL-CA patients and function as a new imaging marker for LV dysfunction and LGE transmurality.
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Affiliation(s)
- Y Zheng
- Department of Radiology, Tsinghua University Hospital, Tsinghua University, Beijing, 100084, China; Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - X Liu
- Department of Neurology, Beijing Geriatric Hospital, Wenquan Road No 118, Haidian District, Beijing 100095, China
| | - K Yang
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - X Chen
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - J Wang
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - K Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen 518055, China
| | - W Dong
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - G Yin
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - S Yu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu 610041, Sichuan, China
| | - S Yang
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - M Lu
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China
| | - G Su
- Department of Cardiology, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250013, China.
| | - S Zhao
- Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beilishi Road No 167, Xicheng District, Beijing 100037, China.
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2
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Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre LA, Meadows J, Peters DC. Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:107-117. [PMID: 37857929 DOI: 10.1007/s10554-023-02968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
A relationship between left atrial strain and pressure has been demonstrated in many studies, but not in an atrial fibrillation (AF) cohort. In this work, we hypothesized that elevated left atrial (LA) tissue fibrosis might mediate and confound the LA strain vs. pressure relationship, resulting instead in a relationship between LA fibrosis and stiffness index (mean LA pressure/LA reservoir strain). Sixty-seven patients with AF underwent a standard cardiac MR exam including long-axis cine views (2 and 4-ch) and a free-breathing high resolution three-dimensional late gadolinium enhancement (LGE) of the atrium (N = 41), within 30 days prior to AF ablation, at which procedure invasive mean left atrial pressure (LAP) was measured. LV and LA Volumes, EF, and comprehensive analysis of LA strains (strain and strain rates and strain timings during the atrial reservoir, conduit and active, i.e. active atrial contraction, phases) were measured and LA fibrosis content (LGE (ml)) was assessed from 3D LGE volumes. LA LGE was well correlated to atrial stiffness index overall (R = 0.59, p < 0.001), and among patient subgroups. Pressure was only correlated to maximal LA volume (R = 0.32) and the time to peak reservoir strain rate (R = 0.32) (both p < 0.01), among all functional measurements. LA reservoir strain was strongly correlated with LAEF (R = 0.95, p < 0.001) and LA minimum volume (r = 0.82, p < 0.001). In our AF cohort, pressure is correlated to maximum LA volume and time to peak reservoir strain. LA pressure/ LA reservoir strain, a metric of stiffness, correlates with LA fibrosis (LA LGE), reflecting Hook's Law.
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Affiliation(s)
- Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Roy Taoutel
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Romy Chamoun
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Joseph Akar
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | | | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA
| | - Lauren A Baldassarre
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Judith Meadows
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, CT, USA
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale Magnetic Resonance Research Center, Yale University, 300 Cedar St, TAC N117, PO Box 208043, New Haven, CT, 06520, USA.
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Paccione EN, Lange M, Orkild BA, Bergquist JA, Kwan E, Hunt B, Dosdall D, Macleod RS, Ranjan R. Effects of Biventricular Pacing Locations on Anti-Tachycardia Pacing Success in a Patient-Specific Model. COMPUTING IN CARDIOLOGY 2023; 2023:10.22489/CinC.2023.369. [PMID: 38435379 PMCID: PMC10906957 DOI: 10.22489/cinc.2023.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Patients with drug-refractory ventricular tachycardia (VT) often undergo implantation of a cardiac defibrillator (ICD). While life-saving, shock from an ICD can be traumatic. To combat the need for defibrillation, ICDs come equipped with low-energy pacing protocols. These anti-tachycardia pacing (ATP) methods are conventionally delivered from a lead inserted at the apex of the right ventricle (RV) with limited success. Recent studies have shown the promise of biventricular leads placed in the left ventricle (LV) for ATP delivery. This study tested the hypothesis that stimulating ATP from multiple biventricular locations will improve termination rates in a patient-specific computational model. VT was first induced in the model, followed by ATP delivery from 1-4 biventricular stimulus sites. We found that combining stimulation sites does not alter termination success so long as a critical stimulus site is included. Combining the RV stimulus site with any combination of LV sites did not affect ATP success except for one case. Including the RV site may allow biventricular ATP to be a robust approach across different scar distributions without affecting the efficacy of other stimulation sites. Combining sites may increase the likelihood of including a critical stimulus site when such information cannot be ascertained.
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Affiliation(s)
- Eric N Paccione
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Matthias Lange
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Benjamin A Orkild
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Jake A Bergquist
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Eugene Kwan
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Bram Hunt
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Derek Dosdall
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
| | - Rob S Macleod
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
- Scientific Computing and Imaging Institute, Salt Lake City, USA
| | - Ravi Ranjan
- University of Utah Department of Biomedical Engineering, Salt Lake City, USA
- Cardiovascular Research and Training Institute, Salt Lake City, USA
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Kamali R, Gillete K, Tate J, Abhyankar DA, Dosdall DJ, Plank G, Bunch TJ, Macleod RS, Ranjan R. Treatment Planning for Atrial Fibrillation Using Patient-Specific Models Showing the Importance of Fibrillatory-Areas. Ann Biomed Eng 2023; 51:329-342. [PMID: 35930093 PMCID: PMC10440744 DOI: 10.1007/s10439-022-03029-5] [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: 01/19/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
Computational models have made it possible to study the effect of fibrosis and scar on atrial fibrillation (AF) and plan future personalized treatments. Here, we study the effect of area available for fibrillatory waves to sustain AF. Then we use it to plan for AF ablation to improve procedural outcomes. CARPentry was used to create patient-specific models to determine the association between the size of residual contiguous areas available for AF wavefronts to propagate and sustain AF [fibrillatory area (FA)] after ablation with procedural outcomes. The FA was quantified in a novel manner accounting for gaps in ablation lines. We selected 30 persistent AF patients with known ablation outcomes. We divided the atrial surface into five areas based on ablation scar pattern and anatomical landmarks and calculated the FAs. We validated the models based on clinical outcomes and suggested future ablation lines that minimize the FAs and terminate rotor activities in simulations. We also simulated the effects of three common antiarrhythmic drugs. In the patient-specific models, the predicted arrhythmias matched the clinical outcomes in 25 of 30 patients (accuracy 83.33%). The average largest FA (FAmax) in the recurrence group was 8517 ± 1444 vs. 6772 ± 1531 mm2 in the no recurrence group (p < 0.004). The final FAs after adding the suggested ablation lines in the AF recurrence group reduced the average FAmax from 8517 ± 1444 to 6168 ± 1358 mm2 (p < 0.001) and stopped the sustained rotor activity. Simulations also correctly anticipated the effect of antiarrhythmic drugs in 5 out of 6 patients who used drug therapy post unsuccessful ablation (accuracy 83.33%). Sizes of FAs available for AF wavefronts to propagate are important determinants for ablation outcomes. FA size in combination with computational simulations can be used to direct ablation in persistent AF to minimize the critical mass required to sustain recurrent AF.
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Affiliation(s)
- Roya Kamali
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Karli Gillete
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Jess Tate
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rob S Macleod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
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Hopman LHGA, Bhagirath P, Mulder MJ, Eggink IN, van Rossum AC, Allaart CP, Götte MJW. Quantification of left atrial fibrosis by 3D late gadolinium-enhanced cardiac magnetic resonance imaging in patients with atrial fibrillation: impact of different analysis methods. Eur Heart J Cardiovasc Imaging 2022; 23:1182-1190. [PMID: 35947873 PMCID: PMC9365307 DOI: 10.1093/ehjci/jeab245] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Various methods and post-processing software packages have been developed to quantify left atrial (LA) fibrosis using 3D late gadolinium-enhancement cardiac magnetic resonance (LGE-CMR) images. Currently, it remains unclear how the results of these methods and software packages interrelate.
Methods and results
Forty-seven atrial fibrillation (AF) patients underwent 3D-LGE-CMR imaging prior to their AF ablation. LA fibrotic burden was derived from the images using open-source CEMRG software and commercially available ADAS 3D-LA software. Both packages were used to calculate fibrosis based on the image intensity ratio (IIR)-method. Additionally, CEMRG was used to quantify LA fibrosis using three standard deviations (3SD) above the mean blood pool signal intensity. Intraclass correlation coefficients were calculated to compare LA fibrosis quantification methods and different post-processing software outputs. The percentage of LA fibrosis assessed using IIR threshold 1.2 was significantly different from the 3SD-method (29.80 ± 14.15% vs. 8.43 ± 5.42%; P < 0.001). Correlation between the IIR-and SD-method was good (r = 0.85, P < 0.001) although agreement was poor [intraclass correlation coefficient (ICC) = 0.19; P < 0.001]. One-third of the patients were allocated to a different fibrosis category dependent on the used quantification method. Fibrosis assessment using CEMRG and ADAS 3D-LA showed good agreement for the IIR-method (ICC = 0.93; P < 0.001).
Conclusions
Both, the IIR1.2 and 3SD-method quantify atrial fibrotic burden based on atrial wall signal intensity differences. The discrepancy in the amount of LA fibrosis between these methods may have clinical implications when patients are classified according to their fibrotic burden. There was no difference in results between post-processing software packages to quantify LA fibrosis if an identical quantification method including the threshold was used.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Iris N Eggink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
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Peters DC, Lamy J, Sinusas AJ, Baldassarre LA. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 2021; 23:14-30. [PMID: 34718484 DOI: 10.1093/ehjci/jeab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan-rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of 'pre-existent' atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.
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Affiliation(s)
- Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
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Liu J, Zhao S, Yu S, Wu G, Wang D, Liu L, Song J, Zhu Y, Kang L, Wang J, Song L. Patterns of Replacement Fibrosis in Hypertrophic Cardiomyopathy. Radiology 2021; 302:298-306. [PMID: 34726536 DOI: 10.1148/radiol.2021210914] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Myocardial replacement fibrosis is one of the major histologic features of hypertrophic cardiomyopathy (HCM), but its characteristics have not been well delineated. Purpose To clarify the characteristics of replacement fibrosis in HCM and to evaluate the prognostic value of the regional extent of fibrosis. Materials and Methods This prospective study evaluated participants with HCM who underwent contrast-enhanced cardiac MRI from March 2011 to April 2019. For each participant, global and 16-segment extent of late gadolinium enhancement (LGE) in the left ventricle (LV) at cardiac MRI was analyzed. The primary end point was all-cause death. Results Among the 798 study participants enrolled (median age, 49 years [interquartile range {IQR}: 38-59 years]; 508 men), 588 (74%) underwent whole-exome sequencing. Thirty-five participants (4%) experienced death from any cause during a median follow-up of 2.9 years (IQR: 1.5-4.7 years). Spearman analysis showed weak correlations between the extent of LGE and wall thickness (LGE of global LV and maximal LV wall thickness, r = 0.35 [P < .001]; LGE and thickness of septum, r = 0.30 [P < .001]). In the 16-segment model, the distribution of LGE was visually inhomogeneous and higher in the basal anterior, basal septal, midanterior, and midseptal regions (P < .001). This similar distribution of LGE was observed in participants with asymmetric septal hypertrophy, those with apical HCM, participants positive for mutation and those negative for mutation, and participants with MYH7 and MYBPC3 mutations. Cox analysis indicated that both the global extent of LGE (adjusted hazard ratio = 1.68 per 10% increase in LGE; P < .001) and the regional extent of LGE (ie, basal, midventricular, and apical regions of LV when on the short-axis view; septum, anterior free wall, inferior free wall, and lateral free wall when on the long-axis view) were associated with adverse outcomes. Conclusion In hypertrophic cardiomyopathy, myocardial replacement fibrosis weakly correlated with hypertrophy, was inhomogeneous and asymmetric, and was predominantly distributed in the interventricular septal wall and anterior free wall at the basal and mid levels. Greater extent of fibrosis was associated with poor prognosis, regardless of its location in the left ventricle. © RSNA, 2021 See also the editorial by Hanneman in this issue.
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Affiliation(s)
- Jie Liu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Shihua Zhao
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Shiqin Yu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Guixin Wu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Dong Wang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lele Liu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Jialin Song
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Yuming Zhu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lianming Kang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Jizheng Wang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lei Song
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
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Gunasekaran S, Kim D. Is Otsu thresholding the answer to reproducible quantification of left atrial scar from late gadolinium-enhancement MRI? J Cardiovasc Electrophysiol 2020; 31:2833-2835. [PMID: 32931626 DOI: 10.1111/jce.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Suvai Gunasekaran
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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