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Lechner I, Reindl M, Stiermaier T, Tiller C, Holzknecht M, Oberhollenzer F, von der Emde S, Mayr A, Feistritzer HJ, Carberry J, Carrick D, Bauer A, Thiele H, Berry C, Eitel I, Metzler B, Reinstadler SJ. Clinical Outcomes Associated With Various Microvascular Injury Patterns Identified by CMR After STEMI. J Am Coll Cardiol 2024; 83:2052-2062. [PMID: 38777509 DOI: 10.1016/j.jacc.2024.03.408] [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: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The prognostic significance of various microvascular injury (MVI) patterns after ST-segment elevation myocardial infarction (STEMI) is not well known. OBJECTIVES This study sought to investigate the prognostic implications of different MVI patterns in STEMI patients. METHODS The authors analyzed 1,109 STEMI patients included in 3 prospective studies. Cardiac magnetic resonance (CMR) was performed 3 days (Q1-Q3: 2-5 days) after percutaneous coronary intervention (PCI) and included late gadolinium enhancement imaging for microvascular obstruction (MVO) and T2∗ mapping for intramyocardial hemorrhage (IMH). Patients were categorized into those without MVI (MVO-/IMH-), those with MVO but no IMH (MVO+/IMH-), and those with IMH (IMH+). RESULTS MVI occurred in 633 (57%) patients, of whom 274 (25%) had an MVO+/IMH- pattern and 359 (32%) had an IMH+ pattern. Infarct size was larger and ejection fraction lower in IMH+ than in MVO+/IMH- and MVO-/IMH- (infarct size: 27% vs 19% vs 18% [P < 0.001]; ejection fraction: 45% vs 50% vs 54% [P < 0.001]). During a median follow-up of 12 months (Q1-Q3: 12-35 months), a clinical outcome event occurred more frequently in IMH+ than in MVO+/IMH- and MVO-/IMH- subgroups (19.5% vs 3.6% vs 4.4%; P < 0.001). IMH+ was the sole independent MVI parameter predicting major adverse cardiovascular events (HR: 3.88; 95% CI: 1.93-7.80; P < 0.001). CONCLUSIONS MVI is associated with future adverse outcomes only in patients with a hemorrhagic phenotype (IMH+). Patients with only MVO (MVO+/IMH-) had a prognosis similar to patients without MVI (MVO-/IMH-). This highlights the independent prognostic importance of IMH in assessing and managing risk after STEMI.
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Affiliation(s)
- Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fritz Oberhollenzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian von der Emde
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
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A X, Liu M, Chen T, Chen F, Qian G, Zhang Y, Chen Y. Non-Contrast Cine Cardiac Magnetic Resonance Derived-Radiomics for the Prediction of Left Ventricular Adverse Remodeling in Patients With ST-Segment Elevation Myocardial Infarction. Korean J Radiol 2023; 24:827-837. [PMID: 37634638 PMCID: PMC10462896 DOI: 10.3348/kjr.2023.0061] [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: 01/17/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the one-week CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC). RESULTS Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00-1.07); P = 0.031) and RAD score (OR: 3.43 (2.34-5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75-0.89) in the training set and 0.75 (0.62-0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72-0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52-0.84) to 0.82 (0.70-0.93) (P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65-0.94) (P = 0.727). CONCLUSION Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters.
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Affiliation(s)
- Xin A
- Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, China
- The Senior Department of Cardiology, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mingliang Liu
- Nankai University, School of Medicine, Tianjin, Nankai, China
| | - Tong Chen
- Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, China
- The Senior Department of Cardiology, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Feng Chen
- Department of Computer Science, the University of Adelaide, Adelaide, Australia
| | - Geng Qian
- Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, China
- The Senior Department of Cardiology, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ying Zhang
- The Senior Department of Cardiology, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yundai Chen
- The Senior Department of Cardiology, the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
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Legallois D, Hodzic A, Milliez P, Manrique A, Dolladille C, Saloux E, Beygui F. Left atrial strain quantified after myocardial infarction is associated with early left ventricular remodeling. Echocardiography 2022; 39:1581-1588. [PMID: 36376262 DOI: 10.1111/echo.15492] [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: 03/22/2022] [Revised: 08/23/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Left ventricular remodeling (LVR) is common and associated with adverse outcome after ST-elevation myocardial infarction (STEMI). We aimed to investigate the association between left atrial (LA) mechanical function using speckle tracking imaging and early LVR at follow-up in STEMI patients. METHODS Baseline 3D thoracic echocardiograms were performed within 48 h following admission and at a median follow-up of 7 months after STEMI. A > 20% increase in the left ventricular (LV) end-diastolic volume compared to baseline at follow-up was defined as LVR. LA global longitudinal strain was evaluated for the reservoir, conduit, and contraction (LASct) phases. RESULTS A total of 121 patients without clinical heart failure (HF) were prospectively included, between June 2015 and October 2018 (age 58.3 ± 12.5 years, male 98 (81%)). Baseline and follow-up LV ejection fraction (LVEF) were 46.8% [41.0, 52.9] and 52.1% [45.8, 57.0] respectively (p < .001). Compared to other patients, those with LVR had significantly lower values of LASct at baseline (-7.4% [-10.1, -6.5] vs. -9.9% [-12.8, -8.1], p < .01), both on univariate and baseline LV volumes-adjusted analyses. Baseline LA strain for reservoir and conduit phases were not associated with significant LVR at follow-up. Intra- and interobserver analysis showed good reproducibility of LA strain. CONCLUSIONS Baseline LASct may help identifying patients without HF after STEMI who are at higher risk of further early LVR and subsequent HF and who may benefit from more intensive management.
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Affiliation(s)
- Damien Legallois
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
| | - Amir Hodzic
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, INSERM Comete, Caen, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
| | - Alain Manrique
- Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France.,Department of Nuclear Medicine, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Charles Dolladille
- Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France.,Department of Pharmacology, Normandie Univ, UNICAEN, CHU de Caen Normandie, PICARO Cardio-Oncology program, Caen, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
| | - Farzin Beygui
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France.,ACTION academic research group, Pitié-Salpêtrière University Hospital, Paris, France
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Vyas R, Changal KH, Bhuta S, Pasadyn V, Katterle K, Niedoba MJ, Vora K, Dharmakumar R, Gupta R. Impact of Intramyocardial Hemorrhage on Clinical Outcomes in ST-Elevation Myocardial Infarction: A Systematic Review and Meta-analysis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100444. [PMID: 39132339 PMCID: PMC11307811 DOI: 10.1016/j.jscai.2022.100444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 08/13/2024]
Abstract
Background Intramyocardial hemorrhage (IMH) occurs after ST-elevation myocardial infarction (STEMI) and has been documented using cardiac magnetic resonance imaging. The prevalence and prognostic significance of IMH are not well described, and the small sample size has limited prior studies. Methods We performed a comprehensive literature search of multiple databases to identify studies that compared outcomes in STEMI patients with or without IMH. The outcomes studied were major adverse cardiovascular events (MACE), infarct size, thrombolysis in myocardial infarction (TIMI) flow after percutaneous coronary intervention (PCI), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), and mortality. Odds ratios (ORs) and standardized mean differences with corresponding 95% CIs were calculated using a random effects model. Results Eighteen studies, including 2824 patients who experienced STEMI (1078 with IMH and 1746 without IMH), were included. The average prevalence of IMH was 39%. There is a significant association between IMH and subsequent MACE (OR, 2.63; 95% CI, 1.79-3.86; P < .00001), as well as IMH and TIMI grade <3 after PCI (OR, 1.75; 95% CI, 1.14-2.68; P = .05). We also found a significant association between IMH and the use of glycoprotein IIb/IIIa inhibitors (OR, 2.34; 95% CI, 1.42-3.85; P = .0008). IMH has a positive association with infarct size (standardized mean difference, 2.19; 95% CI, 1.53-2.86; P < .00001) and LVEDV (standardized mean difference, 0.7; 95% CI, 0.41-0.99; P < .00001) and a negative association with LVEF (standardized mean difference, -0.89; 95% CI, -1.15 to -0.63; P = .01). Predictors of IMH include male sex, smoking, and left anterior descending infarct. Conclusions Intramyocardial hemorrhage is prevalent in approximately 40% of patients who experience STEMI. IMH is a significant predictor of MACE and is associated with larger infarct size, higher LVEDV, and lower LVEF after STEMI.
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Affiliation(s)
- Rohit Vyas
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
| | - Khalid H. Changal
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
| | - Sapan Bhuta
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Vanessa Pasadyn
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Konrad Katterle
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | | | - Keyur Vora
- Department of Medicine and Cardiovascular Institute, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rohan Dharmakumar
- Department of Medicine and Cardiovascular Institute, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
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5
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Role of puerarin in pathological cardiac remodeling: A review. Pharmacol Res 2022; 178:106152. [DOI: 10.1016/j.phrs.2022.106152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/22/2022]
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6
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Implementing the risk stratification in STEMI by cardiovascular magnetic resonance: An academic exercise or real benefit? Int J Cardiol 2022; 352:188-189. [DOI: 10.1016/j.ijcard.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/20/2022]
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7
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Masci PG, Bogaert J. Editorial for "Inflammation in Remote Myocardium and Left Ventricular Remodeling After Acute Myocardial Infarction: A Pilot Study Using T2 Mapping". J Magn Reson Imaging 2021; 55:565-566. [PMID: 34309118 DOI: 10.1002/jmri.27861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, UK
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven and Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Shi K, Ma M, Yang MX, Xia CC, Peng WL, He Y, Li ZL, Guo YK, Yang ZG. Increased oxygenation is associated with myocardial inflammation and adverse regional remodeling after acute ST-segment elevation myocardial infarction. Eur Radiol 2021; 31:8956-8966. [PMID: 34003352 DOI: 10.1007/s00330-021-08032-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/26/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To explore the relationships between oxygenation signal intensity (SI) with myocardial inflammation and regional left ventricular (LV) remodeling in reperfused acute ST-segment elevation myocardial infarction (STEMI) using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR). METHODS Thirty-three STEMI patients and 22 age- and sex-matched healthy volunteers underwent CMR. The protocol included cine function, OS imaging, precontrast T1 mapping, T2 mapping, and late gadolinium enhancement (LGE) imaging. A total of 880 LV segments were included for analysis based on the American Heart Association 16-segment model. For validation, 15 pigs (10 myocardial infarction (MI) model animals and 5 controls) received CMR and were sacrificed for immunohistochemical analysis. RESULTS In the patient study, the acute oxygenation SI showed a stepwise rise among remote, salvaged, and infarcted segments compared with healthy myocardium. At convalescence, all oxygenation SI values besides those in infarcted segments with microvascular obstruction decreased to similar levels. Acute oxygenation SI was associated with early myocardial injury (T1: r = 0.38; T2: r = 0.41; all p < 0.05). Segments with higher acute oxygenation SI values exhibited thinner diastolic walls and decreased wall thickening during follow-up. Multivariable regression modeling indicated that acute oxygenation SI (β = 2.66; p < 0.05) independently predicted convalescent segment adverse remodeling (LV wall thinning). In the animal study, alterations in oxygenation SI were correlated with histological inflammatory infiltrates (r = 0.59; p < 0.001). CONCLUSIONS Myocardial oxygenation by OS-CMR could be used as a quantitative imaging biomarker to assess myocardial inflammation and predict convalescent segment adverse remodeling after STEMI. KEY POINTS • Oxygenation signal intensity (SI) may be an imaging biomarker of inflammatory infiltration that could be used to assess the response to anti-inflammatory therapies in the future. • Oxygenation SI early after myocardial infarction (MI) was associated with left ventricular segment injury at acute phase and could predict regional functional recovery and adverse remodeling late after acute MI. • Oxygenation SI demonstrated a stepwise increase among remote, salvaged, and infarcted segments. Infarcted zones with microvascular obstruction demonstrated a higher oxygenation SI than those without. However, the former showed less pronounced changes over time.
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Affiliation(s)
- Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng-Xi Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Biotherapy and Cancer Center, Sichuan University, Chengdu, Sichuan, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wan-Lin Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Scalise RFM, De Sarro R, Caracciolo A, Lauro R, Squadrito F, Carerj S, Bitto A, Micari A, Bella GD, Costa F, Irrera N. Fibrosis after Myocardial Infarction: An Overview on Cellular Processes, Molecular Pathways, Clinical Evaluation and Prognostic Value. Med Sci (Basel) 2021; 9:medsci9010016. [PMID: 33804308 PMCID: PMC7931027 DOI: 10.3390/medsci9010016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
The ischemic injury caused by myocardial infarction activates a complex healing process wherein a powerful inflammatory response and a reparative phase follow and balance each other. An intricate network of mediators finely orchestrate a large variety of cellular subtypes throughout molecular signaling pathways that determine the intensity and duration of each phase. At the end of this process, the necrotic tissue is replaced with a fibrotic scar whose quality strictly depends on the delicate balance resulting from the interaction between multiple actors involved in fibrogenesis. An inflammatory or reparative dysregulation, both in term of excess and deficiency, may cause ventricular dysfunction and life-threatening arrhythmias that heavily affect clinical outcome. This review discusses cellular process and molecular signaling pathways that determine fibrosis and the imaging technique that can characterize the clinical impact of this process in-vivo.
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Affiliation(s)
- Renato Francesco Maria Scalise
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Rosalba De Sarro
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Rita Lauro
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (R.L.); (F.S.); (A.B.)
| | - Francesco Squadrito
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (R.L.); (F.S.); (A.B.)
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Alessandra Bitto
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (R.L.); (F.S.); (A.B.)
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinico “G. Martino”, 98100 Messina, Italy;
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
- Correspondence: ; Tel.: +39-090-221-23-41; Fax: +39-090-221-23-81
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
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Ma Q, Ma Y, Yu T, Sun Z, Hou Y. Radiomics of Non-Contrast-Enhanced T1 Mapping: Diagnostic and Predictive Performance for Myocardial Injury in Acute ST-Segment-Elevation Myocardial Infarction. Korean J Radiol 2020; 22:535-546. [PMID: 33289360 DOI: 10.3348/kjr.2019.0969] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/15/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of texture analysis on non-contrast-enhanced T1 maps of cardiac magnetic resonance (CMR) imaging for the diagnosis of myocardial injury in acute myocardial infarction (MI). MATERIALS AND METHODS This study included 68 patients (57 males and 11 females; mean age, 55.7 ± 10.5 years) with acute ST-segment-elevation MI who had undergone 3T CMR after a percutaneous coronary intervention. Forty patients of them also underwent a 6-month follow-up CMR. The CMR protocol included T2-weighted imaging, T1 mapping, rest first-pass perfusion, and late gadolinium enhancement. Radiomics features were extracted from the T1 maps using open-source software. Radiomics signatures were constructed with the selected strongest features to evaluate the myocardial injury severity and predict the recovery of left ventricular (LV) longitudinal systolic myocardial contractility. RESULTS A total of 1088 segments of the acute CMR images were analyzed; 103 (9.5%) segments showed microvascular obstruction (MVO), and 557 (51.2%) segments showed MI. A total of 640 segments were included in the 6-month follow-up analysis, of which 160 (25.0%) segments showed favorable recovery of LV longitudinal systolic myocardial contractility. Combined radiomics signature and T1 values resulted in a higher diagnostic performance for MVO compared to T1 values alone (area under the curve [AUC] in the training set; 0.88, 0.72, p = 0.031: AUC in the test set; 0.86, 0.71, p002). Combined radiomics signature and T1 values also provided a higher predictive value for LV longitudinal systolic myocardial contractility recovery compared to T1 values (AUC in the training set; 0.76, 0.55, p < 0.001: AUC in the test set; 0.77, 0.60, p < 0.001). CONCLUSION The combination of radiomics of non-contrast-enhanced T1 mapping and T1 values could provide higher diagnostic accuracy for MVO. Radiomics also provides incremental value in the prediction of LV longitudinal systolic myocardial contractility at six months.
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Affiliation(s)
- Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
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11
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Cardiac magnetic resonance-tissue tracking for the early prediction of adverse left ventricular remodeling after ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2019; 35:2095-2102. [DOI: 10.1007/s10554-019-01659-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/26/2019] [Indexed: 01/20/2023]
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12
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Khalid A, Lim E, Chan BT, Abdul Aziz YF, Chee KH, Yap HJ, Liew YM. Assessing regional left ventricular thickening dysfunction and dyssynchrony via personalized modeling and 3D wall thickness measurements for acute myocardial infarction. J Magn Reson Imaging 2018; 49:1006-1019. [PMID: 30211445 DOI: 10.1002/jmri.26302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Existing clinical diagnostic and assessment methods could be improved to facilitate early detection and treatment of cardiac dysfunction associated with acute myocardial infarction (AMI) to reduce morbidity and mortality. PURPOSE To develop 3D personalized left ventricular (LV) models and thickening assessment framework for assessing regional wall thickening dysfunction and dyssynchrony in AMI patients. STUDY TYPE Retrospective study, diagnostic accuracy. SUBJECTS Forty-four subjects consisting of 15 healthy subjects and 29 AMI patients. FIELD STRENGTH/SEQUENCE 1.5T/steady-state free precession cine MRI scans; LGE MRI scans. ASSESSMENT Quantitative thickening measurements across all cardiac phases were correlated and validated against clinical evaluation of infarct transmurality by an experienced cardiac radiologist based on the American Heart Association (AHA) 17-segment model. STATISTICAL TEST Nonparametric 2-k related sample-based Kruskal-Wallis test; Mann-Whitney U-test; Pearson's correlation coefficient. RESULTS Healthy LV wall segments undergo significant wall thickening (P < 0.05) during ejection and have on average a thicker wall (8.73 ± 1.01 mm) compared with infarcted wall segments (2.86 ± 1.11 mm). Myocardium with thick infarct (ie, >50% transmurality) underwent remarkable wall thinning during contraction (thickening index [TI] = 1.46 ± 0.26 mm) as opposed to healthy myocardium (TI = 4.01 ± 1.04 mm). For AMI patients, LV that showed signs of thinning were found to be associated with a significantly higher percentage of dyssynchrony as compared with healthy subjects (dyssynchrony index [DI] = 15.0 ± 5.0% vs. 7.5 ± 2.0%, P < 0.01). Also, a strong correlation was found between our TI and left ventricular ejection fraction (LVEF) (r = 0.892, P < 0.01), and moderate correlation between DI and LVEF (r = 0.494, P < 0.01). DATA CONCLUSION The extracted regional wall thickening and DIs are shown to be strongly correlated with infarct severity, therefore suggestive of possible practical clinical utility. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1006-1019.
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Affiliation(s)
- Amirah Khalid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine Building, University of Malaya, Kuala Lumpur, Malaysia
| | - Hwa Jen Yap
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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13
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Left ventricular adverse remodeling after myocardial infarction and its association with vitamin D levels. Int J Cardiol 2018; 277:159-165. [PMID: 30139699 DOI: 10.1016/j.ijcard.2018.08.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/07/2018] [Accepted: 08/17/2018] [Indexed: 01/16/2023]
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14
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Selvanayagam JB, Nucifora G. Myocardial Deformation Imaging by Feature-Tracking Cardiac Magnetic Resonance in Acute Myocardial Infarction: Do We Need It? Circ Cardiovasc Imaging 2018; 9:CIRCIMAGING.116.005058. [PMID: 27283008 DOI: 10.1161/circimaging.116.005058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Joseph B Selvanayagam
- From the Department of Heart Health, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia (J.S., G.N.); Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia (J.S.); and Flinders University, Adelaide, Australia (J.S.).
| | - Gaetano Nucifora
- From the Department of Heart Health, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia (J.S., G.N.); Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia (J.S.); and Flinders University, Adelaide, Australia (J.S.)
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15
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Symons R, Pontone G, Schwitter J, Francone M, Iglesias JF, Barison A, Zalewski J, de Luca L, Degrauwe S, Claus P, Guglielmo M, Nessler J, Carbone I, Ferro G, Durak M, Magistrelli P, Lo Presti A, Aquaro GD, Eeckhout E, Roguelov C, Andreini D, Vogt P, Guaricci AI, Mushtaq S, Lorenzoni V, Muller O, Desmet W, Agati L, Janssens S, Bogaert J, Masci PG. Long-Term Incremental Prognostic Value of Cardiovascular Magnetic Resonance After ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging 2018; 11:813-825. [DOI: 10.1016/j.jcmg.2017.05.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
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16
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Symons R, Claus P, Marchi A, Dresselaers T, Bogaert J. Quantitative and qualitative assessment of acute myocardial injury by CMR at multiple time points after acute myocardial infarction. Int J Cardiol 2018; 259:43-46. [PMID: 29506936 DOI: 10.1016/j.ijcard.2018.02.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/11/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent experimental studies have shown a dynamic time course of myocardial edema with an initial wave of edematous reaction within hours after reperfusion which almost resolved at 24 h. However, this dynamic pattern appears to be absent in clinical cohort studies. Thus far, no studies have combined a quantitative and qualitative assessment of acute myocardial injury in a large clinical cohort to explain these divergent findings. METHODS A cohort of 225 patients (59 ± 11 years, 83% men) with successfully reperfused STEMI within 12 h of symptom onset were included. Quantitative measurements of myocardial damage such as T1 mapping and T2 triple short-tau inversion recovery (STIR), contrast-to-noise ratio (CNR) and their impact on area-at-risk (AAR), infarct size (IS), and myocardial salvage index (MSI) were assessed at different time points. One-way analysis of variance (ANOVA) and linear regression analysis was used to compare myocardial damage at the different time points. RESULTS A small fraction of patients underwent CMR within 24 h of reperfusion (17/225, 7.6%). No significant variations in AAR, IS, MSI, T2 STIR CNR, or native T1 maps were observed between the different time points after reperfusion. Time of CMR was not a significant predictor of AAR (P = 0.90), IS (P = 0.27), MSI (P = 0.23) or T2 STIR CNR (P = 0.23). CONCLUSIONS The majority of CMR exams in STEMI patients are performed outside the dynamic time window of early post-MI edema. The stable pattern of markers of acute myocardial damage at different time points suggests these markers are reliable for the prognostication of patients after STEMI.
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Affiliation(s)
- Rolf Symons
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alberto Marchi
- Medical Pathology Department, Careggi University Hospital, Florence, Italy
| | - Tom Dresselaers
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium.
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17
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Bogaert J, Curione D, Morais P, Barreiro-Perez M, Tilborghs S, Maes F, Dresselaers T. Imaging Ischemic and Reperfusion Injury in Acute Myocardial Infarction: Putting the Pieces Together With CMR. JACC Cardiovasc Imaging 2017; 10:1520-1523. [PMID: 28734921 DOI: 10.1016/j.jcmg.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/28/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Jan Bogaert
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium.
| | - Davide Curione
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium
| | - Pedro Morais
- Lab on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium; Life and Health Sciences Research Institute/Biomaterials, Biodegradables and Biomimetics Research Group-Portugal Government Associate Laboratory, Braga/Guimarães, Portugal; Instituto de Engenharia Mecânica e Gestão Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Manuel Barreiro-Perez
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium
| | - Sofie Tilborghs
- Medical Imaging Research Center, ESAT-PSI, Processing Speech and Images (PSI), Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Frederik Maes
- Medical Imaging Research Center, ESAT-PSI, Processing Speech and Images (PSI), Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium
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18
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Zhang L, Mandry D, Chen B, Huttin O, Hossu G, Wang H, Beaumont M, Girerd N, Felblinger J, Odille F. Impact of microvascular obstruction on left ventricular local remodeling after reperfused myocardial infarction. J Magn Reson Imaging 2017; 47:499-510. [DOI: 10.1002/jmri.25780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/15/2017] [Indexed: 01/17/2023] Open
Affiliation(s)
- Lin Zhang
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- Zhongnan Hospital of Wuhan University, Department of Cardiology; Wuhan China
| | - Damien Mandry
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- CHRU Nancy, Pôle Imagerie; Nancy France
| | - Bailiang Chen
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | | | - Gabriela Hossu
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | - Hairong Wang
- Zhongnan Hospital of Wuhan University, Department of Cardiology; Wuhan China
| | - Marine Beaumont
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | - Nicolas Girerd
- CHRU Nancy, Department of Cardiology; Nancy France
- INSERM, CIC-P 9501; Nancy France
| | - Jacques Felblinger
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- CHRU Nancy, Pôle Imagerie; Nancy France
- INSERM, CIC-IT 1433; Nancy France
| | - Freddy Odille
- IADI; INSERM-U947, Université de Lorraine; Nancy France
- INSERM, CIC-IT 1433; Nancy France
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19
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Hendriks T, Hartman MHT, Vlaar PJJ, Prakken NHJ, van der Ende YMY, Lexis CPH, van Veldhuisen DJ, van der Horst ICC, Lipsic E, Nijveldt R, van der Harst P. Predictors of left ventricular remodeling after ST-elevation myocardial infarction. Int J Cardiovasc Imaging 2017; 33:1415-1423. [PMID: 28389968 PMCID: PMC5539273 DOI: 10.1007/s10554-017-1131-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/31/2017] [Indexed: 11/23/2022]
Abstract
Adverse left ventricular (LV) remodeling after acute ST-elevation myocardial infarction (STEMI) is associated with morbidity and mortality. We studied clinical, biochemical and angiographic determinants of LV end diastolic volume index (LVEDVi), end systolic volume index (LVESVi) and mass index (LVMi) as global LV remodeling parameters 4 months after STEMI, as well as end diastolic wall thickness (EDWT) and end systolic wall thickness (ESWT) of the non-infarcted myocardium, as compensatory remote LV remodeling parameters. Data was collected in 271 patients participating in the GIPS-III trial, presenting with a first STEMI. Laboratory measures were collected at baseline, 2 weeks, and 6–8 weeks. Cardiovascular magnetic resonance imaging (CMR) was performed 4 months after STEMI. Linear regression analyses were performed to determine predictors. At baseline, patients were 21% female, median age was 58 years. At 4 months, mean LV ejection fraction (LVEF) was 54 ± 9%, mean infarct size was 9.0 ± 7.9% of LVM. Strongest univariate predictors (all p < 0.001) were peak Troponin T for LVEDVi (R2 = 0.26), peak CK-MB for LVESVi (R2 = 0.41), NT-proBNP at 2 weeks for LVMi (R2 = 0.24), body surface area for EDWT (R2 = 0.32), and weight for ESWT (R2 = 0.29). After multivariable analysis, cardiac biomarkers remained the strongest predictors of LVMi, LVEDVi and LVESVi. NT-proBNP but none of the acute cardiac injury biomarkers were associated with remote LV wall thickness. Our analyses illustrate the value of cardiac specific biochemical biomarkers in predicting global LV remodeling after STEMI. We found no evidence for a hypertrophic response of the non-infarcted myocardium.
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Affiliation(s)
- Tom Hendriks
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Minke H T Hartman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Pieter J J Vlaar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Niek H J Prakken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yldau M Y van der Ende
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Chris P H Lexis
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Lipsic
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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20
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Huttin O, Mandry D, Eschalier R, Zhang L, Micard E, Odille F, Beaumont M, Fay R, Felblinger J, Camenzind E, Zannad F, Girerd N, Marie PY. Cardiac remodeling following reperfused acute myocardial infarction is linked to the concomitant evolution of vascular function as assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:2. [PMID: 28063459 PMCID: PMC5219670 DOI: 10.1186/s12968-016-0314-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular (LV) remodeling following acute myocardial infarction (MI) is difficult to predict at an individual level although a possible interfering role of vascular function has yet to be considered to date. This study aimed to determine the extent to which this LV remodeling is influenced by the concomitant evolution of vascular function and LV loading conditions, as assessed by phase-contrast Cardiovascular Magnetic Resonance (CMR) of the ascending aorta. METHODS CMR was performed in 121 patients, 2-4 days after reperfusion of a first ST-segment elevation myocardial infarction and 6 months thereafter. LV remodeling was: (i) assessed by the 6-month increase in end-diastolic volume (EDV) and/or ejection fraction (EF) and (ii) correlated with the indexed aortic stroke volume (mL.m-2), determined by a CMR phase-contrast sequence, along with derived functional vascular parameters (total peripheral vascular resistance (TPVR), total arterial compliance index, effective arterial elastance). RESULTS At 6 months, most patients were under angiotensin enzyme converting inhibitors (86%) and beta-blockers (84%) and, on average, all functional vascular parameters were improved whereas blood pressure levels were not. An increase in EDV only (EDV+/EF-) was documented in 17% of patients at 6 months, in EF only (EDV-/EF+) in 31%, in both EDV and EF (EDV+/EF+) in 12% and neither EDV nor EF (EDV-/EF-) in 40%. The increase in EF was mainly and independently linked to a concomitant decline in TPVR (6-month change in mmHg.min.m2.L-1, EDV-/EF-: +1 ± 8, EDV+/EF-: +3 ± 9, EDV-/EF+: -7 ± 6, EDV+/EF+: -15 ± 20, p < 0.001) while the absence of any EF improvement was associated with high persisting rates of abnormally high TPVR at 6 months (EDV-/EF-: 31%, EDV+/EF-: 38%, EDV-/EF+: 5%, EDV+/EF+: 13%, p = 0.007). By contrast, the 6-month increase in EDV was mainly dependent on cardiac as opposed to vascular parameters and particularly on the presence of microvascular obstruction at baseline (EDV-/EF-: 37%, EDV+/EF-: 76%, EDV-/EF+: 38%, EDV+/EF+: 73%, p = 0.003). CONCLUSION LV remodeling following reperfused MI is strongly influenced by the variable decrease in systemic vascular resistance under standard care vasodilating medication. The CMR monitoring of vascular resistance may help to tailor these medications for improving vascular resistance and consequently, LV ejection fraction. TRIAL REGISTRATION NCT01109225 on ClinicalTrials.gov site (April, 2010).
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Affiliation(s)
- Olivier Huttin
- CHRU-Nancy, Department of Cardiology, Nancy, F-54000, France
- INSERM, UMR-1116, Nancy, F-54000, France
| | - Damien Mandry
- INSERM, UMR-947, Nancy, F-54000, France
- CHRU-Nancy, Department of Radiology, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
| | - Romain Eschalier
- CHU-Clermont-Ferrand, Department of Cardiology, Clermont-Ferrand, F-63000, France
- Université d'Auvergne, UMR6284, Clermont-Ferrand, F-63000, France
| | - Lin Zhang
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
| | - Emilien Micard
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Freddy Odille
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Marine Beaumont
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | | | - Jacques Felblinger
- INSERM, UMR-947, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Edoardo Camenzind
- CHRU-Nancy, Department of Cardiology, Nancy, F-54000, France
- INSERM, UMR-1116, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
| | - Faïez Zannad
- INSERM, UMR-1116, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Nicolas Girerd
- INSERM, UMR-1116, Nancy, F-54000, France
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France
- INSERM CIC 1433, Nancy, F-54000, France
| | - Pierre Y Marie
- INSERM, UMR-1116, Nancy, F-54000, France.
- Faculty of Medicine, Université de Lorraine, Nancy, F-54000, France.
- CHRU-Nancy, Hôpitaux de BRABOIS, Service de Médecine Nucléaire, Allée du Morvan, 54500, Vandœuvre, France.
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21
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Perea RJ, Morales-Ruiz M, Ortiz-Perez JT, Bosch X, Andreu D, Borras R, Acosta J, Penela D, Prat-González S, de Caralt TM, Martínez M, Morales-Romero B, Lasalvia L, Donnelly J, Jiménez W, Mira A, Mont L, Berruezo A. Utility of galectin-3 in predicting post-infarct remodeling after acute myocardial infarction based on extracellular volume fraction mapping. Int J Cardiol 2016; 223:458-464. [PMID: 27544605 DOI: 10.1016/j.ijcard.2016.08.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/31/2022]
Abstract
AIMS ST-segment elevation myocardial infarction (STEMI) triggers remote extracellular matrix expansion. Myocardial extracellular volume fraction (ECV), determined by cardiovascular magnetic resonance, permits quantification of interstitial space expansion. Our aim was to determine the relationship between early serum fibrosis biomarkers and 180-day post-infarct remote myocardium remodeling using ECV. METHODS AND RESULTS In 26 patients with STEMI, functional imaging, T1-mapping, and late-gadolinium-enhancement were performed on a 3-T CMR scanner at baseline (days 3 to 5) and 180days. Biomarkers were measured at days 1, 3, and 7 after STEMI. The mean initial and follow-up left ventricular ejection fraction (LVEF) were 48.3±18.1% and 52.6±12.3%, respectively. Initial infarct size was 11.6±16.8% of LV mass. ECV in the remote myocardium at 180days correlated with indexed end-systolic volume (r=0.4, p=0.045). A significant correlation was observed between galectin-3 at day 7 and ECV at 6months (r=0.428, p=0.037). A trend towards a direct correlation was found for BNP (r=0.380, p=0.059). Multivariate analysis revealed that BNP and galectin-3 were independent predictors of long-term changes in ECV and explained nearly 30% of the variance in this parameter (r2=0.34; p=0.01). A galectin-3 cutoff value of 10.15ng/mL was the most powerful predictor of high ECV values (≥28.5%) at follow-up. Galectin-3 at day 7 was an independent predictor of high ECV values at follow-up (OR=22.51; CI 95%: 2.1-240.72; p=0.01) with 0.76 AUC (CI: 0.574-0.964; p=0.03). CONCLUSIONS Galectin-3 measured acutely after STEMI is an independent predictor of increased ECV at 6-month follow-up that might be useful for long-term risk stratification.
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Affiliation(s)
- Rosario J Perea
- Department of Radiology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Spain
| | - Manuel Morales-Ruiz
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, University of Barcelona, IDIBAPS, Centro de Investigaciones Biomedicas en Red en Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Physiological Sciences I, University of Barcelona, Barcelona, Spain
| | - Jose T Ortiz-Perez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Xavier Bosch
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - David Andreu
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Roger Borras
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Juan Acosta
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Diego Penela
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Susanna Prat-González
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Teresa M de Caralt
- Department of Radiology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Spain
| | - Mikel Martínez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Blai Morales-Romero
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, University of Barcelona, IDIBAPS, Centro de Investigaciones Biomedicas en Red en Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Luis Lasalvia
- Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA
| | | | - Wladimiro Jiménez
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, University of Barcelona, IDIBAPS, Centro de Investigaciones Biomedicas en Red en Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Physiological Sciences I, University of Barcelona, Barcelona, Spain
| | - Aurea Mira
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, University of Barcelona, IDIBAPS, Centro de Investigaciones Biomedicas en Red en Enfermedades Hepaticas y Digestivas (CIBERehd), Barcelona, Spain; Department of Physiological Sciences I, University of Barcelona, Barcelona, Spain
| | - Lluis Mont
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Antonio Berruezo
- Cardiology Department, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain.
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22
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Leong CO, Liew YM, Bilgen M, Abdul Aziz YF, Chee KH, Chiam YK, Lim E. Assessment of infarct-specific cardiac motion dysfunction using modeling and multimodal magnetic resonance merging. J Magn Reson Imaging 2016; 45:525-534. [DOI: 10.1002/jmri.25390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/30/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chen Onn Leong
- Department of Biomedical Engineering; Faculty of Engineering, University of Malaya; Kuala Lumpur Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering; Faculty of Engineering, University of Malaya; Kuala Lumpur Malaysia
| | - Mehmet Bilgen
- Biophysics Department; Faculty of Medicine, Adnan Menderes University; Aydin Turkey
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging; University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya; Kuala Lumpur Malaysia
| | - Kok Han Chee
- Department of Medicine; Faculty of Medicine, University of Malaya; Kuala Lumpur Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering; Faculty of Computer Science & Information Technology, University of Malaya; Kuala Lumpur Malaysia
| | - Einly Lim
- Department of Biomedical Engineering; Faculty of Engineering, University of Malaya; Kuala Lumpur Malaysia
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23
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Carrick D, Haig C, Ahmed N, McEntegart M, Petrie MC, Eteiba H, Hood S, Watkins S, Lindsay MM, Davie A, Mahrous A, Mordi I, Rauhalammi S, Sattar N, Welsh P, Radjenovic A, Ford I, Oldroyd KG, Berry C. Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance. Circ Cardiovasc Imaging 2016; 9:e004148. [PMID: 26763281 PMCID: PMC4718183 DOI: 10.1161/circimaging.115.004148] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background— The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Methods and Results— We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of <20 ms. Microvascular obstruction was assessed with late gadolinium enhancement. Adverse remodeling was defined as an increase in left ventricular end-diastolic volume ≥20% at 6 months. Cardiovascular death or heart failure events post discharge were assessed during follow-up. Two hundred forty-five patients had evaluable T2* data (mean±age, 58 [11] years; 76% men). Myocardial hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (P<0.001), whereas microvascular obstruction decreased with time post reperfusion. Conclusions— Myocardial hemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.
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Affiliation(s)
- David Carrick
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Caroline Haig
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Nadeem Ahmed
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Margaret McEntegart
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Mark C Petrie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Hany Eteiba
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Stuart Hood
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Stuart Watkins
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - M Mitchell Lindsay
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Andrew Davie
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Ahmed Mahrous
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Ify Mordi
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Samuli Rauhalammi
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Naveed Sattar
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Paul Welsh
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Aleksandra Radjenovic
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Ian Ford
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Keith G Oldroyd
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.)
| | - Colin Berry
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.).
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24
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Symons R, Masci PG, Francone M, Claus P, Barison A, Carbone I, Agati L, Galea N, Janssens S, Bogaert J. Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker's paradox revisited. Eur Heart J 2016; 37:2756-2764. [DOI: 10.1093/eurheartj/ehv738] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/10/2015] [Indexed: 12/22/2022] Open
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25
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Bogaert J, Eitel I. Role of cardiovascular magnetic resonance in acute coronary syndrome. Glob Cardiol Sci Pract 2016; 2015:24. [PMID: 26779508 PMCID: PMC4614331 DOI: 10.5339/gcsp.2015.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/30/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jan Bogaert
- KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology, Angiology, Intensive care medicine), Lübeck, Germany
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26
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Pourmorteza A, Chen MY, van der Pals J, Arai AE, McVeigh ER. Correlation of CT-based regional cardiac function (SQUEEZ) with myocardial strain calculated from tagged MRI: an experimental study. Int J Cardiovasc Imaging 2015; 32:817-23. [PMID: 26706935 DOI: 10.1007/s10554-015-0831-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/22/2015] [Indexed: 01/02/2023]
Abstract
The objective of this study was to investigate the correlation between local myocardial function estimates from CT and myocardial strain from tagged MRI in the same heart. Accurate detection of regional myocardial dysfunction can be an important finding in the diagnosis of functionally significant coronary artery disease. Tagged MRI is currently a reference standard for noninvasive regional myocardial function analysis; however, it has practical drawbacks. We have developed a CT imaging protocol and automated image analysis algorithm for estimating regional cardiac function from a few heartbeats. This method tracks the motion of the left ventricular (LV) endocardial surface to produce local function maps: we call the method Stretch Quantification of Endocardial Engraved Zones (SQUEEZ). Myocardial infarction was created by ligation of the left anterior descending coronary artery for 2 h followed by reperfusion in canine models. Tagged and cine MRI scans were performed during the reperfusion phase and first-pass contrast enhanced CT scans were acquired. The average delay between the CT and MRI scans was <1 h. Circumferential myocardial strain (Ecc) was calculated from the tagged MRI data. The agreement between peak systolic Ecc and SQUEEZ was investigated in 162 segments in the 9 hearts. Linear regression and Bland-Altman analysis was used to assess the correlation between the two metrics of local LV function. The results show good agreement between SQUEEZ and Ecc: (r = 0.71, slope = 0.78, p < 0.001). Furthermore, Bland-Altman showed a small bias of -0.02 with 95 % confidence interval of 0.1, and standard deviation of 0.05 representing ~6.5 % of the dynamic range of LV function. The good agreement between the estimates of local myocardial function obtained from CT SQUEEZ and tagged MRI provides encouragement to investigate the use of SQUEEZ for measuring regional cardiac function at a low clinical dose in humans.
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Affiliation(s)
- Amir Pourmorteza
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA.
| | - Marcus Y Chen
- Advanced Cardiovascular Imaging Laboratory, Cardiopulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jesper van der Pals
- Advanced Cardiovascular Imaging Laboratory, Cardiopulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- Advanced Cardiovascular Imaging Laboratory, Cardiopulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elliot R McVeigh
- Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego, San Diego, CA, USA
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27
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Ding S, Li Z, Ge H, Qiao ZQ, Chen YL, Andong AL, Yang F, Kong LC, Jiang M, He B, Pu J. Impact of Early ST-Segment Changes on Cardiac Magnetic Resonance-Verified Intramyocardial Haemorrhage and Microvascular Obstruction in ST-Elevation Myocardial Infarction Patients. Medicine (Baltimore) 2015; 94:e1438. [PMID: 26334905 PMCID: PMC4616502 DOI: 10.1097/md.0000000000001438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to explore the significance of different ST-segment changes before and after percutaneous coronary intervention (PCI), in relation to cardiac magnetic resonance (CMR)-verified microvascular obstruction (MVO) along with intramyocardial hemorrhage (IMH) in ST-elevation myocardial infarction (STEMI) patients.This study enrolled 108 STEMI patients who received primary PCI and had no contraindication of CMR investigation. Sum ST-segment elevation (STE), maximal STE on admission and sum ST-segment resolution (STR), and single-lead STR and residual STE at 60 minutes after primary PCI were assessed. MVO and IMH were determined by contrast-enhanced CMR.Patients were classified into 3 groups: 30 patients with MVO(-)/IMH(-), 25 with MVO(+)/IMH(-), and 53 with MVO(+)/IMH(+). Sum STE (P = 0.001), maximal STE (P < 0.001), and residual STE (P = 0.025) were highest and single-lead STR was lowest (P = 0.044) in the MVO(+)/IMH(+) group. Receiver operator characteristics curve analysis revealed that maximal STE was the most powerful factor for distinguishing between MVO(+) and MVO(-) patients (optimal threshold = 0.5 mV, area under the curve, AUC = 0.718, P < 0.001), or IMH(+) and IMH(-) patients (optimal threshold = 0.5 mV, AUC = 0.697, P < 0.001). In multivariate analysis, maximal STE was identified as the most powerful independent predictor of MVO (odds ratio [OR] = 4.30, P < 0.001) and IMH (OR = 2.44, P = 0.001), whereas sum STE was the strongest correlate of both the number of MVO segments (r = 0.42, P < 0.001) and IMH segments (r = 0.43, P < 0.001).The presence of MVO and IMH in infarcted tissue was relevant to ST-segment changes in STEMI patients. Maximal STE was a powerful independent predictor of the presence of MVO and IMH, whereas sum STE was a strong correlate of the number of MVO and IMH segments.
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Affiliation(s)
- Song Ding
- From the Department of Cardiology (SD, ZL, HG, Z-QO, Y-LC, FY, L-CK, MJ, BH, JP); and Department of Radiology (A-LA), Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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