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He J, Yang W, Wu W, Yin G, Zhuang B, Xu J, Zhou D, Zhang J, Wang Y, Zhu L, Sun X, Sirajuddin A, Teng Z, Kureshi F, Arai AE, Zhao S, Lu M. Heart Failure with Normal Natriuretic Peptide Levels and Preserved Ejection Fraction: A Prospective Clinical and Cardiac MRI Study. Radiol Cardiothorac Imaging 2024; 6:e230281. [PMID: 38695743 PMCID: PMC11211949 DOI: 10.1148/ryct.230281] [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: 09/14/2023] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 06/16/2024]
Abstract
Purpose To describe the clinical presentation, comprehensive cardiac MRI characteristics, and prognosis of individuals with predisposed heart failure with preserved ejection fraction (HFpEF). Materials and Methods This prospective cohort study (part of MISSION-HFpEF [Multimodality Imaging in the Screening, Diagnosis, and Risk Stratification of HFpEF]; NCT04603404) was conducted from January 1, 2019, to September 30, 2021, and included individuals with suspected HFpEF who underwent cardiac MRI. Participants who had primary cardiomyopathy and primary valvular heart disease were excluded. Participants were split into a predisposed HFpEF group, defined as HFpEF with normal natriuretic peptide levels based on an HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, and Final Etiology) score of 4 from the latest European Society of Cardiology guidelines, and an HFpEF group (HFA-PEFF score of ≥ 5). An asymptomatic control group without heart failure was also included. Clinical and cardiac MRI-based characteristics and outcomes were compared between groups. The primary end points were death, heart failure hospitalization, or stroke. Results A total of 213 participants with HFpEF, 151 participants with predisposed HFpEF, and 100 participants in the control group were analyzed. Compared with the control group, participants with predisposed HFpEF had worse left ventricular remodeling and function and higher systemic inflammation. Compared with participants with HFpEF, those with predisposed HFpEF, whether obese or not, were younger and had higher plasma volume, lower prevalence of atrial fibrillation, lower left atrial volume index, and less impaired left ventricular global longitudinal strain (-12.2% ± 2.8 vs -13.9% ± 3.1; P < .001) and early-diastolic global longitudinal strain rate (eGLSR, 0.52/sec ± 0.20 vs 0.57/sec ± 0.15; P = .03) but similar prognosis. Atrial fibrillation occurrence (hazard ratio [HR] = 3.90; P = .009), hemoglobin level (HR = 0.94; P = .001), and eGLSR (per 0.2-per-second increase, HR = 0.28; P = .002) were independently associated with occurrence of primary end points in participants with predisposed HFpEF. Conclusion Participants with predisposed HFpEF showed relatively unique clinical and cardiac MRI features, warranting greater clinical attention. eGLSR should be considered as a prognostic factor in participants with predisposed HFpEF. Keywords: Heart Failure with Preserved Ejection Fraction, Normal Natriuretic Peptide Levels, Cardiovascular Magnetic Resonance, Myocardial Strain, Prognosis Clinical trial registration no. NCT04603404 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Jian He
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Wenjing Yang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Weichun Wu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Gang Yin
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Baiyan Zhuang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Jing Xu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Di Zhou
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Jian Zhang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Yining Wang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Leyi Zhu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Xiaoxin Sun
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Arlene Sirajuddin
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Zhongzhao Teng
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Faraz Kureshi
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Andrew E. Arai
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Minjie Lu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y.,
B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography
(W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.),
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China; Department of
Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing,
China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.);
Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology,
University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis
Cardiovascular Advanced Imaging, St David’s Healthcare, Austin, Tex
(F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No.
167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
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Liu J, Li Y, Peng LQ, Gao Y, Shi K, Qian WL, Yan WF, Yang ZG. Effect of Metabolic Syndrome on Left Atrial and Left Ventricular Deformation and Atrioventricular Interactions in Patients With Myocardial Infarction. J Magn Reson Imaging 2024. [PMID: 38682602 DOI: 10.1002/jmri.29406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is associated with worse prognosis in patients with myocardial infarction (MI). However, it is unclear how MetS in MI patients is associated with left atrial (LA) and left ventricular (LV) deformation. PURPOSE To determine the effect of MetS on LA and LV deformation and atrioventricular interactions in MI patients. STUDY TYPE Retrospective. POPULATION One hundred eighty-one MI patients (73 MetS+ and 108 MetS-), 107 age- and sex-matched controls (49 MetS+ and 58 MetS-). FIELD STRENGTH/SEQUENCE 3.0 T/balanced steady-state free precession (SSFP)/segmented phase-sensitive inversion recovery SSFP sequence. ASSESSMENT LA strain and strain rates (reservoir, conduit, and active), left atrioventricular coupling index (LACI), and LV geometry and radial, circumferential and longitudinal global peak strains (PS) were compared among groups. STATISTICAL TESTS Two-way analysis of variance, Spearman and Pearson's correlation coefficients, and multivariable linear regression analysis. P value <0.05 indicated statistical significance. RESULTS Compared with controls, the MI patients with or without MetS showed impaired LA function (reservoir, conduit, and active) and LV deformation (radial, circumferential, and longitudinal PS) and higher LACI. The MetS+ group had lower LA reservoir and conduit function and LV deformation than MetS- group. The MetS-MI interaction was not statistically significant. Furthermore, multivariable linear regression showed that MetS was independently associated with LA and LV deformation (β = -0.181 to -0.209) in MI patients; LA function was independently associated with LV circumferential PS (β = 0.230 to 0.394) and longitudinal PS (β = 0.189 to 0.420), and LA passive strain and strain rate were negatively associated with LV mass (β = -0.178 and -0.298). DATA CONCLUSION MetS may be associated with the LA and LV dysfunction in MI patients. Impaired LV deformation and LV hypertrophy are independently associated with LA dysfunction in MI patients, and the MI patients have higher LACI than controls, suggesting atrioventricular interaction alterations. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: 3.
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Affiliation(s)
- Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Qing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Min CY, Gao Y, Jiang YN, Guo YK, Shi K, Yang ZG, Li Y. The additive effect of metabolic syndrome on left ventricular impairment in patients with obstructive coronary artery disease assessed by 3.0 T cardiac magnetic resonance feature tracking. Cardiovasc Diabetol 2024; 23:133. [PMID: 38654269 DOI: 10.1186/s12933-024-02225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) can increase the risk of morbidity and mortality of cardiovascular disease and obstructive coronary artery disease (OCAD), which usually have a poor prognosis. This study aimed to explore the impact of MetS on left ventricular (LV) deformation and function in OCAD patients and investigate the independent factors of impaired LV function and deformation. MATERIALS AND METHODS A total of 121 patients with OCAD and 52 sex- and age-matched controls who underwent cardiac magnetic resonance scanning were enrolled in the study. All OCAD patients were divided into two groups: OCAD with MetS [OCAD(MetS+), n = 83] and OCAD without MetS [OCAD(MetS-), n = 38]. LV functional and global strain parameters were measured and compared among the three groups. Multivariable linear regression analyses were constructed to investigate the independent factors of LV impairment in OCAD patients. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to test the prediction efficiency of MetS for LV impairment. RESULTS From controls to the OCAD(MetS-) group to the OCAD(MetS+) group, LV mass (LVM) increased, and LV global function index (LVGFI) and LV global longitudinal peak strain (GLPS) decreased (all p < 0.05). Compared with the OCAD(MetS-) group, the LV GLPS declined significantly (p = 0.027), the LVM increased (p = 0.006), and the LVGFI decreased (p = 0.043) in the OCAD(MetS+) group. After adjustment for covariates in OCAD patients, MetS was an independent factor of decreased LV GLPS (β = - 0.211, p = 0.002) and increased LVM (β = 0.221, p = 0.003). The logistic multivariable regression analysis and ROC analysis showed that combined MetS improved the efficiency of predicting LV GLPS reduction (AUC = 0.88) and LVM (AUC = 0.89) increase. CONCLUSIONS MetS aggravated the damage of LV deformation and function in OCAD patients and was independently associated with LV deformation and impaired LV strain. Additionally, MetS increased the prediction efficiency of increased LVM and decreased LV GLPS. Early detection and intervention of MetS in patients with OCAD is of great significance.
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Affiliation(s)
- Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yi-Ning Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Kong H, Cao J, Zhang L, An J, Wu X, He Y. Myocardial deformation characteristics assessed by cardiovascular magnetic resonance feature tracking in a healthy Chinese population. Heliyon 2024; 10:e28341. [PMID: 38623204 PMCID: PMC11016585 DOI: 10.1016/j.heliyon.2024.e28341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To explore global/regional myocardial deformation across various layers, vascular distributions, specific levels and distinct walls in healthy individuals using cardiovascular magnetic resonance feature tracking (CMR-FT). Methods We selected a cohort of 55 healthy participants and CMR cine images were used to obtain the left ventricular (LV) peak longitudinal, circumferential, radial strains (LS, CS, RS). The characteristics of normal LV strain in various layers (endocardium, myocardium, epicardium), territories [left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA)], levels (basal, middle, apical) and walls (anterior, septum, inferior, lateral) were compared. Results The absolute values of the LV global LS and CS gradually decreased from endocardium to epicardium. The absolute LV global RS (65.7 ± 47.7%) was maximum relative to LS (-22.0 ± 10.8%) and CS (-22.8 ± 7.7%). The absolute values of the LCX territorial strain were the largest compared with the LAD and RCA territorial strains. Regional RS, endo-CS and endo-LS gradually increased from the basal to the apical level. The LV lateral walls had the highest strain values (CS, LS, and RS). Conclusions Variations in normal LV strain values across various layers, territories, levels, and walls were observed, suggesting the necessity for careful clinical interpretation of these strain values. These findings also partially revealed the complexity of normal cardiac mechanics.
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Affiliation(s)
- Huihui Kong
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiaxin Cao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance, MR Collaboration NE Asia, Shenzhen, China
| | - Xiaohua Wu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Wang H, Deng W, Zhang Y, Yang J, Wang Z, Liu B, Han Y, Yu Y, Zhao R, Xiaohu Li. Changes in subclinical cardiac abnormalities 1 Year after recovering from COVID-19 in patients without clinical cardiac findings. Heliyon 2024; 10:e27380. [PMID: 38495174 PMCID: PMC10943378 DOI: 10.1016/j.heliyon.2024.e27380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Aim To evaluate the subclinical cardiac involvement in COVID-19 patients without clinical cardiac evidence using cardiac MR imaging. Material and methods Participants recovered from COVID-19 without cardiac symptoms and no cardiovascular medical history were enrolled in a prospective cohort study. They underwent baseline cardiac MR and follow-up cardiac MR > 300 days after discharge (n = 20). The study also included healthy controls (n = 20). Extracellular volume fraction (ECV), native T1, and 2D strain data were assessed and compared. Results The ECV values of participants at baseline [30.0% (28.3%-32.5%)] and at follow-up [31.0% (28.0%-32.8%)] were increased compared to the healthy control group [27.0% (25.3%-28.0%)] (both p < 0.001). However, the ECV increase from baseline cardiac MR to follow-up cardiac MR was not significant (p = 0.378). There was a statistically significant difference in global native T1 between baseline [1140 (1108.3-1192.0) ms] and follow-up [1176.0 (1113.0-1206.3) ms] (p = 0.016). However, no native T1 difference was found between the healthy controls [1160.7 (1119.6-1195.4) ms] and the baseline (p = 0.394) or follow-up group (p = 0.168). The global T2 was 41(40-42) ms at follow-up which was within the normal range. In addition, We found a recovery in 2D GLS among COVID-19 participants between baseline and follow-up [-12.4(-11.7 to -14.3)% vs. -17.2(-16.2 to -18.3)%; p<0.001]. Conclusion Using cardiac MR myocardial tissue and strain imaging parameters, 35% of people without cardiac symptoms or clinical evidence of myocardial injury still had subclinical myocardial tissue characteristic abnormalities at 300 days, but 2D GLS had recovered.
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Affiliation(s)
- Haitao Wang
- Department of Radiology, No.2 People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Wei Deng
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui Province, No. 218 Jixi Road, Hefei, 230022, China
| | - Yang Zhang
- Department of Radiology, Fuyang People's Hospital, Fuyang, 236015, Anhui Province, China
| | - Jinxiu Yang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui Province, No. 218 Jixi Road, Hefei, 230022, China
| | - Zhen Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui Province, No. 218 Jixi Road, Hefei, 230022, China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui Province, No. 218 Jixi Road, Hefei, 230022, China
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, College of Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui Province, No. 218 Jixi Road, Hefei, 230022, China
| | - Ren Zhao
- Department of Cardiology The First Affiliated Hospital of Anhui Medical University,Anhui, China
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, Hefei, Anhui Province, No. 218 Jixi Road, Hefei, 230022, China
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Iyer NR, Chan SP, Liew OW, Chong JPC, Bryant JA, Le TT, Chandramouli C, Cozzone PJ, Eisenhaber F, Foo R, Richards AM, Lam CSP, Ugander M, Chin CWL. Global longitudinal strain and plasma biomarkers for prognosis in heart failure complicated by diabetes: a prospective observational study. BMC Cardiovasc Disord 2024; 24:141. [PMID: 38443793 PMCID: PMC10913625 DOI: 10.1186/s12872-024-03810-5] [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: 11/19/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Heart failure (HF) and diabetes are associated with increased incidence and worse prognosis of each other. The prognostic value of global longitudinal strain (GLS) measured by cardiovascular magnetic resonance (CMR) has not been established in HF patients with diabetes. METHODS In this prospective, observational study, consecutive patients (n = 315) with HF underwent CMR at 3T, including GLS, late gadolinium enhancement (LGE), native T1, and extracellular volume fraction (ECV) mapping. Plasma biomarker concentrations were measured including: N-terminal pro B-type natriuretic peptide(NT-proBNP), high-sensitivity troponin T(hs-TnT), growth differentiation factor 15(GDF-15), soluble ST2(sST2), and galectin 3(Gal-3). The primary outcome was a composite of all-cause mortality or HF hospitalisation. RESULTS Compared to those without diabetes (n = 156), the diabetes group (n = 159) had a higher LGE prevalence (76 vs. 60%, p < 0.05), higher T1 (1285±42 vs. 1269±42ms, p < 0.001), and higher ECV (30.5±3.5 vs. 28.8±4.1%, p < 0.001). The diabetes group had higher NT-pro-BNP, hs-TnT, GDF-15, sST2, and Gal-3. Diabetes conferred worse prognosis (hazard ratio (HR) 2.33 [95% confidence interval (CI) 1.43-3.79], p < 0.001). In multivariable Cox regression analysis including clinical markers and plasma biomarkers, sST2 alone remained independently associated with the primary outcome (HR per 1 ng/mL 1.04 [95% CI 1.02-1.07], p = 0.001). In multivariable Cox regression models in the diabetes group, both GLS and sST2 remained prognostic (GLS: HR 1.12 [95% CI 1.03-1.21], p = 0.01; sST2: HR per 1 ng/mL 1.03 [95% CI 1.00-1.06], p = 0.02). CONCLUSIONS Compared to HF patients without diabetes, those with diabetes have worse plasma and CMR markers of fibrosis and a more adverse prognosis. GLS by CMR is a powerful and independent prognostic marker in HF patients with diabetes.
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Affiliation(s)
- Nithin R Iyer
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Siew-Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oi Wah Liew
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jenny P C Chong
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Medical School, Singapore, Singapore
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Patrick J Cozzone
- Agency for Science, Technology and Research, Singapore Bioimaging Consortium, Singapore, Singapore
| | - Frank Eisenhaber
- Bioinformatics Institute, Agency for Science, Technology and Research, Singapore, Singapore
- LASA - Lausitz Advanced Scientific Applications gGmbH, Weißwasser, Germany
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Roger Foo
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research, Genome Institute of Singapore, Singapore, Singapore
| | - A Mark Richards
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Carolyn S P Lam
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- University Medical Centre Groningen, Groningen, The Netherlands
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Calvin W-L Chin
- Cardiovascular Sciences ACP, Duke-NUS Medical School, Singapore, Singapore.
- National Heart Centre Singapore, Singapore, Singapore.
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Yang W, Zhu L, He J, Wu W, Zhang Y, Zhuang B, Xu J, Zhou D, Wang Y, Liu G, Sun X, Zhang Q, Sirajuddin A, Arai AE, Zhao S, Lu M. Long-term outcomes prediction in diabetic heart failure with preserved ejection fraction by cardiac MRI. Eur Radiol 2024:10.1007/s00330-024-10658-y. [PMID: 38421414 DOI: 10.1007/s00330-024-10658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES We aimed to explore imaging features including tissue characterization and myocardial deformation in diabetic heart failure with preserved ejection fraction (HFpEF) patients by magnetic resonance imaging (MRI) and investigate its prognostic value for adverse outcomes. MATERIALS AND METHODS Patients with HFpEF who underwent cardiac MRI between January 2010 and December 2016 were enrolled. Feature-tracking (FT) analysis and myocardial fibrosis were assessed by cardiac MRI. Cox proportional regression analysis was performed to determine the association between MRI variables and primary outcomes. Primary outcomes were all-cause death or heart failure hospitalization during the follow-up period. RESULTS Of the 335 enrolled patients with HFpEF, 191 had diabetes mellitus (DM) (mean age: 58.7 years ± 10.8; 137 men). During a median follow-up of 10.2 years, 91 diabetic HFpEF and 56 non-diabetic HFpEF patients experienced primary outcomes. DM was a significant predictor of worse prognosis in HFpEF. In diabetic HFpEF, the addition of conventional imaging variables (left ventricular ejection fraction, left atrial volume index, extent of late gadolinium enhancement (LGE)) and global longitudinal strain (GLS) resulted in a significant increase in the area under the receiver operating characteristic curve (from 0.693 to 0.760, p < 0.05). After adjustment for multiple clinical and imaging variables, each 1% worsening in GLS was associated with a 9.8% increased risk of adverse events (p = 0.004). CONCLUSIONS Diabetic HFpEF is characterized by more severely impaired strains and myocardial fibrosis, which is identified as a high-risk HFpEF phenotype. In diabetic HFpEF, comprehensive cardiac MRI provides incremental value in predicting prognosis. Particularly, MRI-FT measurement of GLS is an independent predictor of adverse outcome in diabetic HFpEF. CLINICAL RELEVANCE STATEMENT Our findings suggested that MRI-derived variables, especially global longitudinal strain, played a crucial role in risk stratification and predicting worse prognosis in diabetic heart failure with preserved ejection fraction, which could assist in identifying high-risk patients and guiding therapeutic decision-making. KEY POINTS • Limited data are available on the cardiac MRI features of diabetic heart failure with preserved ejection fraction, including myocardial deformation and tissue characterization, as well as their incremental prognostic value. • Diabetic heart failure with preserved ejection fraction patients was characterized by more impaired strains and myocardial fibrosis. Comprehensive MRI, including tissue characterization and global longitudinal strain, provided incremental value for risk prediction. • MRI served as a valuable tool for identifying high-risk patients and guiding clinical management in diabetic heart failure with preserved ejection fraction.
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Affiliation(s)
- Wenjing Yang
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Leyi Zhu
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jian He
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Weichun Wu
- Departments of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yuhui Zhang
- Department of Heart Failure Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Baiyan Zhuang
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jing Xu
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Di Zhou
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yining Wang
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Guanshu Liu
- Department of Neurology, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Xiaoxin Sun
- Departments of Nuclear Medicine, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Arlene Sirajuddin
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Shihua Zhao
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Minjie Lu
- Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China.
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Wang F, Pu C, Ma S, Zhou J, Jiang Y, Yu F, Zhang S, Wu Y, Zhang L, He C, Hu H. The effects of flip angle and gadolinium contrast agent on single breath-hold compressed sensing cardiac magnetic resonance cine for biventricular global strain assessment. Front Cardiovasc Med 2024; 11:1286271. [PMID: 38347952 PMCID: PMC10859435 DOI: 10.3389/fcvm.2024.1286271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
Background Due to its potential to significantly reduce scanning time while delivering accurate results for cardiac volume function, compressed sensing (CS) has gained traction in cardiovascular magnetic resonance (CMR) cine. However, further investigation is necessary to explore its feasibility and impact on myocardial strain results. Materials and methods A total of 102 participants [75 men, 46.5 ± 17.1 (SD) years] were included in this study. Each patient underwent four consecutive cine sequences with the same slice localization, including the reference multi-breath-hold balanced steady-state free precession (bSSFPref) cine, the CS cine with the same flip angle as bSSFPref before (CS45) and after (eCS45) contrast enhancement, and the CS cine (eCS70) with a 70-degree flip angle after contrast enhancement. Biventricular strain parameters were derived from cine images. Two-tailed paired t-tests were used for data analysis. Results Global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) were observed to be significantly lower in comparison to those obtained from bSSFPref sequences for both the right and left ventricles (all p < 0.001). No significant difference was observed on biventricular GRS-LAX (long-axis) and GLS values derived from enhanced and unenhanced CS cine sequences with the same flip angle, but remarkable reductions were noted in GRS-SAX (short-axis) and GCS values (p < 0.001). After contrast injection, a larger flip angle caused a significant elevation in left ventricular strain results (p < 0.001) but did not affect the right ventricle. The increase in flip angle appeared to compensate for contrast agent affection on left ventricular GRS-SAX, GCS values, and right ventricular GRS-LAX, GLS values. Conclusion Despite incorporating gadolinium contrast agents and applying larger flip angles, single breath-hold CS cine sequences consistently yielded diminished strain values for both ventricles when compared with conventional cine sequences. Prior to employing this single breath-hold CS cine sequence to refine the clinical CMR examination procedure, it is crucial to consider its impact on myocardial strain results.
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Affiliation(s)
- Fuyan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siying Ma
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Junjie Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yangyang Jiang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feidan Yu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingjie Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Cha MJ, Hong YJ, Park CH, Cha YJ, Kim TH, Kim C, Park CH. Utilities and Limitations of Cardiac Magnetic Resonance Imaging in Dilated Cardiomyopathy. Korean J Radiol 2023; 24:1200-1220. [PMID: 38016680 DOI: 10.3348/kjr.2023.0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/30/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is one of the most common types of non-ischemic cardiomyopathy. DCM is characterized by left ventricle (LV) dilatation and systolic dysfunction without coronary artery disease or abnormal loading conditions. DCM is not a single disease entity and has a complex historical background of revisions and updates to its definition because of its diverse etiology and clinical manifestations. In cases of LV dilatation and dysfunction, conditions with phenotypic overlap should be excluded before establishing a DCM diagnosis. The differential diagnoses of DCM include ischemic cardiomyopathy, valvular heart disease, burned-out hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, and non-compaction. Cardiac magnetic resonance (CMR) imaging is helpful for evaluating DCM because it provides precise measurements of cardiac size, function, mass, and tissue characterization. Comprehensive analyses using various sequences, including cine imaging, late gadolinium enhancement imaging, and T1 and T2 mapping, may help establish differential diagnoses, etiological work-up, disease stratification, prognostic determination, and follow-up procedures in patients with DCM phenotypes. This article aimed to review the utilities and limitations of CMR in the diagnosis and assessment of DCM.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea.
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Zhang TY, An DA, Zhou H, Ni Z, Wang Q, Chen B, Lu R, Huang J, Zhou Y, Hu J, Kim DH, Wilson M, Mou S, Wu LM. Fractal analysis: Left ventricular trabecular complexity cardiac MRI adds independent risks for heart failure with preserved ejection fraction in participants with end-stage renal disease. Int J Cardiol 2023; 391:131334. [PMID: 37696365 DOI: 10.1016/j.ijcard.2023.131334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To measure left ventricular (LV) trabecular complexity by fractal dimension (FD) in patients with end-stage renal disease (ESRD), and assess whether FD was an independent risk factor for heart failure with preserved ejection fraction (HFpEF), or a significant predictor for adverse outcome in this population. METHODS The study retrospectively enrolled 104 participants with ESRD who underwent 3.0 T cardiac magnetic resonance imaging (MRI) from June 2018 to November 2020. LV trabeculation was quantified with fractal analysis of short-axis cine slices to estimate the FD. Logistic regression analyses were used to evaluate FD and cardiac MRI parameters and to find independent risk predictors. Cox proportional hazard regression was used to investigate the association between FD and MACE. RESULTS LV FD was higher in in the HFpEF group than those in the non-HFpEF group, with the greatest difference near the base of the ventricle. Age, minimum left atrial volume index, and LV mean basal FD were independent predictors for HFpEF in patients with ESRD. Combining the mean basal FD with typical predictive factors resulted in a C-index (0.902 vs 0.921), which was not significantly higher. Same improvements were found for net reclassification improvement [0.642; 95% confidence interval (CI), 0.254-1.029] and integrated discrimination index (0.026; 95% CI, 0.008-0.061). Participants with a LV global FD above the cutoff value (1.278) had higher risks of MACE in ESRD patients. CONCLUSIONS LV trabecular complexity measured by FD was an independent risk factor for HFpEF, and a significant predictor for MACE among patients with ESRD.
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Affiliation(s)
- Tian-Yi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Hang Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Zhaohui Ni
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Qin Wang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Binghua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Renhua Lu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiaying Huang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yin Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Doo Hee Kim
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Molly Wilson
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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11
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Zhang Y, Zhang X, Wang Y, Hu X, Wang B, Yang J, Zhao X, Zhang L. Relationship between diffuse fibrosis assessed by CMR and depressed myocardial strain in different stages of heart failure. Eur J Radiol 2023; 164:110848. [PMID: 37156180 DOI: 10.1016/j.ejrad.2023.110848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/22/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To investigate the extent of the left ventricular (LV) diffuse myocardial fibrosis and the association with the degree of impaired myocardial strain in different stages of heart failure. BACKGROUND The increased diffuse myocardial fibrosis impairs the LV systolic and diastolic function. Previous studies found that the global longitudinal strain (GLS) impacted survival in patients with heart failure with preserved ejection fraction (HFpEF). However, limited data are available regarding the association between the degree of diffuse myocardial fibrosis and the severity of impaired myocardial strain in HFpEF. METHODS Sixty-six consecutive participants with heart failure (HF), and 15 healthy controls underwent cardiac magnetic resonance (CMR) examination. T1 mapping to calculate extracellular volume fractions (ECV) were used to assess diffuse myocardial fibrosis. ECV and myocardial strains were compared among the 3 groups. Associations between these two factors were also explored. RESULTS The patients with HFpEF showed increased myocardial ECV fractions (32.9 % ± 3.7 % vs. 29.2 % ± 2.9 %, p < 0.001) compared with the control group. The patients with HFm + rEF also had increased myocardial ECV fractions (36.8 % ± 5.4 % vs. 32.9 % ± 3.7 %, p < 0.001) compared with HFpEF. The myocardial ECV was significantly correlated with the GLS (r = 0.422, p = 0.020), global circumferential strain (GCS) (r = 0.491, p = 0.006), and global radial strain (GRS) (r = -0.533, p = 0.002) in the HFpEF groups, but no significant correlation was found in the HFm + rEF group (GLS: r = -0.002, p = 0.990; GCS: r = 0.153, p = 0.372; GRS: r = 0.070, p = 0.685) CONCLUSIONS: In patients with HF, only patients with HFpEF exhibited a significant correlation between increased diffuse myocardial fibrosis and impaired myocardial strain. Diffuse myocardial fibrosis plays a unique role in affecting myocardial strain in patients with HFpEF.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Xunan Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Yalan Wang
- Department of Ultrasonography, The Third People's Hospital of Bengbu, 38 Shenglizhong Road, Bengshan District, Bengbu, China.
| | - Xinxing Hu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Bin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Jia Yang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Xiance Zhao
- Philips Healthcare, 718 Lingshi Road, Jingan District, Shanghai, China.
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
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12
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Feher A, Miller EJ, Peters DC, Mojibian HR, Sinusas AJ, Hinchcliff M, Baldassarre LA. Impaired left-ventricular global longitudinal strain by feature-tracking cardiac MRI predicts mortality in systemic sclerosis. Rheumatol Int 2023; 43:849-858. [PMID: 36894756 DOI: 10.1007/s00296-023-05294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
Impaired left-ventricular (LV) and right-ventricular (RV) cardiac magnetic resonance (CMR) strain has been documented in systemic sclerosis (SSc). However, it is unknown whether the CMR strain is predictive of adverse outcomes in SSc. Therefore, we set out to investigate the prognostic value of CMR strain in SSc. Patients with SSc who underwent CMR for clinical indications between 11/2010 and 07/2020 were retrospectively studied. LV and RV strain was evaluated by feature tracking. The association between strain, late gadolinium enhancement (LGE), and survival was evaluated with time to event and Cox-regression analyses. During the study period, 42 patients with SSc (age: 57 ± 14 years, 83% female, 57% limited cutaneous SSc, SSc duration: 7 ± 8 years) underwent CMR. During the median follow-up of 3.6 years, 11 patients died (26%). Compared to surviving patients, patients who died had significantly worse LV GLS (- 8.2 ± 6.2% versus - 12.1 ± 2.9%, p = 0.03), but no difference in LV global radial, circumferential, or RV strain values. Patients within the quartile of most impaired LV GLS (≥ - 12.8%, n = 10) had worse survival when compared to patients with preserved LV GLS (< - 12.8%, n = 32, log-rank p = 0.02), which persisted after controlling for LV cardiac output, LV cardiac index, reduced LV ejection fraction, or presence of LGE. In addition, patients who had both impaired LV GLS and LGE (n = 5) had worse survival than patients with LGE or impaired GLS alone (n = 14) and compared to those without any of these features (n = 17, p = 0.003). In our retrospective cohort of patients with SSc undergoing CMR for clinical indications, LV GLS and LGE were found to be predictive of overall survival.
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Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA. .,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Hamid R Mojibian
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Monique Hinchcliff
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lauren A Baldassarre
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P. O. Box 208017, Dana 3, New Haven, CT, 06520, USA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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13
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Zhang TY, An DA, Zhou H, Ni Z, Wang Q, Chen B, Lu R, Huang J, Zhou Y, Kim DH, Wilson M, Wu LM, Mou S. Texture analysis of native T1 images as a novel method for non-invasive assessment of heart failure with preserved ejection fraction in end-stage renal disease patients. Eur Radiol 2023; 33:2027-2038. [PMID: 36260118 DOI: 10.1007/s00330-022-09177-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore the diagnostic potential of texture analysis applied to native T1 maps obtained from cardiac magnetic resonance (CMR) images for the assessment of heart failure with preserved ejection fraction (HFpEF) among patients with end-stage renal disease (ESRD). METHODS This study, conducted from June 2018 to November 2020, included 119 patients (35 on hemodialysis, 55 on peritoneal dialysis, and 29 with kidney transplants) in Renji Hospital. Native T1 maps were assessed with texture analysis, using a freely available software package, in participants who underwent cardiac MRI at 3.0 T. Four texture features, selected by dimension reduction specific to the diagnosis of HFpEF, were analyzed. Multivariate logistic regression was performed to examine the independent association between the selected features and HFpEF in ESRD patients. RESULTS Seventy-six of 119 patients were diagnosed with HFpEF. Demographic, laboratory, cardiac MRI, and echocardiogram characteristics were compared between HFpEF and non-HFpEF groups. The four texture features that were analyzed showed statistically significant differences between groups. In multivariate analysis, age, left atrial volume index (LAVI), and sum average 4 (SA4) turned out to be independent predictors for HFpEF in ESRD patients. Combining the texture feature, SA4, with typical predictive factors resulted in higher C-index (0.923 vs. 0.898, p = 0.045) and a sensitivity and specificity of 79.2% and 95.2%, respectively. CONCLUSIONS Texture analysis of T1 maps adds diagnostic value to typical clinical parameters for the assessment of heart failure with preserved ejection fraction in patients with end-stage renal disease. KEY POINTS • Non-invasive assessment of HFpEF can help predict prognosis in ESRD patients and help them take timely preventative measures. • Texture analysis of native T1 maps adds diagnostic value to the typical clinical parameters for the assessment of HFpEF in patients with ESRD.
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Affiliation(s)
- Tian-Yi Zhang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Hang Zhou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Qin Wang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Binghua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Renhua Lu
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Jiaying Huang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Yin Zhou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Doo Hee Kim
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Molly Wilson
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
| | - Shan Mou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
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14
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The Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain Analysis in Heart Failure with Preserved Ejection Fraction. CONTRAST MEDIA & MOLECULAR IMAGING 2023; 2023:5996741. [PMID: 36793498 PMCID: PMC9925252 DOI: 10.1155/2023/5996741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/02/2022] [Accepted: 12/24/2022] [Indexed: 02/08/2023]
Abstract
Background Strain analysis of cardiac magnetic resonance (CMR) is critical for the diagnosis and prognosis of heart failure (HF) with preserved ejection fraction (HFpEF). Our study aimed to identify the diagnostic and prognostic value of strain analysis revealed by CMR in HFpEF. Methods Participants in HFpEF and control were recruited according to the guideline. Baseline information, clinical parameters, blood samples were collected, and echocardiography and CMR examination were performed. Various parameters, including global longitudinal strain, global circumferential strain (GCS) and global radial strain in left ventricle (LV), right ventricle (RV), and left atrium, were measured from CMR. Receiver operator curve (ROC) was established to evaluate the diagnostic and prognostic value of strains in HFpEF. Results Seven strains, with the exception of RVGCS, were employed to generate ROC curves after t-test. All strains had significant diagnostic value for HFpEF. The area under curve (AUC) of LV strains was greater than 0.7 and the AUC of the combined analysis of LV strains was 0.858 (95% confidence interval (CI): 0.798-0.919, sensitivity: 0.713, specificity: 0.875, P < 0.001), indicating that they had a higher diagnostic value than individual LV strains. However, individual strains had no predictive value in identifying end-point events in HFpEF, the AUC of coanalysis of LV strains was 0.722 (95% CI: 0.573-0.872, sensitivity: 0.500, specificity: 0.959, P = 0.004), indicating its prognostic relevance. Conclusion Individual strain analysis in CMR may be useful for diagnosing HFpEF, the combination of LV strain analysis had the highest diagnostic value. Moreover, the prognostic value of individual strain analysis in predicting HFpEF outcome was not satisfactory while the combined usage of LV strain analysis was prognostically valuable in HFpEF outcome prediction.
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15
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Clinical Utility of Strain Imaging in Assessment of Myocardial Fibrosis. J Clin Med 2023; 12:jcm12030743. [PMID: 36769393 PMCID: PMC9917743 DOI: 10.3390/jcm12030743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/26/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Myocardial fibrosis (MF) is a non-reversible process that occurs following acute or chronic myocardial damage. MF worsens myocardial deformation, remodels the heart and raises myocardial stiffness, and is a crucial pathological manifestation in patients with end-stage cardiovascular diseases and closely related to cardiac adverse events. Therefore, early quantitative analysis of MF plays an important role in risk stratification, clinical decision, and improvement in prognosis. With the advent and development of strain imaging modalities in recent years, MF may be detected early in cardiovascular diseases. This review summarizes the clinical usefulness of strain imaging techniques in the non-invasive assessment of MF.
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16
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Lin S, Yang Z, Liu Y, Bi Y, Liu Y, Zhang Z, Zhang X, Jia Z, Wang X, Mao J. Risk Prediction Models and Novel Prognostic Factors for Heart Failure with Preserved Ejection Fraction: A Systematic and Comprehensive Review. Curr Pharm Des 2023; 29:1992-2008. [PMID: 37644795 PMCID: PMC10614113 DOI: 10.2174/1381612829666230830105740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/24/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) have large individual differences, unclear risk stratification, and imperfect treatment plans. Risk prediction models are helpful for the dynamic assessment of patients' prognostic risk and early intensive therapy of high-risk patients. The purpose of this study is to systematically summarize the existing risk prediction models and novel prognostic factors for HFpEF, to provide a reference for the construction of convenient and efficient HFpEF risk prediction models. METHODS Studies on risk prediction models and prognostic factors for HFpEF were systematically searched in relevant databases including PubMed and Embase. The retrieval time was from inception to February 1, 2023. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias in included studies. The predictive value of risk prediction models for end outcomes was evaluated by sensitivity, specificity, the area under the curve, C-statistic, C-index, etc. In the literature screening process, potential novel prognostic factors with high value were explored. RESULTS A total of 21 eligible HFpEF risk prediction models and 22 relevant studies were included. Except for 2 studies with a high risk of bias and 2 studies with a moderate risk of bias, other studies that proposed risk prediction models had a low risk of bias overall. Potential novel prognostic factors for HFpEF were classified and described in terms of demographic characteristics (age, sex, and race), lifestyle (physical activity, body mass index, weight change, and smoking history), laboratory tests (biomarkers), physical inspection (blood pressure, electrocardiogram, imaging examination), and comorbidities. CONCLUSION It is of great significance to explore the potential novel prognostic factors of HFpEF and build a more convenient and efficient risk prediction model for improving the overall prognosis of patients. This review can provide a substantial reference for further research.
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Affiliation(s)
- Shanshan Lin
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
- Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, West Tuanpo New Town, Jinghai District, Tianjin 301617, China
| | - Zhihua Yang
- Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, West Tuanpo New Town, Jinghai District, Tianjin 301617, China
| | - Yangxi Liu
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
- Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, West Tuanpo New Town, Jinghai District, Tianjin 301617, China
| | - Yingfei Bi
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
| | - Yu Liu
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
| | - Zeyu Zhang
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
- Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, West Tuanpo New Town, Jinghai District, Tianjin 301617, China
| | - Xuan Zhang
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
- Tianjin University of Traditional Chinese Medicine, No. 10, Poyang Lake Road, West Tuanpo New Town, Jinghai District, Tianjin 301617, China
| | - Zhuangzhuang Jia
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
| | - Xianliang Wang
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
| | - Jingyuan Mao
- Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, Changling Road, Xiqing District, Tianjin 300381, China
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17
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Kulkarni AA, Chudgar PD, Burkule NJ, Kamat NV. Mitral Annulus Disjunction and Arrhythmic Mitral Valve Prolapse: Emerging Role of Cardiac Magnetic Resonance Imaging in the Workup. Indian J Radiol Imaging 2022; 32:576-581. [DOI: 10.1055/s-0042-1754357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractMitral valve prolapse is a commonly described entity with a highly variable and benign course. However, it is associated with ventricular arrhythmias and sudden cardiac death in a small subset of patients. Recent studies have yielded insight into myocardial mechanics and the causation of ventricular arrhythmias in these groups of patients.Mitral annular disjunction (MAD) characterized by detachment of mitral annulus from left ventricular myocardium is associated with morphological and functional remodeling of the left ventricular myocardium. Resultant fibrosis acts as a substrate of ventricular arrhythmia and sudden cardiac death.We present two such cases of arrhythmic mitral valve prolapse associated with MAD. Cardiac magnetic resonance imaging provides excellent morphological information and also helps in the assessment of fibrosis.
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Affiliation(s)
- Amol A. Kulkarni
- Department of Radiodiagnosis, Jupiter Hospital, Thane, Maharashtra, India
| | - Priya D. Chudgar
- Department of Radiodiagnosis, Jupiter Hospital, Thane, Maharashtra, India
| | - Nitin J. Burkule
- Department of Cardiology, Jupiter Hospital, Thane, Maharashtra, India
| | - Nikhil V. Kamat
- Department of Radiodiagnosis, Jupiter Hospital, Thane, Maharashtra, India
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18
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Papanastasiou CA, Bazmpani MA, Kokkinidis DG, Zegkos T, Efthimiadis G, Tsapas A, Karvounis H, Ziakas A, Kalogeropoulos AP, Kramer CM, Karamitsos TD. The prognostic value of right ventricular ejection fraction by cardiovascular magnetic resonance in heart failure: A systematic review and meta-analysis. Int J Cardiol 2022; 368:94-103. [PMID: 35961612 DOI: 10.1016/j.ijcard.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is considered the gold standard for the assessment of right ventricular ejection fraction (RVEF). Previous studies have suggested that RVEF may be a predictor of adverse outcomes in heart failure (HF). In this study, we aimed to systematically review the prognostic value of RVEF, evaluated by CMR, across the spectrum of left ventricular systolic function in patients with HF. METHODS Electronic databases were searched for studies investigating the prognostic value of RVEF in HF, irrespective of left ventricular ejection fraction (LVEF). A random-effects meta-analysis was conducted for mortality and HF hospitalization. Subgroup analyses were also performed based on the presence of reduced (<50%) or preserved LVEF (≥50%). RESULTS In total, 46 studies enrolling 14,344 patients were included. In the pooled analyses, impaired RVEF was a powerful predictor of mortality (HR: 1.26, 95% CI: 1.18-1.33, I2: 13%, per 10% decrease in RVEF) and death or HF hospitalization (HR: 1.31, 95% Cl: 1.2-1.42, I2: 27%, per 10% decrease in RVEF). A decrease in RVEF was strongly associated with increased risk of mortality or hospitalization both in HF with reduced EF (HR: 1.24, 95% CI: 1.13-1.36, I2: 2%, per 10% decrease in RVEF) and in HF with preserved EF (HR: 1.24, 95% CI: 1.09-1.40, I2: 0%, per 10% decrease in RVEF). CONCLUSION Impaired RVEF on CMR strongly predicts adverse outcomes in patients with HF regardless of LVEF. RV systolic function should be carefully evaluated in these patients. Prospero Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256967.
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Affiliation(s)
- Christos A Papanastasiou
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Anna Bazmpani
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, New Haven, CT, USA
| | - Thomas Zegkos
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Efthimiadis
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, UK
| | - Haralambos Karvounis
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Christopher M Kramer
- Department of Medicine (Cardiovascular Division), University of Virginia Health System, Charlottesville, VA, USA
| | - Theodoros D Karamitsos
- Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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19
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Wang J, Li Y, Guo YK, Huang S, Shi R, Yan WF, Qian WL, He GX, Yang ZG. The adverse impact of coronary artery disease on left ventricle systolic and diastolic function in patients with type 2 diabetes mellitus: a 3.0T CMR study. Cardiovasc Diabetol 2022; 21:30. [PMID: 35193565 PMCID: PMC8864799 DOI: 10.1186/s12933-022-01467-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background Coronary artery disease (CAD) confers considerable morbidity and mortality in diabetes. However, the role of CAD in additive effect of left ventricular (LV) function has rarely been explored in type 2 diabetes mellitus (T2DM) patients. This study aimed to investigate how CAD affect LV systolic and diastolic function in T2DM patients. Materials and methods A total of 282 T2DM patients {104 patients with CAD [T2DM (CAD +)] and 178 without [T2DM (CAD −)]} and 83 sex- and age- matched healthy controls underwent cardiac magnetic resonance scanning. LV structure, function, global strains [including systolic peak strain (PS), peak systolic (PSSR) and diastolic strain rate (PDSR) in radial, circumferential and longitudinal directions] and late gadolinium enhancement (LGE) parameters were measured. T2DM (CAD +) patients were divided into two subgroups based on the median of Gensini score (60) which was calculated to assess the severity of CAD. Multivariable linear regression analyses were constructed to investigate the determinants of reduced LV function. Results Compared with normal controls, T2DM (CAD −) patients exhibited increased LV end-diastolic and end-systolic volume index and decreased LV global strains, while T2DM(CAD +) patients showed more marked increase and decrease than T2DM(CAD-) and healthy controls, except for longitudinal PDSR (PDSR-L) (all P < 0.017). All of LV global strains demonstrated a progressive decrease from normal controls, through Gensini score ≤ 60, to Gensini score > 60 group, except for PDSR-L (all P < 0.017). CAD was an independent predictor of reduced LV global circumferential PS (GCPS, β = 0.22, p < 0.001), PSSR (PSSR-C, β = 0.17, p = 0.005), PDSR (PDSR-C, β = 0.22, p < 0.001), global radial PS (GRPS, β = 0.19, p = 0.001), and global longitudinal PS (GLPS, β = 0.18, p = 0.003) in T2DM. The Gensini score was associated with decreased GCPS, PSSR-C, PDSR-C, GRPS, and GLPS in T2DM (CAD +) (all p < 0.05). Conclusion CAD has an additive deleterious effect on LV systolic and diastolic function in T2DM patients. Among T2DM (CAD +) patients, the Gensini score is associated with reduced LV contractile and diastolic function. Trial registration Retrospectively registered
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Affiliation(s)
- Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, 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, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Guang-Xi He
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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20
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Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, Li Y. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12020445. [PMID: 35204536 PMCID: PMC8871506 DOI: 10.3390/diagnostics12020445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingzhu Qian
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
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Song L, Zhao X, Lv W, Zeng J, Wang Y, Gong B, Kalogeropoulos AP, Pu H, Bai Y, Peng S. Preliminary study on the diagnostic value of cardiac magnetic resonance feature tracking for malignant ventricular arrhythmias in non-ischemic dilated cardiomyopathy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:215. [PMID: 35280384 PMCID: PMC8908127 DOI: 10.21037/atm-22-660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022]
Abstract
Background Patients with nonischemic dilated cardiomyopathy (NIDCM) and malignant ventricular arrhythmia (MVA) often have a poor prognosis and a high risk of sudden cardiac death. Although the diagnosis of MVA is straightforward by electrocardiogram (ECG), the underlying abnormalities of ventricular mechanics in these patients are unknown. This study aims to preliminarily explore the value of cardiac magnetic resonance feature tracking (CMR-FT) for MVA in dilated cardiomyopathy. Methods In this retrospective study, patients with NIDCM who met inclusion criteria were divided into an MVA group and a non-MVA group (included from January 2018 to September 2021). The interobserver agreement of myocardial strain parameters, including global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), were tested. The GLS, GCS, GRS, left ventricular ejection fraction (LVEF), Tpeak-Tend interval on ECG and brain natriuretic peptide (BNP) were compared between groups. Single-factor and multifactor receiver operating characteristic (ROC) curve analyses were conducted to calculate the area under the ROC curve (AUC), cut-off point, sensitivity, and specificity of these parameters in predicting MVA in NIDCM. Results A total of 161 NIDCM patients were included (54 in the MVA group). GLS, GCS, and GRS had good interobserver agreement (all intraclass correlation coefficients >0.80). The absolute GLS and GCS, GRS and LVEF were lower in the MVA group than the non-MVA group (P<0.001), Tpeak-Tend and BNP were higher (P<0.001). Single-factor ROC curve analysis showed that GLS, GCS and GRS had certain diagnostic value for MVA (AUC =0.795, 0.802, and 0.754, respectively). Among them, GCS had higher sensitivity and specificity (GCS 0.796/0.776, GLS 0.778/0.757, GRS 0.741/0.692). Multifactor ROC curve analysis showed the combination of GLS and GCS (AUC =0.810), the combination of GCS and GRS (AUC =0.802), the combination of GLS and GRS (AUC =0.787), the combination of GLS, GCS, and GRS (AUC =0.810). Conclusions The three-dimensional myocardial strain parameters (especially GLS and GCS) measured by CMR-FT had certain diagnostic value and could reflect the underlying abnormality of ventricular mechanics of NIDCM with MVA.
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Affiliation(s)
- Linsheng Song
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenlong Lv
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie Zeng
- Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Gong
- Human Disease Genes Key Laboratory of Sichuan Province and Institute of Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, NY, USA
| | - Hong Pu
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yifeng Bai
- Department of Oncology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shengkun Peng
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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22
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Kar J, Cohen MV, McQuiston SA, Poorsala T, Malozzi CM. Direct left-ventricular global longitudinal strain (GLS) computation with a fully convolutional network. J Biomech 2022; 130:110878. [PMID: 34871894 PMCID: PMC8896910 DOI: 10.1016/j.jbiomech.2021.110878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
This study's purpose was to develop a direct MRI-based, deep-learning semantic segmentation approach for computing global longitudinal strain (GLS), a known metric for detecting left-ventricular (LV) cardiotoxicity in breast cancer. Displacement Encoding with Stimulated Echoes cardiac image phases acquired from 30 breast cancer patients and 30 healthy females were unwrapped via a DeepLabV3 + fully convolutional network (FCN). Myocardial strains were directly computed from the unwrapped phases with the Radial Point Interpolation Method. FCN-unwrapped phases of a phantom's rotating gel were validated against quality-guided phase-unwrapping (QGPU) and robust transport of intensity equation (RTIE) phase-unwrapping. FCN performance on unwrapping human LV data was measured with F1 and Dice scores versus QGPU ground-truth. The reliability of FCN-based strains was assessed against RTIE-based strains with Cronbach's alpha (C-α) intraclass correlation coefficient. Mean squared error (MSE) of unwrapping the phantom experiment data at 0 dB signal-to-noise ratio were 1.6, 2.7 and 6.1 with FCN, QGPU and RTIE techniques. Human data classification accuracies were F1 = 0.95 (Dice = 0.96) with FCN and F1 = 0.94 (Dice = 0.95) with RTIE. GLS results from FCN and RTIE were -16 ± 3% vs. -16 ± 3% (C-α = 0.9) for patients and -20 ± 3% vs. -20 ± 3% (C-α = 0.9) for healthy subjects. The low MSE from the phantom validation demonstrates accuracy of phase-unwrapping with the FCN and comparable human subject results versus RTIE demonstrate GLS analysis accuracy. A deep-learning methodology for phase-unwrapping in medical images and GLS computation was developed and validated in a heterogeneous cohort.
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Affiliation(s)
- Julia Kar
- Departments of Mechanical Engineering and Pharmacology University of South Alabama 150 Jaguar Drive, Mobile, AL 36688 Phone: 251 460 7456
| | - Michael V. Cohen
- Department of Cardiology College of Medicine University of South Alabama 1700 Center Street, Mobile, AL 36604
| | - Samuel A. McQuiston
- Department of Radiology University of South Alabama 2451 USA Medical Center Drive, Mobile, AL 36617
| | - Teja Poorsala
- Departments of Oncology and Hematology University of South Alabama 101 Memorial Hospital Drive, Building 3 Mobile, AL 36608
| | - Christopher M. Malozzi
- Department of Cardiology College of Medicine University of South Alabama 1700 Center Street, Mobile, AL 36604
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Heart failure with preserved ejection fraction assessed by cardiac magnetic resonance: From clinical uses to emerging techniques. Trends Cardiovasc Med 2021; 33:141-147. [PMID: 34933114 DOI: 10.1016/j.tcm.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) account for approximately 50% of those with heart failure (HF) and have increased morbidity and mortality when compared to those with HF with reduced ejection fraction. Currently, the pathophysiology and diagnostic criteria for HFpEF remain unclear, contributing significantly to delays in creating a beneficial and tailored treatment that can improve the prognosis of HFpEF. A multitude of studies have exclusively tested and illustrated the diagnostic value of echocardiography imaging in HFpEF; however, a widely-accepted criterion to identify HFpEF using cardiovascular magnetic resonance (CMR) imaging has not been established. As the gold standard for cardiac structural, functional measurement, and tissue characterization, CMR holds great potential for the early discovery of the pathophysiology, diagnosis, and risk stratification of HFpEF. This review aims to comprehensively discuss the diagnostic and prognostic role of CMR parameters in the setting of HFpEF through validated routine and prospective emerging techniques, and provide clinical perspectives for CMR imaging application in HFpEF.
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24
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Kato S, Fukui K, Kodama S, Azuma M, Nakayama N, Iwasawa T, Kimura K, Tamura K, Utsunomiya D. Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction. J Cardiovasc Magn Reson 2021; 23:112. [PMID: 34657615 PMCID: PMC8522041 DOI: 10.1186/s12968-021-00807-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) has been proposed as a novel mechanism for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). Recent studies have suggested the potential utility of coronary flow reserve (CFR) as a marker of CMD in patients with HFpEF. Phase contrast (PC) cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method to quantify CFR. We aimed to investigate the prognostic value of CMR-derived CFR in patients with HFpEF. METHODS Data from 163 HFpEF patients (73 ± 9 years; 86 [53%] female) were retrospectively analyzed. Coronary sinus blood flow was measured in all patients, and myocardial blood flow was calculated as coronary sinus blood flow divided by left ventricular mass. CFR was calculated as the myocardial blood flow during adenosine triphosphate infusion divided by that at rest. Adverse events were defined as all-cause death and hospitalization due to HF exacerbation. Event-free survival stratified according to CFR < 2.0 was estimated with Kaplan-Meier survival methods and Log-rank test. RESULTS During a median follow-up of 4.1 years, 26 patients (16%) experienced adverse events. CMR-derived CFR was significantly lower in HFpEF with adverse events compared with those without (1.93 ± 0.38 vs. 2.67 ± 0.52, p < 0.001). On a Kaplan Meier curve, the rates of adverse events were significantly higher in HFpEF patients with CFR < 2.0 compared with HFpEF with CFR ≥ 2.0 (p < 0.001). The area under the curve of CFR for predicting adverse events was significantly higher than that of LGE (0.881 vs. 0.768, p = 0.037) and GLS (0.881 vs. 0.747, p = 0.036). CONCLUSIONS CFR assessed using coronary sinus PC cine CMR may be useful as a non-invasive prognostic marker for HFpEF patients.
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Affiliation(s)
- Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Sho Kodama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Naoki Nakayama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Holzknecht M, Reindl M, Tiller C, Reinstadler SJ, Lechner I, Pamminger M, Schwaiger JP, Klug G, Bauer A, Metzler B, Mayr A. Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters. Clin Res Cardiol 2021; 110:1599-1611. [PMID: 33884479 PMCID: PMC8484167 DOI: 10.1007/s00392-021-01855-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
AIM We aimed to investigate the comparative prognostic value of left ventricular ejection fraction (LVEF), mitral annular plane systolic excursion (MAPSE), fast manual long-axis strain (LAS) and global longitudinal strain (GLS) determined by cardiac magnetic resonance (CMR) in patients after ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS This observational cohort study included 445 acute STEMI patients treated with primary percutaneous coronary intervention (pPCI). Comprehensive CMR examinations were performed 3 [interquartile range (IQR): 2-4] days after pPCI for the determination of left ventricular (LV) functional parameters and infarct characteristics. Primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as composite of death, re-infarction and congestive heart failure. During a follow-up of 16 [IQR: 12-49] months, 48 (11%) patients experienced a MACE. LVEF (p = 0.023), MAPSE (p < 0.001), LAS (p < 0.001) and GLS (p < 0.001) were significantly related to MACE. According to receiver operating characteristic analyses, only the area under the curve (AUC) of GLS was significantly higher compared to LVEF (0.69, 95% confidence interval (CI) 0.64-0.73; p < 0.001 vs. 0.60, 95% CI 0.55-0.65; p = 0.031. AUC difference: 0.09, p = 0.020). After multivariable analysis, GLS emerged as independent predictor of MACE even after adjustment for LV function, infarct size and microvascular obstruction (hazard ratio (HR): 1.13, 95% CI 1.01-1.27; p = 0.030), as well as angiographical (HR: 1.13, 95% CI 1.01-1.28; p = 0.037) and clinical parameters (HR: 1.16, 95% CI 1.05-1.29; p = 0.003). CONCLUSION GLS emerged as independent predictor of MACE after adjustment for parameters of LV function and myocardial damage as well as angiographical and clinical characteristics with superior prognostic validity compared to LVEF.
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Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Johannes P Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milser Strasse 10, 6060, Hall in Tirol, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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He J, Yang W, Wu W, Li S, Yin G, Zhuang B, Xu J, Sun X, Zhou D, Wei B, Sirajuddin A, Teng Z, Zhao S, Kureshi F, Lu M. Early Diastolic Longitudinal Strain Rate at MRI and Outcomes in Heart Failure with Preserved Ejection Fraction. Radiology 2021; 301:582-592. [PMID: 34519577 DOI: 10.1148/radiol.2021210188] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Assessment of subclinical myocardial dysfunction by using feature tracking has shown promise in prognosis evaluation of heart failure with preserved ejection fraction (HFpEF). Global early diastolic longitudinal strain rate (eGLSR) can identify earlier diastolic dysfunction; however, limited data are available on its prognostic value in HFpEF. Purpose To evaluate the association between left ventricular (LV) eGLSR and primary composite outcomes (all-cause death or heart failure hospitalization) in patients with HFpEF. Materials and Methods In this retrospective study, consecutive patients with HFpEF (included from January 2010 to March 2013) underwent cardiovascular MRI. The correlation between eGLSR and variables was assessed by using linear regression. The association between eGLSR (obtained with use of feature tracking) and outcomes was analyzed by using Cox proportional regression. Results A total of 186 patients with HFpEF (mean age ± standard deviation, 59 years ± 12; 77 women) were included. The eGLSR was weakly correlated with LV end-diastole volume index (Pearson correlation coefficient [r] = -0.35; P < .001), heart rate (r = 0.35; P < .001), and LV ejection fraction (r = 0.30; P < .001) and moderately correlated with LV end-systole volume index (r = -0.41; P < .001). At a median follow-up of 9.2 years (interquartile range, 8.7-10.0 years), 72 patients experienced primary composite outcomes. Impaired eGLSR, defined as an eGLSR of less than 0.57 per second, was associated with a greater rate of heart failure hospitalization or all-cause death (hazard ratio, 2.0 [95% CI: 1.1, 3.7]; P = .02) after adjusting for multiple clinical and imaging-based variables. Conclusion Left ventricular global early diastolic longitudinal strain rate obtained from cardiovascular MRI feature tracking was independently associated with adverse outcomes in patients with heart failure with preserved ejection fraction. © RSNA, 2021 Online supplemental material is available for this article. An earlier incorrect version appeared online. This article was corrected on October 22, 2021.
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Affiliation(s)
- Jian He
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Wenjing Yang
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Weichun Wu
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Shuang Li
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Gang Yin
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Baiyan Zhuang
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Jing Xu
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Xiaoxin Sun
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Di Zhou
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Binqi Wei
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Arlene Sirajuddin
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Zhongzhao Teng
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Shihua Zhao
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Faraz Kureshi
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
| | - Minjie Lu
- From the Departments of Magnetic Resonance Imaging (J.H., W.Y., S.L., G.Y., B.Z., J.X., D.Z., S.Z., M.L.), Echocardiography (W.W.), and Nuclear Medicine (X.S.), and Heart Failure Care Unit, Heart Failure Center (B.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Radiology, University of Cambridge, Cambridge, England (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L.)
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Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction. Cardiovasc Diabetol 2021; 20:185. [PMID: 34521391 PMCID: PMC8442278 DOI: 10.1186/s12933-021-01379-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with sex-specific pathophysiology. Estrogen deficiency is believed to be responsible for the development of HFpEF in women. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes. While diabetes mellitus (DM) frequently coexists with HFpEF in women and is associated with worse outcomes, the changes in myocardial contractility among women with HFpEF and the DM phenotype is yet unknown. Therefore, we aimed to investigate sex-related differences in left ventricular (LV) contractility dysfunction in HFpEF comorbid with DM. Methods A total of 224 patients who underwent cardiac cine MRI were included in this study. Sex-specific differences in LV structure and function in the context of DM were determined. LV systolic strains (global longitudinal strain [GLS], circumferential strain [GCS] and radial strain [GRS]) were measured using cine MRI. The determinants of impaired myocardial strain for women and men were assessed. Results The prevalence of DM did not differ between sexes (p > 0.05). Despite a similar LV ejection fraction, women with DM demonstrated a greater LV mass index than women without DM (p = 0.023). The prevalence of LV geometry patterns by sex did not differ in the non-DM subgroup, but there was a trend toward a more abnormal LV geometry in women with DM (p = 0.072). The magnitudes of systolic strains were similar between sexes in the non-DM group (p > 0.05). Nevertheless, in the DM subgroup, there was significant impairment in women in systolic strains compared with men (p < 0.05). In the multivariable analysis, DM was associated with impaired systolic strains in women (GLS [β = 0.26; p = 0.007], GCS [β = 0.31; p < 0.001], and GRS [β = −0.24; p = 0.016]), whereas obesity and coronary artery disease were associated with impaired systolic strains in men (p < 0.05). Conclusions Women with DM demonstrated greater LV contractile dysfunction, which indicates that women with HFpEF comorbid with DM have a high-risk phenotype of cardiac failure that may require more aggressive and personalized medical treatment.
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Kammerlander AA, Nitsche C, Donà C, Koschutnik M, Dannenberg V, Mascherbauer K, Schönbauer R, Zafar A, Winter MP, Bartko PE, Goliasch G, Hengstenberg C, Mascherbauer J. Heart failure with preserved ejection fraction after left-sided valve surgery: prevalent and relevant. Eur J Heart Fail 2021; 23:2008-2016. [PMID: 34506046 PMCID: PMC9293454 DOI: 10.1002/ejhf.2345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS To investigate the epidemiological and prognostic relationship between heart failure with preserved ejection fraction (HFpEF) and left-sided valve surgery using all-cause mortality as a primary endpoint. METHODS AND RESULTS We studied a total of 973 patients, of whom 673 had undergone left-sided valve surgery (time from surgery to enrolment 50 ± 30 months after valve surgery) and 300 patients with HFpEF without prior surgery served as control group. Among patients after surgery, 67.4% fulfilled all criteria of HFpEF according to current guideline recommendations, 20.6% had no heart failure (HF), and 12.0% had HF with mid-range or reduced ejection fraction (HFmrEF/HFrEF). During 83 ± 39 months of follow-up, a total of 335 (34.4%) patients died. Compared to surgical patients with no subsequent HF, patients with HFpEF and HFmrEF/HFrEF after surgery showed significantly higher all-cause mortality rates [hazard ratio (HR) 1.80, 95% confidence interval (CI) 1.25-2.57, P = 0.001; and HR 1.86, 95% CI 1.16-2.98, P = 0.010, respectively]. This increased mortality rate was similar to the control HFpEF group without surgery (HR 2.05, 95% CI 1.38-3.02, P < 0.001). Results remained consistent after adjustment for clinical and imaging risk factors and when using the established HFA-PEFF risk score for HFpEF diagnosis. Notably, only 12.5% of HFpEF patients after surgery were diagnosed with HF despite regular follow-up visits by board-certified cardiologists. In contrast, 92.1% of HFmrEF/HFrEF patients after surgery were diagnosed correctly. CONCLUSIONS Heart failure with preserved ejection fraction following left-sided valve surgery is highly prevalent, associated with unfavourable outcomes, but rarely recognized.
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Affiliation(s)
| | - Christian Nitsche
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Varius Dannenberg
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Robert Schönbauer
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Amna Zafar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Max-Paul Winter
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Philipp E Bartko
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Julia Mascherbauer
- Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
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Galea N, Pambianchi G, Cundari G, Sturla F, Marchitelli L, Putotto C, Versacci P, De Paulis R, Francone M, Catalano C. Impaction of regurgitation jet on anterior mitral leaflet is associated with diastolic dysfunction in patients with bicuspid aortic valve and mild insufficiency: a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 2021; 38:211-221. [PMID: 34448067 PMCID: PMC8818636 DOI: 10.1007/s10554-021-02384-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
To assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging. Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain. Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10 ± 0.2 1/s vs. 1.34 ± 0.5 1/s vs. 1.53 ± 0.3 1/s, p:0.001 and 0.68 ± 0.2 1/s vs. 1.17 ± 0.2 1/s vs. 1.05 ± 0.4 1/s ; p < 0.001, PDV = − 101.6 ± 28.1 deg/s vs. − 201.4 ± 85.9 deg/s vs. − 221.6 ± 67.1 deg/s; p < 0.001 and − 28.1 ± 8 mm/s vs. − 38.9 ± 11.1 mm/s vs. − 43.6 ± 14.3 mm/s, p < 0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups. In BAV patients with mild AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling.
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Affiliation(s)
- Nicola Galea
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. .,Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Sturla
- Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy.,Unicamillus International Medical University in Rome, Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
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Wang Y, Liang J, Zheng S, He A, Chen C, Zhao X, Hua M, Xu J, Zheng Z, Liu M. Combined associations of obesity and metabolic health with subclinical left ventricular dysfunctions: Danyang study. ESC Heart Fail 2021; 8:3058-3069. [PMID: 33938155 PMCID: PMC8318506 DOI: 10.1002/ehf2.13403] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
Aims The association of strictly defined metabolic healthy obese (MHO) with subclinical cardiac function was unclear. Our study aims to examine the role of MHO in subclinical cardiac dysfunction in a Chinese population. Methods and results The study subjects were recruited from Danyang from 2017 to 2019. Obesity was defined by body mass index (BMI) categories (normal weight, overweight and obesity). Metabolic health was strictly defined as having neither any of the guidelines recommended metabolic syndrome components nor insulin resistance. Thus, subjects were grouped by BMI categories and metabolic health status as six groups. Preclinical systolic (global longitudinal strain [GLS]) and diastolic function were assessed by 2D speckle tracking, and transmitral and tissue Doppler imaging, respectively. The 2757 participants (mean age ± standard deviation, 52.7 ± 11.7 years) included 1613 (58.5%) women, 999 (36.2%) obese, 2080 (75.4%) metabolically unhealthy and 93 (3.4%) MHO participants. After adjustment for covariates, the trend was similar for left ventricular (LV) ejection fraction (Ptrend ≥ 0.07) but significantly worse for GLS, e′ and E/e′ (Ptrend ≤ 0.02) across the six groups or passing from normal weight to obese individuals irrespective of metabolic status. MHO participants had lower GLS (20.4 vs. 21.4%) and e′ (9.6 vs. 10.6 cm/s) compared with controls (P < 0.0001) but had similar GLS (P = 0.47) compared with metabolically unhealthy obese (MUO). Regardless of obesity status, metabolically unhealthy participants had worse diastolic function compared with their metabolically healthy counterparts (P ≤ 0.0004). Compared with controls, MHO individuals were at higher risk of subclinical LV systolic dysfunction (OR = 3.44, 95% CI = 1.25–9.49, P = 0.02). These results were robust to sensitivity analysis. Conclusions MHO was substantially associated with worse subclinical systolic function although early diastolic dysfunction seemed to be more accentuated in MUO.
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Affiliation(s)
- Ye Wang
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Junya Liang
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Shasha Zheng
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Anxia He
- Department of EchocardiographyAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Chao Chen
- Department of EchocardiographyAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Xixuan Zhao
- Department of EchocardiographyAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Mulian Hua
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Junyao Xu
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Ziwen Zheng
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Ming Liu
- Institute of HypertensionAffiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese MedicineNanjingChina
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Abstract
Classification of heart failure is based on the left ventricular ejection fraction (EF): preserved EF, midrange EF, and reduced EF. There remains an unmet need for further heart failure phenotyping of ventricular structure-function relationships. Because of high spatiotemporal resolution, cardiac magnetic resonance (CMR) remains the reference modality for quantification of ventricular contractile function. The authors aim to highlight novel frameworks, including theranostic use of ferumoxytol, to enable more efficient evaluation of ventricular function in heart failure patients who are also frequently anemic, and to discuss emerging quantitative CMR approaches for evaluation of ventricular structure-function relationships in heart failure.
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