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Nowak S, Bischoff LM, Pennig L, Kaya K, Isaak A, Theis M, Block W, Pieper CC, Kuetting D, Zimmer S, Nickenig G, Attenberger UI, Sprinkart AM, Luetkens JA. Deep Learning Virtual Contrast-Enhanced T1 Mapping for Contrast-Free Myocardial Extracellular Volume Assessment. J Am Heart Assoc 2024; 13:e035599. [PMID: 39344639 DOI: 10.1161/jaha.124.035599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 08/19/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND The acquisition of contrast-enhanced T1 maps to calculate extracellular volume (ECV) requires contrast agent administration and is time consuming. This study investigates generative adversarial networks for contrast-free, virtual extracellular volume (vECV) by generating virtual contrast-enhanced T1 maps. METHODS AND RESULTS This retrospective study includes 2518 registered native and contrast-enhanced T1 maps from 1000 patients who underwent cardiovascular magnetic resonance at 1.5 Tesla. Recent hematocrit values of 123 patients (hold-out test) and 96 patients from a different institution (external evaluation) allowed for calculation of conventional ECV. A generative adversarial network was trained to generate virtual contrast-enhanced T1 maps from native T1 maps for vECV creation. Mean and SD of the difference per patient (ΔECV) were calculated and compared by permutation of the 2-sided t test with 10 000 resamples. For ECV and vECV, differences in area under the receiver operating characteristic curve (AUC) for discriminating hold-out test patients with normal cardiovascular magnetic resonance versus myocarditis or amyloidosis were tested with Delong's test. ECV and vECV showed a high agreement in patients with myocarditis (ΔECV: hold-out test, 2.0%±1.5%; external evaluation, 1.9%±1.7%) and normal cardiovascular magnetic resonance (ΔECV: hold-out test, 1.9%±1.4%; external evaluation, 1.5%±1.2%), but variations in amyloidosis were higher (ΔECV: hold-out test, 6.2%±6.0%; external evaluation, 15.5%±6.4%). In the hold-out test, ECV and vECV had a comparable AUC for the diagnosis of myocarditis (ECV AUC, 0.77 versus vECV AUC, 0.76; P=0.76) and amyloidosis (ECV AUC, 0.99 versus vECV AUC, 0.96; P=0.52). CONCLUSIONS Generation of vECV on the basis of native T1 maps is feasible. Multicenter training data are required to further enhance generalizability of vECV in amyloidosis.
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Affiliation(s)
- Sebastian Nowak
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Lenhard Pennig
- Department of Diagnostic and Interventional Radiology University Hospital Cologne Cologne Germany
| | - Kenan Kaya
- Department of Diagnostic and Interventional Radiology University Hospital Cologne Cologne Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Maike Theis
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Wolfgang Block
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center University Hospital Bonn Bonn Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center University Hospital Bonn Bonn Germany
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology University Hospital Bonn Bonn Germany
- Quantitative Imaging Laboratory Bonn (QILaB) University Hospital Bonn Bonn Germany
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Damlin A, Kjellberg F, Themudo R, Chow K, Engblom H, Oscarson M, Nickander J. No differences in native T1 of the renal cortex between Fabry disease patients and healthy subjects in cardiac dedicated native T1 maps. J Cardiovasc Magn Reson 2024:101104. [PMID: 39332708 DOI: 10.1016/j.jocmr.2024.101104] [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: 01/02/2024] [Revised: 08/31/2024] [Accepted: 09/20/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked inherited lysosomal storage disease that is caused by deficient activity of the enzyme alpha-galactosidase A. Cardiovascular magnetic resonance (CMR) imaging can detect cardiac sphingolipid accumulation using native T1 mapping. The kidneys are often visible in cardiac CMR native T1 maps, however it is currently unknown if the maps can be used to detect sphingolipid accumulation in the kidneys of FD patients. Therefore, the aim of this study was to evaluate if cardiac dedicated native T1 maps can be used to detect sphingolipid accumulation in the kidneys. METHODS FD patients (n=18, 41 ± 10 years, 44% male) and healthy subjects (n=38, 41 ± 16 years, 47% male) were retrospectively enrolled. Native T1 maps were acquired at 1.5T (MAGNETOM Aera) using MOLLI research sequences. Native T1 values were measured by manually delineating regions of interest (ROI) in the renal cortex, renal medulla, heart, spleen, blood, and liver. Endo- and epicardial borders were delineated in the myocardium and averaged across all slices. Blood ROIs were placed in the left-ventricular blood pool in the midventricular slice. RESULTS There were no differences in native T1 between the FD patients and the healthy subjects in the renal cortex (1034±88 ms vs 1056±59 ms, p=0.29), blood (1614±111 ms vs 1576 ± 100 ms, p=0.22), spleen (1143±45 ms vs 1132±70 ms, p=0.54) or liver (568±49 ms vs 557±47 ms, p=0.41). Native T1 was lower in the hearts of the FD patients compared to healthy subjects (951±79 vs 1006±38, p<0.01), and higher in the renal medulla (1635±144 vs 1514±81, p<0.01). The results were similar when stratified for sex. CONCLUSION Compared to healthy subjects, patients with FD and cardiac involvement had no differences in native T1 of the renal cortex. FD patients had higher native T1 in the renal medulla, which is not totally explained by differences in blood native T1 but may reflect a hyperfiltration state in the development of renal failure. The findings suggest that sphingolipid accumulation in the renal cortex in FD patients could not be detected with cardiac dedicated research native T1 maps.
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Affiliation(s)
- Anna Damlin
- Department of Clinical Physiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Felix Kjellberg
- Department of Clinical Physiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Raquel Themudo
- Department of Clinical Physiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Kelvin Chow
- Cardiovascular MR R&D Siemens Medical Solutions Inc. Chicago, USA
| | - Henrik Engblom
- Department of Clinical Physiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Oscarson
- Department of Endocrinology and Centre for inherited metabolic diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Manhard MK, Kilpattu Ramaniharan A, Tkach JA, Trout AT, Dillman JR, Pednekar AS. Simultaneous Multiparameter Mapping of the Liver in a Single Breath-Hold or Respiratory-Triggered Acquisition Using Multi-Inversion Spin and Gradient Echo MRI. J Magn Reson Imaging 2024. [PMID: 39192381 DOI: 10.1002/jmri.29584] [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: 04/25/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Quantitative parametric mapping is an increasingly important tool for noninvasive assessment of chronic liver disease. Conventional parametric mapping techniques require multiple breath-held acquisitions and provide limited anatomic coverage. PURPOSE To investigate a multi-inversion spin and gradient echo (MI-SAGE) technique for simultaneous estimation of T1, T2, and T2* of the liver. STUDY TYPE Prospective. SUBJECTS Sixteen research participants, both adult and pediatric (age 17.5 ± 4.6 years, eight male), with and without known liver disease (seven asymptomatic healthy controls, two fibrotic liver disease, five steatotic liver disease, and two fibrotic and steatotic liver disease). FIELD STRENGTH/SEQUENCE 1.5 T, single breath-hold and respiratory triggered MI-SAGE, breath-hold modified Look-Locker inversion recovery (MOLLI, T1 mapping), breath-hold gradient and spin echo (GRASE, T2 mapping), and multiple gradient echo (mGRE, T2* mapping) sequences. ASSESSMENT Agreement between hepatic T1, T2, and T2* estimated using MI-SAGE and conventional parametric mapping sequences was evaluated. Repeatability and reproducibility of MI-SAGE were evaluated using a same-session acquisition and second-session acquisition. STATISTICAL TESTS Bland-Altman analysis with bias assessment and limits of agreement (LOA) and intraclass correlation coefficients (ICC). RESULTS Hepatic T1, T2, and T2* estimates obtained using the MI-SAGE technique had mean biases of 72 (LOA: -22 to 166) msec, -3 (LOA: -10 to 5) msec, and 2 (LOA: -5 to 8) msec (single breath-hold) and 36 (LOA: -43 to 120) msec, -3 (LOA: -17 to 11) msec, and 4 (LOA: -3 to 11) msec (respiratory triggered), respectively, in comparison to conventional acquisitions using MOLLI, GRASE, and mGRE. All MI-SAGE estimates had strong repeatability and reproducibility (ICC > 0.72). DATA CONCLUSION Hepatic T1, T2, and T2* estimates obtained using an MI-SAGE technique were comparable to conventional methods, although there was a 12%/6% for breath-hold/respiratory triggered underestimation of T1 values compared to MOLLI. Both respiratory triggered and breath-hold MI-SAGE parameter maps demonstrated strong repeatability and reproducibility. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mary Kate Manhard
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amol S Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Possick S, Khungar V, Deshpande R. Cardiac evaluation of the liver transplant candidate. Curr Opin Organ Transplant 2024; 29:299-304. [PMID: 37995156 DOI: 10.1097/mot.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize recent changes in the cardiac evaluation of adult liver transplant candidates. Over the last several years, there have been significant advances in the use of coronary computed tomography angiography (CCTA) with and without fractional flow reserve (FFR) and increasingly widespread availability of coronary calcium scoring for risk stratification for obstructive coronary artery disease. This has led to novel strategies for risk stratification in cirrhotic patients being considered for liver transplant and an updated American Heart Association (AHA) position paper on the evaluation of liver and kidney transplant candidates. The diagnosis of cirrhotic cardiomyopathy has been refined. These new diagnostic criteria require that specific echocardiographic parameters are evaluated in all patients. The definition of pulmonary hypertension on echocardiography has been altered and no longer utilizes right atrium (RA) pressure estimates based on inferior vena cava (IVC) size and collapse. This provides more volume neutral estimates of pulmonary pressure. RECENT FINDINGS Although CCTA has outstanding negative predictive value, false positive results are not uncommon and often lead to further testing. Revised diagnostic criteria for cirrhotic cardiomyopathy improve risk stratification for peri-operative volume overload and outcomes. Refined pulmonary hypertension criteria provide improved guidance for right heart catheterization (RHC) and referral to subspecialists. There are emerging data regarding the safety and efficacy of TAVR for severe aortic stenosis in cirrhotic patients. SUMMARY Increased utilization of noninvasive testing, including CCTA and/or coronary calcium scoring, can improve the negative predictive value of testing for obstructive coronary artery disease and potentially reduce reliance on coronary angiography. Application of the 2020 criteria for cirrhotic cardiomyopathy will improve systolic and diastolic function assessment and subsequent perioperative risk stratification. The use of global strain scores is emphasized, as it provides important information beyond ejection fraction and diastolic parameters. A standardized one-parameter echo cut-off for elevated pulmonary pressures simplifies both evaluation and follow-up. Innovative transcutaneous techniques for valvular stenosis and regurgitation offer new options for patients at prohibitive surgical risk.
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Affiliation(s)
| | - Vandana Khungar
- Yale University School of Medicine, Transplant Hepatology, Hepatology, Gastroenterology
| | - Ranjit Deshpande
- Department of Anesthesia, Yale University School of Medicine, New Haven, Connecticut, USA
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Gananandan K, Wiese S, Møller S, Mookerjee RP. Cardiac dysfunction in patients with cirrhosis and acute decompensation. Liver Int 2024; 44:1832-1841. [PMID: 38712826 DOI: 10.1111/liv.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Abstract
The prevalence of cirrhotic cardiomyopathy (CCM) has been reported as high as 60%-70% in patients with liver cirrhosis and is associated with various negative outcomes. There has been a growing understanding of CCM over recent years. Indeed, the development of imaging techniques has enabled new diagnostic criteria to be proposed by the Cirrhotic Cardiomyopathy Consortium. However, important unanswered questions remain over pathophysiological mechanisms, optimal diagnostic modalities and potential treatment options. While there has been an increasing volume of literature evaluating CCM, there is a lack of clarity on its implications in acute decompensation, acute-on-chronic liver failure and following interventions such as transjugular intrahepatic portosystemic shunt insertion and liver transplantation. This review aims to summarise the literature in these challenging domains and suggest where future research should focus. We conclude that systemic inflammation and structural myocardial changes are likely to be crucial in the pathophysiology of the disease, but the relative contribution of different components remains elusive. Furthermore, future studies need to use standardised diagnostic criteria for CCM as well as incorporate newer imaging techniques assessing both myocardial structure and function. Finally, while specific treatments are currently lacking, therapeutics targeting systemic inflammation, microbial dysbiosis and bacterial translocation are promising targets and warrant further research.
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Affiliation(s)
- Kohilan Gananandan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
| | - Signe Wiese
- Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Copenhagen, Denmark
- Gastroenterology Unit, Medical Division, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Møller
- Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rajeshwar P Mookerjee
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Wang J, Diao Y, Xu Y, Guo J, Li W, Li Y, Wan K, Sun J, Han Y, Chen Y. Liver T1 Mapping Derived From Cardiac Magnetic Resonance Imaging: A Potential Prognostic Marker in Idiopathic Dilated Cardiomyopathy. J Magn Reson Imaging 2024; 60:675-685. [PMID: 38174826 DOI: 10.1002/jmri.29223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Hepatic alterations are common aftereffects of heart failure (HF) and ventricular dysfunction. The prognostic value of liver injury markers derived from cardiac MRI studies in nonischemic dilated cardiomyopathy (DCM) patients is unclear. PURPOSE Evaluate the prognostic performance of liver injury markers derived from cardiac MRI studies in DCM patients. STUDY TYPE Prospective. POPULATION Three hundred fifty-six consecutive DCM patients diagnosed according to ESC guidelines (age 48.7 ± 14.2 years, males 72.6%). FIELD STRENGTH/SEQUENCE Steady-state free precession, modified Look-Locker inversion recovery T1 mapping and phase sensitive inversion recovery late gadolinium enhancement (LGE) sequences at 3 T. ASSESSMENT Clinical characteristics, conventional MRI parameters (ventricular volumes, function, mass), native myocardial and liver T1, liver extracellular volume (ECV), and myocardial LGE presence were assessed. Patients were followed up for a median duration of 48.3 months (interquartile range 42.0-69.9 months). Primary endpoints included HF death, sudden cardiac death, heart transplantation, and HF readmission; secondary endpoints included HF death, sudden cardiac death, and heart transplantation. Models were developed to predict endpoints and the incremental value of including liver parameters assessed. STATISTICAL TESTS Optimal cut-off value was determined using receiver operating characteristic curve and Youden method. Survival analysis was performed using Kaplan-Meier and Cox proportional hazard. Discriminative power of models was compared using net reclassification improvement and integrated discriminatory index. P value <0.05 was considered statistically significant. RESULTS 47.2% patients reached primary endpoints; 25.8% patients reached secondary endpoints. Patients with elevated liver ECV (cut-off 34.4%) had significantly higher risk reaching primary and secondary endpoints. Cox regression showed liver ECV was an independent prognostic predictor, and showed independent prognostic value for primary endpoints and long-term HF readmission compared to conventional clinical and cardiac MRI parameters. DATA CONCLUSIONS Liver ECV is an independent prognostic predictor and may serve as an innovative approach for risk stratification for DCM. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jiaqi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yike Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiajun Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yangjie Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Cardiovascular Medicine, Wexner Medical Center, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Gomes NBN, Torres US, Ferraz MLCG, D'Ippolito G. Advanced Magnetic Resonance Imaging for Detection of Liver Fibrosis and Inflammation in Autoimmune Hepatitis: A State-of-the-Art Review. Semin Ultrasound CT MR 2024:S0887-2171(24)00050-7. [PMID: 39069278 DOI: 10.1053/j.sult.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Autoimmune hepatitis is a rare chronic liver disease, associated with a high level of morbidity and high mortality; approximately 40% of patients with severe untreated disease die within 6 months of diagnosis. It should be treated to achieve complete biochemical and histologic resolution of the disease using corticosteroids and immunosuppression to prevent further progression to cirrhosis. The use of invasive liver biopsy is recommended for the staging and assessment of inflammation and fibrosis for treatment decision-making in the face of an unsatisfactory response or clinical remission, including being a determinant for withdrawal of immunosuppression. On the other hand, liver biopsy is invasive, costly, and not free of complications. It also has potential sampling error and poor interobserver agreement. The limitations of liver biopsy highlight the importance of developing new imaging biomarkers that allow accurate and non-invasive assessment of autoimmune hepatitis in terms of liver inflammation and fibrosis, developing the virtual biopsy concept. Therefore, we review the state-of-the-art of Magnetic Resonance Imaging sequences for the noninvasive evaluation of autoimmune hepatitis, including historical advances and future directions.
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Affiliation(s)
- Natália B N Gomes
- Department of Radiology, Grupo Fleury, São Paulo, São Paulo, Brazil; Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Ulysses S Torres
- Department of Radiology, Grupo Fleury, São Paulo, São Paulo, Brazil; Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil.
| | - Maria Lucia C G Ferraz
- Department of Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Giuseppe D'Ippolito
- Department of Radiology, Grupo Fleury, São Paulo, São Paulo, Brazil; Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
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Edin C, Ekstedt M, Karlsson M, Wegmann B, Warntjes M, Swahn E, Östgren CJ, Ebbers T, Lundberg P, Carlhäll CJ. Liver fibrosis is associated with left ventricular remodeling: insight into the liver-heart axis. Eur Radiol 2024:10.1007/s00330-024-10798-1. [PMID: 38795131 DOI: 10.1007/s00330-024-10798-1] [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: 11/01/2023] [Revised: 03/21/2024] [Accepted: 04/04/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE In nonalcoholic fatty liver disease (NAFLD), liver fibrosis is the strongest predictor of adverse outcomes. We sought to investigate the relationship between liver fibrosis and cardiac remodeling in participants from the general population using magnetic resonance imaging (MRI), as well as explore potential mechanistic pathways by analyzing circulating cardiovascular biomarkers. METHODS In this cross-sectional study, we prospectively included participants with type 2 diabetes and individually matched controls from the SCAPIS (Swedish CArdioPulmonary bioImage Study) cohort in Linköping, Sweden. Between November 2017 and July 2018, participants underwent MRI at 1.5 Tesla for quantification of liver proton density fat fraction (spectroscopy), liver fibrosis (stiffness from elastography), left ventricular (LV) structure and function, as well as myocardial native T1 mapping. We analyzed 278 circulating cardiovascular biomarkers using a Bayesian statistical approach. RESULTS In total, 92 participants were enrolled (mean age 59.5 ± 4.6 years, 32 women). The mean liver stiffness was 2.1 ± 0.4 kPa. 53 participants displayed hepatic steatosis. LV concentricity increased across quartiles of liver stiffness. Neither liver fat nor liver stiffness displayed any relationships to myocardial tissue characteristics (native T1). In a regression analysis, liver stiffness was related to increased LV concentricity. This association was independent of diabetes and liver fat (Beta = 0.26, p = 0.0053), but was attenuated (Beta = 0.17, p = 0.077) when also adjusting for circulating levels of interleukin-1 receptor type 2. CONCLUSION MRI reveals that liver fibrosis is associated to structural LV remodeling, in terms of increased concentricity, in participants from the general population. This relationship could involve the interleukin-1 signaling. CLINICAL RELEVANCE STATEMENT Liver fibrosis may be considered a cardiovascular risk factor in patients without cirrhosis. Further research on the mechanisms that link liver fibrosis to left ventricular concentricity may reveal potential therapeutic targets in patients with non-alcoholic fatty liver disease (NAFLD). KEY POINTS Previously, studies on liver fibrosis and cardiac remodeling have focused on advanced stages of liver fibrosis. Liver fibrosis is associated with left ventricular (LV) concentricity and may relate to interleukin-1 receptor type 2. Interleukin-1 signaling is a potential mechanistic interlink between early liver fibrosis and LV remodeling.
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Affiliation(s)
- Carl Edin
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mattias Ekstedt
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Markus Karlsson
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Bertil Wegmann
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Marcel Warntjes
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Eva Swahn
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Fang Z, Jia S, Mou X, Li Z, Hu T, Tu Y, Zhao J, Zhang T, Lin W, Lu Y, Feng C, Xia S. Shared genetic architecture and causal relationship between liver and heart disease. iScience 2024; 27:109431. [PMID: 38523778 PMCID: PMC10959668 DOI: 10.1016/j.isci.2024.109431] [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: 10/13/2023] [Revised: 01/08/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
This study investigates the relationship and genetic mechanisms of liver and heart diseases, focusing on the liver-heart axis (LHA) as a fundamental biological basis. Through genome-wide association study analysis, we explore shared genes and pathways related to LHA. Shared genetic factors are found in 8 out of 20 pairs, indicating genetic correlations. The analysis reveals 53 loci with pleiotropic effects, including 8 loci exhibiting shared causality across multiple traits. Based on SNP-p level tissue-specific multi-marker analysis of genomic annotation (MAGMA) analysis demonstrates significant enrichment of pleiotropy in liver and heart diseases within different cardiovascular tissues and female reproductive appendages. Gene-specific MAGMA analysis identifies 343 pleiotropic genes associated with various traits; these genes show tissue-specific enrichment primarily in the liver, cardiovascular system, and other tissues. Shared risk loci between immune cells and both liver and cardiovascular diseases are also discovered. Mendelian randomization analyses provide support for causal relationships among the investigated trait pairs.
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Affiliation(s)
- Ziyi Fang
- Department of Gastroenterology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Sixiang Jia
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Xuanting Mou
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Zhe Li
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Tianli Hu
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Yiting Tu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianqiang Zhao
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Tianlong Zhang
- Department of Critical Care Medicine, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Wenting Lin
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Yile Lu
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Chao Feng
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Shudong Xia
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
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10
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Almeida F, Sousa A. Cirrhotic cardiomyopathy: Pathogenesis, clinical features, diagnosis, treatment and prognosis. Rev Port Cardiol 2024; 43:203-212. [PMID: 38142819 DOI: 10.1016/j.repc.2023.07.010] [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: 04/06/2023] [Revised: 06/09/2023] [Accepted: 07/30/2023] [Indexed: 12/26/2023] Open
Abstract
Cardiac dysfunction among cirrhotic patients has long been recognized in the medical community. While it was originally believed to be a direct result of alcohol toxicity, in the last 30 years cirrhotic cardiomyopathy (CCM) has been described as a syndrome characterized by chronic cardiac dysfunction in cirrhotic patients in the absence of known cardiac disease, regardless of the etiology of cirrhosis. CCM occurs in about 60% of patients with cirrhosis and plays a critical role in disease progression and treatment outcomes. Due to its predominantly asymptomatic course, diagnosing CCM is challenging and requires a high index of suspicion and a multiparametric approach. Patients with CCM usually present with the following triad: impaired myocardial contractile response to exercise, inadequate ventricular relaxation, and electrophysiological abnormalities (notably prolonged QT interval). In recent years, research in this area has grown expeditiously and a new set of diagnostic criteria has been developed by the Cirrhotic Cardiomyopathy Consortium, to properly identify patients with CCM. Nevertheless, CCM is still largely unknown among clinicians, and a major part of its pathophysiology and treatment is yet to be understood. In the present work, we aim to compile and summarize the available data on the pathogenesis, clinical features, diagnosis, treatment, and prognosis of CCM.
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Affiliation(s)
| | - Alexandra Sousa
- Cardiology Department, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Porto, Portugal
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11
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Pint D, Gevaert AB, Vanwolleghem T, Chapelle T, Dams K. Heart failure with severely reduced ejection fraction after liver transplantation: a case report and review of the literature. Acta Clin Belg 2024; 79:46-51. [PMID: 37927044 DOI: 10.1080/17843286.2023.2278240] [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: 06/20/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a strenuous event for the cardiovascular system. Cardiovascular events (CVE), including heart failure (HF), arrhythmias and myocardial ischemia, are important causes of peri- and post-liver transplantation morbidity and mortality. CASE PRESENTATION We describe the case of a 45-year-old male patient who developed heart failure with severely reduced ejection fraction (HFrEF) after receiving liver transplantation (LT) for end-stage post-alcoholic liver cirrhosis. Preoperative transthoracic echocardiography (TTE) demonstrated borderline left ventricular ejection fraction (LVEF) of 50% and diastolic dysfunction grade 2. On coronary angiography, the patient had no coronary stenoses. Persistent vasopressor need, increasing creatinine levels and progressive pleural effusion characterized the early postoperative period. TTE on postoperative day 6 revealed a new finding of a markedly reduced LVEF of 15%, accompanied by a discrete increase in hs-TnI and CK-MB without electrocardiographic (ECG) ST-T abnormalities. LVEF did not recover completely (EF 45%) during follow-up. The patient had a sudden death 4.5 months post-liver transplantation. CONCLUSION Our case demonstrates that the risk of post-LT systolic dysfunction is not excluded by preoperative resting examinations within normal range and highlights the need for preoperative cardiac stress assessment (e.g. dobutamine echocardiography or stress cardiac magnetic resonance imaging) before LT. In addition, patients on a liver-transplant waiting list with cardiac dysfunction should be followed by a multidisciplinary team including a dedicated cardiology team experienced in managing liver-related cardiac pathology.
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Affiliation(s)
- Dorien Pint
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics (LEMP), Antwerp University, Antwerp, Belgium
- European Reference Network RARE-LIVER, Antwerp University Hospital, Antwerp, Belgium
| | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Karolien Dams
- Department of Critical Care Medicine, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
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12
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Dimitroglou Y, Aggeli C, Alexopoulou A, Tsartsalis D, Patsourakos D, Koukos M, Tousoulis D, Tsioufis K. The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy. Life (Basel) 2024; 14:179. [PMID: 38398688 PMCID: PMC10890501 DOI: 10.3390/life14020179] [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: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association-in the majority of studies-with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis.
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Affiliation(s)
- Yannis Dimitroglou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Constantina Aggeli
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Alexandra Alexopoulou
- Second Department of Medicine & Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece;
| | - Dimitrios Tsartsalis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Dimitrios Patsourakos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Markos Koukos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Dimitris Tousoulis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
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13
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Skouloudi M, Bonou MS, Adamantou M, Parastatidou D, Kapelios C, Masoura K, Efstathopoulos E, Aggeli C, Papatheodoridis GV, Barbetseas J, Cholongitas E. Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium. Liver Int 2023; 43:2727-2742. [PMID: 37641813 DOI: 10.1111/liv.15714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The new criteria of Cirrhotic Cardiomyopathy Consortium (CCC) propose the use of left ventricular global longitudinal strain (LV-GLS) for evaluation of systolic function in patients with cirrhosis. The aim of this study was to evaluate LV-GLS and left atrial (LA) strain in association with the severity of liver disease and to assess the characteristics of cirrhotic cardiomyopathy (CCM). METHODS One hundred and thirty-five cirrhotic patients were included. Standard echocardiography and speckle tracking echocardiography (2D-STE) were performed, and dual X-ray absorptiometry was used to quantify the total and regional fat mass. CCM was defined, based on the criteria of CCC, as having advanced diastolic dysfunction, left ventricular ejection fraction ≤50% and/or a GLS <18%. RESULTS LV-GLS lower or higher than the absolute mean value (22.7%) was not associated with mortality (logrank, p = 0.96). LV-GLS was higher in patients with Model for end stage liver disease (MELD) score ≥15 compared to MELD score <15 (p = 0.004). MELD score was the only factor independently associated with systolic function (LV-GLS <22.7% vs. ≥22.7%) (Odds Ratio:1.141, p = 0.032). Patients with CCM (n = 11) had higher values of estimated volume of visceral adipose tissue compared with patients without CCM (median: 735 vs. 641 cm3 , p = 0.039). On multivariable Cox regression analysis, MELD score [Hazard Ratio (HR):1.26, p < 0.001] and LA reservoir strain (HR:0.96, p = 0.017) were the only factors independently associated with the outcome. CONCLUSION In our study, absolute LV-GLS was higher in more severe liver disease, and LA reservoir strain was significantly associated with the outcome in patients with end-stage liver disease.
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Affiliation(s)
- Marina Skouloudi
- Department of Cardiology, General Hospital of Athens "Laiko", Athens, Greece
| | - Maria S Bonou
- Department of Cardiology, General Hospital of Athens "Laiko", Athens, Greece
| | - Magdalini Adamantou
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Despoina Parastatidou
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Christos Kapelios
- Department of Cardiology, General Hospital of Athens "Laiko", Athens, Greece
| | - Konstantina Masoura
- Department of Cardiology, General Hospital of Athens "Laiko", Athens, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, General Hospital of Athens "Hippokration", National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - John Barbetseas
- Department of Cardiology, General Hospital of Athens "Laiko", Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
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14
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Møller S, Wiese S, Barløse M, Hove JD. How non-alcoholic fatty liver disease and cirrhosis affect the heart. Hepatol Int 2023; 17:1333-1349. [PMID: 37770804 DOI: 10.1007/s12072-023-10590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023]
Abstract
Liver diseases affect the heart and the vascular system. Cardiovascular complications appear to be a leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and cirrhosis. The predominant histological changes in the liver range from steatosis to fibrosis to cirrhosis, which can each affect the cardiovascular system differently. Patients with cirrhotic cardiomyopathy (CCM) and NAFLD are at increased risk of impaired systolic and diastolic dysfunction and for suffering major cardiovascular events. However, the pathophysiological mechanisms behind these risks differ depending on the nature of the liver disease. Accurate assessment of symptoms by contemporary diagnostic modalities is essential for identifying patients at risk, for evaluating candidates for treatment, and prior to any invasive procedures. This review explores current perspectives within this field.
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Affiliation(s)
- Søren Møller
- Department Clinical Physiology and Nuclear Medicine 260, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Copenhagen University Hospital, Kettegaards alle 30, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Signe Wiese
- Gastro Unit, Medical Division, Hvidovre Hospital, Hvidovre, Denmark
| | - Mads Barløse
- Department Clinical Physiology and Nuclear Medicine 260, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Copenhagen University Hospital, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Jens D Hove
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark
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15
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Kajal K, Premkumar M, Izzy M, Kulkarni AV, Duseja AK, Divyaveer S, Loganathan S, Sihag B, Gupta A, Bahl A, Rathi S, Taneja S, De A, Verma N, Sharma N, Kaur H, Zohmangaihi D, Kumar V, Bhujade H, Chaluvashetty SB, Kalra N. Cirrhotic cardiomyopathy influences clinical outcomes and enhances performance of conventional risk prediction models in acute-on-chronic liver failure with severe sepsis. Aliment Pharmacol Ther 2023; 58:903-919. [PMID: 37688403 DOI: 10.1111/apt.17695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Point-of-care echocardiography (POC-Echo) is an essential intensive care hemodynamic monitoring tool. AIMS To assess POC-Echo parameters [i.e., cardiac index (CI), systemic vascular resistance index (SVRI) and cirrhotic cardiomyopathy (CCM) markers] and serum biomarkers in predicting circulatory failure (need for vasopressors) and mortality in patients with acute-on-chronic liver failure (ACLF) having sepsis-induced hypotension. METHODS We performed serial POC-Echo within 6 hours (h) of presentation and subsequently at 24, 48 and 72 h in patients with ACLF and sepsis-induced hypotension admitted to our liver intensive care unit. Clinical data, POC-Echo data and serum biomarkers were collected prospectively. RESULTS We enrolled 120 patients [59% men, aged 49 ± 12 years, 56% alcohol-related disease and median MELDNa of 30 (27-32)], of whom 68 (56.6%) had circulatory failure, with overall mortality of 60%. CCM was present in 52.5%. The predictors of circulatory failure were CI (aHR -1.5; p = 0.021), N-terminal brain natriuretic peptide (aHR -1.1; p = 0.007) and CCM markers; e' septal mitral velocity (aHR -0.5; p = 0.039) and E/e' ratio (aHR -1.2; p = 0.045). Reduction in CI by 20% and SVRI by 15% at 72 h predicted mortality with a sensitivity of 84% and 72%, and specificity 76% and 65%, respectively (p < 0.001). The MELD-CCM model and CLIF-CCM model were computed as MELDNa + 1.815 × E/e' (septal) + 0.402 × e' (septal) and CLIF-C ACLF + 1.815 × E/e' (septal) + 0.402 × e' (septal), respectively, based on multivariable logistic regression. Both scores outperformed MELDNa (z-score = -2.073, p = 0.038) and CLIF-C ACLF score (z score = -2.683, p-value = 0.007), respectively, in predicting 90-day mortality. CONCLUSION POC-Echo measurements such as CCM markers (E/e' and e' velocity) and change in CI reliably predict circulatory failure and mortality in ACLF with severe sepsis. CCM markers significantly enhanced the CLIF-C ACLF and MELDNa predictive performance.
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Affiliation(s)
- Kamal Kajal
- Departments of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manhal Izzy
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, Tennessee, USA
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ajay Kumar Duseja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Divyaveer
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sekar Loganathan
- Departments of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhupendra Sihag
- Departments of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Departments of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Departments of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Departments of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Kaur
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepy Zohmangaihi
- Departments of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishesh Kumar
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvashetty
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Kinno M, Izzy M. Editorial: The interplay of bile acids and the heart-another piece in the puzzle of cirrhotic cardiomyopathy. Aliment Pharmacol Ther 2023; 58:486-487. [PMID: 37499104 DOI: 10.1111/apt.17600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Menhel Kinno
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Manhal Izzy
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Isaak A, Bratz J, Kravchenko D, Mesropyan N, Eckardt I, Bischoff LM, Weinhold L, Kuetting D, Pieper CC, Attenberger U, Zimmer S, Luetkens JA. A novel and simple cardiac magnetic resonance score (PE 2RT) predicts outcome in takotsubo syndrome. Eur Radiol 2023; 33:5498-5508. [PMID: 36949253 PMCID: PMC10326093 DOI: 10.1007/s00330-023-09543-x] [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: 07/24/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS). METHODS Patients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PE2RT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PE2RT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan-Meier estimator. RESULTS Seventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2-6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4-36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PE2RT score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). PE2RT score was associated with MACE on Cox regression analysis (hazard ratio per PE2RT feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more PE2RT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001). CONCLUSIONS The introduced PE2RT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR. KEY POINTS • Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PE2RT features) are relatively common in takotsubo syndrome. • The proposed PE2RT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
| | - Johanna Bratz
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Irina Eckardt
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Institute of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
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18
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Isaak A, Chang J, Mesropyan N, Kravchenko D, Endler C, Bischoff L, Böhling N, Pieper CC, Kuetting D, Strassburg CP, Attenberger U, Jansen C, Praktiknjo M, Luetkens JA. Cardiac involvement in non-cirrhotic portal hypertension: MRI detects myocardial fibrosis and oedema similar to compensated cirrhosis. Eur Heart J Cardiovasc Imaging 2023; 24:949-960. [PMID: 36423215 DOI: 10.1093/ehjci/jeac235] [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: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 08/03/2023] Open
Abstract
AIMS The exact role of portal hypertension in cirrhotic cardiomyopathy remains unclear, and it is uncertain whether cardiac abnormalities also occur in non-cirrhotic portal hypertension (NCPH). This magnetic resonance imaging (MRI) study aimed to evaluate the presence of subclinical myocardial dysfunction, oedema, and fibrosis in NCPH. METHODS AND RESULTS In this prospective study (2018-2022), participants underwent multiparametric abdominal and cardiac MRI including assessment of cardiac function, myocardial oedema, late gadolinium enhancement (LGE), and abdominal and cardiac mapping [T1 and T2 relaxation times, extracellular volume fraction (ECV)]. A total of 111 participants were included [44 participants with NCPH (48 ± 15 years; 23 women), 47 cirrhotic controls, and 20 healthy controls]. The cirrhotic group was dichotomized (Child A vs. Child B/C). NCPH participants demonstrated a more hyperdynamic circulation compared with healthy controls (cardiac index: 3.7 ± 0.6 vs. 3.2 ± 0.8 L/min/m², P = 0.004; global longitudinal strain: -27.3 ± 4.6 vs. -24.6 ± 3.5%, P = 0.022). The extent of abnormalities indicating myocardial fibrosis and oedema in NCPH was comparable with Child A cirrhosis (e.g. LGE presence: 32 vs. 33 vs. 69%, P = 0.004; combined T1 and T2 elevations: 46 vs. 27 vs. 69%, P = 0.017; NCPH vs. Child A vs. Child B/C). Correlations between splenic T1 and myocardial T1 values were found (r = 0.41; P = 0.007). Splenic T1 values were associated with the presence of LGE (odds ratio, 1.010; 95% CI: 1.002, 1.019; P = 0.013). CONCLUSION MRI parameters of myocardial fibrosis and oedema were altered in participants with NCPH to a similar extent as in compensated cirrhosis and were associated with splenic markers of portal hypertension, indicating specific portal hypertensive cardiomyopathy.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leon Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nina Böhling
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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19
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Isaak A, Pomareda I, Mesropyan N, Kravchenko D, Endler C, Bischoff L, Pieper CC, Kuetting D, Attenberger U, Zimmer S, Putensen C, Schewe J, Kreyer S, Luetkens JA. Cardiovascular Magnetic Resonance in Survivors of Critical Illness: Cardiac Abnormalities Are Associated With Acute Kidney Injury. J Am Heart Assoc 2023; 12:e029492. [PMID: 37119085 PMCID: PMC10227222 DOI: 10.1161/jaha.123.029492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/28/2023] [Indexed: 04/30/2023]
Abstract
Background The objective of this study was to investigate cardiac abnormalities in intensive care unit (ICU) survivors of critical illness and to determine whether temporary acute kidney injury (AKI) is associated with more pronounced findings on cardiovascular magnetic resonance. Methods and Results There were 2175 patients treated in the ICU (from 2015 until 2021) due to critical illness who were screened for study eligibility. Post-ICU patients without known cardiac disease were prospectively recruited from March 2021 to May 2022. Participants underwent cardiovascular magnetic resonance including assessment of cardiac function, myocardial edema, late gadolinium enhancement, and mapping including extracellular volume fraction. Student t test, Mann-Whitney U test, and χ2 tests were used. There were 48 ICU survivors (46±15 years of age, 28 men, 29 with AKI and continuous kidney replacement therapy, and 19 without AKI) and 20 healthy controls who were included. ICU survivors had elevated markers of myocardial fibrosis (T1: 995±31 ms versus 957±21 ms, P<0.001; extracellular volume fraction: 24.9±2.5% versus 22.8±1.2%, P<0.001; late gadolinium enhancement: 1% [0%-3%] versus 0% [0%-0%], P<0.001), more frequent focal late gadolinium enhancement lesions (21% versus 0%, P=0.03), and an impaired left ventricular function (eg, ejection fraction: 57±6% versus 60±5%, P=0.03; systolic longitudinal strain: 20.3±3.7% versus 23.1±3.5%, P=0.004) compared with healthy controls. ICU survivors with AKI had higher myocardial T1 (1002±33 ms versus 983±21 ms; P=0.046) and extracellular volume fraction values (25.6±2.6% versus 23.9±1.9%; P=0.02) compared with participants without AKI. Conclusions ICU survivors of critical illness without previously diagnosed cardiac disease had distinct abnormalities on cardiovascular magnetic resonance including signs of myocardial fibrosis and systolic dysfunction. Findings were more abnormal in participants who experienced AKI with necessity of continuous kidney replacement therapy during their ICU stay. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05034588.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Isabel Pomareda
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Christoph Endler
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Leon Bischoff
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Claus C. Pieper
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
| | - Sebastian Zimmer
- Clinic for Internal Medicine II, Heart Center BonnUniversity Hospital BonnBonnGermany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnGermany
| | - Jens‐Christian Schewe
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnGermany
- Department of Anesthesiology, Intensive Care Medicine and Pain TherapyUniversity Medical Centre RostockRostockGermany
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital BonnBonnGermany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional RadiologyUniversity Hospital BonnBonnGermany
- Quantitative Imaging Lab Bonn (QILaB)University Hospital BonnBonnGermany
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20
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Xu Y, Li Y, Li S, Xue S, Liu J. Dual-energy CT quantification of extracellular liver volume predicts short-term disease progression in patients with hepatitis B liver cirrhosis-acute decompensation. Insights Imaging 2023; 14:51. [PMID: 36977956 PMCID: PMC10050608 DOI: 10.1186/s13244-023-01393-x] [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: 10/21/2022] [Accepted: 02/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Liver cirrhosis-acute decompensation (LC-AD) has rapid short-term disease progression and difficult early risk stratification. The purpose is to develop and validate a model based on dual-energy CT quantification of extracellular liver volume (ECVIC-liver) for predicting the occurrence of acute-on-chronic liver failure (ACLF) within 90 days in patients with hepatitis B (HBV) LC-AD. METHODS The retrospective study included patients with HBV LC-AD who underwent dual-energy CT scans of the liver from January 2018 to March 2022 and were randomized to training group (215 patients) and validation group (92 patients). The primary outcome was the need for readmission within 90 days due to ACLF. Based on the training group data, independent risk factors for disease progression in clinical and dual-energy CT parameters were identified and modeled by logistic regression analysis. Based on the training and validation groups data, receiver operating characteristic (ROC) curves, calibration curves, and decision analysis curves (DCA) were used to verify the discrimination, calibration, and clinical validity of the nomogram. RESULTS Chronic liver failure consortium-acute decompensation score (CLIF-C ADs) (p = 0.008) and ECVIC-liver (p < 0.001) were independent risk factors for ACLF within 90 days. The AUC of the model combined ECVIC-liver and CLIF-C ADs were 0.893 and 0.838 in the training and validation groups, respectively. The calibration curves show good agreement between predicted and actual risks. The DCA indicates that the model has good clinical application. CONCLUSION The model combined ECVIC-liver and CLIF-C ADs can early predict the occurrence of ACLF within 90 days in HBV LC-AD patients.
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Affiliation(s)
- Yuan Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Yufeng Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shouxiao Xue
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianli Liu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.
- Second Clinical School, Lanzhou University, Lanzhou, China.
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China.
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21
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CV – Zirrhotische Kardiomyopathie in der MRT. ROFO-FORTSCHR RONTG 2023. [DOI: 10.1055/a-1312-0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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22
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Assessment of hepatic fat content and prediction of myocardial fibrosis in athletes by using proton density fat fraction sequence. LA RADIOLOGIA MEDICA 2023; 128:58-67. [PMID: 36627501 PMCID: PMC9931772 DOI: 10.1007/s11547-022-01571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To explore the characteristics of the hepatic fat content in athletes, and predict late gadolinium enhancement (LGE) based on magnetic resonance imaging-proton density fat fraction (MRI-PDFF). MATERIAL AND METHODS From March 2020 to March 2021, 233 amateur athletes and 42 healthy sedentary controls were prospectively recruited. The liver fat content of four regions of interest (ROIs 1-4), the mean liver fat fraction (FF), cardiac function, and myocardium LGE were recorded, respectively. The values of ROIs 1-4 and FF were compared between athletes and controls. According to the liver fat content threshold for distinguishing athletes and controls, the cutoff total exercise time that induced a change in liver fat was obtained. The correlations among the liver fat content, cardiac function, and other parameters were analyzed. Moreover, the liver fat content was used to predict myocardium LGE by logistic regression. RESULTS There were significant differences for the values of ROI 1, ROI 3, ROI 4, and FF between athletes and controls (allp< 0.05). The cutoff total exercise time for inducing a change in the liver fat content was 1680 h (area under the curve [AUC] = 0.593, specificity = 83.3,p< 0.05). Blood indexes, cardiac function, and basic clinical parameters were related to liver fat content (allp< 0.05). The prediction model for LGE had an AUC value of 0.829 for the receiver operator characteristic curve. CONCLUSION MRI-PDFF could assess liver fat content and predict cardiac fibrosis in athletes for risk stratification and follow-up.
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23
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Kwan AC, Sun N, Driver M, Botting P, Navarrette J, Ouyang D, Hussain SK, Noureddin M, Li D, Ebinger JE, Berman DS, Cheng S. Cardiovascular and hepatic disease associations by magnetic resonance imaging: A retrospective cohort study. Front Cardiovasc Med 2022; 9:1009474. [PMID: 36324754 PMCID: PMC9618632 DOI: 10.3389/fcvm.2022.1009474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hepatic disease is linked to cardiovascular events but the independent association between hepatic and cardiovascular disease remains unclear, given shared risk factors. Methods This was a retrospective study of consecutive patients with a clinical cardiac MRI (CMR) and a serological marker of hepatic fibrosis, the FIB-4 score, within one year of clinical imaging. We assessed the relations between FIB-4 scores grouped based on prior literature: low (< 1.3), moderate (1.3–3.25), and high (>3.25), and abnormalities detected by comprehensive CMR grouped into 4 domains: cardiac structure (end diastolic volumes, atrial dimensions, wall thickness); cardiac function (ejection fractions, wall motion abnormalities, cardiac output); vascular structure (ascending aortic and pulmonary arterial sizes); and cardiac composition (late gadolinium enhancement, T1 and T2 times). We used Poisson regression to examine the association between the conventionally defined FIB-4 category (low <1.3, moderate 1.3–3.25, and high >3.25) and any CMR abnormality while adjusting for demographics and traditional cardiovascular risk factors. Results Of the 1668 patients studied (mean age: 55.971 ± 7.28, 901 [54%] male), 85.9% had ≥1 cardiac abnormality with increasing prevalence seen within the low (82.0%) to moderate (88.8%) to high (92.3%) FIB-4 categories. Multivariable analyses demonstrated the presence of any cardiac abnormality was significantly associated with having a high-range FIB-4 (prevalence ratio 1.07, 95% CI: 1.01–1.13); notably, the presence of functional cardiac abnormalities were associated with being in the high FIB-4 range (1.41, 1.21–1.65) and any vascular abnormalities with being in the moderate FIB-4 range (1.22, 1.01–1.47). Conclusions Elevated FIB-4 was associated with cardiac functional and vascular abnormalities even after adjustment for shared risk factors in a cohort of patients with clinically referred CMR. These CMR findings indicate that cardiovascular abnormalities exist in the presence of subclinical hepatic fibrosis, irrespective of shared risk factors, underscoring the need for further studies of the heart-liver axis.
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Affiliation(s)
- Alan C. Kwan
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
- *Correspondence: Alan C. Kwan
| | - Nancy Sun
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Matthew Driver
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Patrick Botting
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Jesse Navarrette
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - David Ouyang
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Shehnaz K. Hussain
- Department of Public Health Sciences, School of Medicine and Comprehensive Cancer Center, University of California, Davis, CA, United States
| | - Mazen Noureddin
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Debiao Li
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Joseph E. Ebinger
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel S. Berman
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Susan Cheng
- Departments of Cardiology, Internal Medicine, Biomedical Sciences, and Imaging, Smidt Heart Institute and Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA, United States
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Mascherbauer K, Donà C, Koschutnik M, Dannenberg V, Nitsche C, Duca F, Heitzinger G, Halavina K, Steinacher E, Kronberger C, Bardach C, Beitzke D, Loewe C, Waldmann E, Trauner M, Barkto P, Goliasch G, Mascherbauer J, Hengstenberg C, Kammerlander A. Hepatic T1-Time Predicts Cardiovascular Risk in All-Comers Referred for Cardiovascular Magnetic Resonance: A Post-Hoc Analysis. Circ Cardiovasc Imaging 2022; 15:e014716. [PMID: 36256728 DOI: 10.1161/circimaging.122.014716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Liver damage is frequently observed in patients with cardiovascular disease but infrequently quantified. We hypothesized that in patients with cardiovascular disease undergoing cardiac magnetic resonance, liver T1-times indicate liver damage and are associated with cardiovascular outcome. METHODS We measured hepatic T1-times, displayed on standard cardiac T1-maps, in an all-comer cardiac magnetic resonance-cohort. At the time of cardiac magnetic resonance, we assessed validated general liver fibrosis scores. Kaplan-Meier estimates and Cox-regression models were used to investigate the association between hepatic T1-times and a composite endpoint of non-fatal myocardial infarction, heart failure hospitalization, and death. RESULTS One thousand seventy-five participants (58±18 year old, 47% female) were included (972 patients, 50 controls, 53 participants with transient elastography). Hepatic T1-times were 590±89 ms in patients and 574±45 ms in controls (P=0.052). They were significantly correlated with cardiac size and function, presence of atrial fibrillation, NT-pro-BNP levels, and gamma-glutamyl-transferase levels (P<0.001 for all). During follow-up (58±31 months), a total of 280 (29%) events occurred. On Cox-regression, high hepatic T1-times yielded a significantly higher risk for events (adjusted hazard ratio, 1.66 [95% CI, 1.45-1.89] per 100 ms increase; P<0.001), even when adjusted for age, sex, left and right ventricular ejection fraction, NT-proBNP (N-terminal prohormone of brain natriuretic peptide), and myocardial T1-time. On receiver operating characteristic analysis and restricted cubic splines, we found that a hepatic T1-time exceeding 610 ms was associated with excessive risk. CONCLUSIONS Hepatic T1-times on standard cardiac magnetic resonance scans were significantly associated with cardiac size and function, comorbidities, natriuretic peptides, and independently predicted cardiovascular mortality and morbidity. A hepatic T1-time >610 ms seems to indicate excessive risk. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04220450.
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Affiliation(s)
- Katharina Mascherbauer
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Carolina Donà
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Matthias Koschutnik
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Varius Dannenberg
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Christian Nitsche
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Franz Duca
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Gregor Heitzinger
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Kseniya Halavina
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Eva Steinacher
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Christina Kronberger
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Constanze Bardach
- Division of Cardiovascular and Interventional Radiology (C.B., D.B., C.L.), Medical University of Vienna
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology (C.B., D.B., C.L.), Medical University of Vienna
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology (C.B., D.B., C.L.), Medical University of Vienna
| | - Elisabeth Waldmann
- Division of Gastroenterology and Hepatology (E.W., M.T.), Medical University of Vienna
| | - Michael Trauner
- Division of Gastroenterology and Hepatology (E.W., M.T.), Medical University of Vienna
| | - Philipp Barkto
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Georg Goliasch
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Julia Mascherbauer
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna.,Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria (J.M.)
| | - Christian Hengstenberg
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
| | - Andreas Kammerlander
- Division of Cardiology (K.M., C.D., M.K., V.D., C.N., F.D., G.H., K.H., E.S., C.K., P.B., G.G., J.M., C.H., A.K.), Medical University of Vienna
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Isaak A, Kravchenko D, Mesropyan N, Endler C, Bischoff LM, Vollbrecht T, Thomas D, Dabir D, Zimmer S, Attenberger U, Kuetting D, Luetkens JA. Layer-specific Strain Analysis with Cardiac MRI Feature Tracking in Acute Myocarditis. Radiol Cardiothorac Imaging 2022; 4:e210318. [PMID: 35833169 PMCID: PMC9274313 DOI: 10.1148/ryct.210318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of layer-specific cardiac MRI feature-tracking (FT) strain analysis in patients with acute myocarditis. MATERIALS AND METHODS Seventy patients (mean age, 43 years ± 19 [SD]; 46 men) with clinically defined acute myocarditis and 42 healthy controls who underwent cardiac MRI from March 2014 to November 2018 were retrospectively analyzed. FT-based left ventricular peak systolic global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at subendocardial, midmyocardial, and subepicardial layers. The 2018 Lake Louise criteria (LLC) were assessed. Patients with myocarditis were dichotomized into two groups: those with preserved and those with reduced ejection fraction. For statistical analysis, unpaired t test, one-way analysis of variance, Pearson correlation, and receiver operating characteristic analysis were used. RESULTS GLS and GCS values of all layers (eg, midmyocardial GCS: -21.3% ± 5.5 vs -28.0% ± 4.3; P < .001) were impaired in patients with myocarditis compared with controls. Only subepicardial GLS (-20.0% ± 3.3 vs -17.5% ± 3.3; P < .001) and midmyocardial GCS values (-28.0% ± 4.3 vs -23.1% ± 4.3; P < .001) could differentiate between controls and patients with preserved ejection fraction. Midmyocardial GCS correlated with inflammatory myocardial parameters (eg, late gadolinium enhancement percentage, r = 0.48, P < .001). Midmyocardial GCS (area under the receiver operating characteristic curve [AUC], 0.82) and subepicardial GLS (AUC, 0.77) had the highest diagnostic performance for acute myocarditis diagnosis (P < .05 against all other strain parameters). The diagnostic performance of the 2018 LLC was significantly improved by inclusion of these two strain parameters (AUC, 0.92 vs 0.97; P = .04). CONCLUSION Diagnostic performance of cardiac MRI FT strain was different between myocardial layers in acute myocarditis, with midmyocardial GCS and subepicardial GLS providing the highest diagnostic performance.Keywords: MRI, Cardiac, Heart, Left Ventricle, Inflammation, Tissue Characterization, MR-Functional Imaging, Feature-Tracking Strain, Acute Myocarditis Supplemental material is available for this article. © RSNA, 2022.
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Comparison of Hepatic Tissue Characterization between T1-Mapping and Non-Contrast Computed Tomography. J Clin Med 2022; 11:jcm11102863. [PMID: 35628989 PMCID: PMC9144343 DOI: 10.3390/jcm11102863] [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: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Non-contrast computed tomography (CT) is frequently used to assess non-alcoholic/metabolic fatty liver disease (NAFLD/MAFLD), which is associated with cardiovascular risk. Although liver biopsy is considered the gold standard for diagnosis, standardized scores and non-contrast computed tomography (CT) are used instead. On standard cardiac T1-maps on cardiovascular imaging (CMR) exams for myocardial tissue characterization hepatic tissue is also visible. We hypothesized that there is a significant correlation between hepatic tissue T1-times on CMR and Hounsfield units (HU) on non-contrast CT. Methods: We retrospectively identified patients undergoing a non-contrast CT including the abdomen, a CMR including T1-mapping, and laboratory assessment within 30 days. Patients with storage diseases were excluded. Results: We identified 271 patients (62 ± 15 y/o, 49% female) undergoing non-contrast CT and CMR T1-mapping within 30 days. Mean hepatic HU values were 54 ± 11 on CT and native T1-times were 598 ± 102 ms on CMR and there was a weak, but significant, correlation between these parameters (r = −0.136, p = 0.025). On age and sex adjusted regression analysis, lower liver HU values indicated a dismal cardiometabolic risk profile, including higher HbA1C (p = 0.005) and higher body mass index (p < 0.001). In contrast, native hepatic T1-times yielded a more pronounced cardiac risk profile, including impaired systolic function (p = 0.045) and higher NT-proBNP values (N-Terminal Brain Natriuretic Peptide) (p = 0.004). Conclusions: Hepatic T1-times are easy to assess on standard T1-maps on CMR but only weakly correlated with hepatic HU values on CT and clinical NAFLD/MAFLD scores. Liver T1-times, however, are linked to impaired systolic function and higher natriuretic peptide levels. The prognostic value and clinical usefulness of hepatic T1-times in CMR cohorts warrants further research.
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Gulsin GS, McVeigh N, Leipsic JA, Dodd JD. Cardiovascular CT and MRI in 2020: Review of Key Articles. Radiology 2021; 301:263-277. [PMID: 34491130 DOI: 10.1148/radiol.2021211002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the global coronavirus pandemic, cardiovascular imaging continued to evolve throughout 2020. It was an important year for cardiac CT and MRI, with increasing prominence in cardiovascular research, use in clinical decision making, and in guidelines. This review summarizes key publications in 2020 relevant to current and future clinical practice. In cardiac CT, these have again predominated in assessment of patients with chest pain and structural heart diseases, although more refined CT techniques, such as quantitative plaque analysis and CT perfusion, are also maturing. In cardiac MRI, the major developments have been in patients with cardiomyopathy and myocarditis, although coronary artery disease applications remain well represented. Deep learning applications in cardiovascular imaging have continued to advance in both CT and MRI, and these are now closer than ever to routine clinical adoption. Perhaps most important has been the rapid deployment of MRI in enhancing understanding of the impact of COVID-19 infection on the heart. Although this review focuses primarily on articles published in Radiology, attention is paid to other leading journals where published CT and MRI studies will have the most clinical and scientific value to the practicing cardiovascular imaging specialist.
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Affiliation(s)
- Gaurav S Gulsin
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
| | - Niall McVeigh
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
| | - Jonathon A Leipsic
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
| | - Jonathan D Dodd
- From the Department of Radiology, University of British Columbia, St Paul's Hospital, Vancouver, Canada (G.S.G., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the Leicester National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, England (G.S.G.); Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland (N.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.)
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Faron A, Isaak A, Mesropyan N, Reinert M, Schwab K, Sirokay J, Sprinkart AM, Bauernfeind FG, Dabir D, Pieper CC, Heine A, Kuetting D, Attenberger U, Landsberg J, Luetkens JA. Cardiac MRI Depicts Immune Checkpoint Inhibitor-induced Myocarditis: A Prospective Study. Radiology 2021; 301:602-609. [PMID: 34581628 DOI: 10.1148/radiol.2021210814] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) for cancer treatment are associated with a spectrum of immune-related adverse events, including ICI-induced myocarditis; however, the extent of subclinical acute cardiac effects related to ICI treatment is unclear. Purpose To explore the extent of cardiac injury and inflammation related to ICI therapy that can be detected with use of cardiac MRI. Materials and Methods In this prospective study from November 2019 to April 2021, oncologic participants, without known underlying structural heart disease or cardiac symptoms, underwent multiparametric cardiac MRI before planned ICI therapy (baseline) and 3 months after starting ICI therapy (follow-up). The cardiac MRI protocol incorporated assessment of cardiac function, including systolic myocardial strain, myocardial edema, late gadolinium enhancement (LGE), T1 and T2 relaxation times, and extracellular volume fraction. The paired t test, Wilcoxon signed-rank test, and McNemar test were used for intraindividual comparisons. Results Twenty-two participants (mean age ± standard deviation, 65 years ± 14; 13 men) were evaluated, receiving a median of four infusions of ICI therapy (interquartile range, four to six infusions). Compared with baseline MRI, participants displayed increased markers of diffuse myocardial edema at follow-up (T1 relaxation time, 972 msec ± 26 vs 1006 msec ± 36 [P < .001]; T2 relaxation time, 54 msec ± 3 vs 58 msec ± 4 [P < .001]; T2 signal intensity ratio, 1.5 ± 0.3 vs 1.7 ± 0.3 [P = .03]). Left ventricular average systolic longitudinal strain had decreased at follow-up MRI (-23.4% ± 4.8 vs -19.6% ± 5.1, respectively; P = .005). New nonischemic LGE lesions were prevalent in two of 22 participants (9%). Compared with baseline, small pericardial effusions were more evident at follow-up (one of 22 participants [5%] vs 10 of 22 [45%]; P = .004). Conclusion In participants who received immune checkpoint inhibitor therapy for cancer treatment, follow-up cardiac MRI scans showed signs of systolic dysfunction and increased parameters of myocardial edema and inflammation. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Anton Faron
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Matthäus Reinert
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Katjana Schwab
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Judith Sirokay
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alois M Sprinkart
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franz-Georg Bauernfeind
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Darius Dabir
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C Pieper
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Annkristin Heine
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jennifer Landsberg
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Desai MS. Mechanistic insights into the pathophysiology of cirrhotic cardiomyopathy. Anal Biochem 2021; 636:114388. [PMID: 34587512 DOI: 10.1016/j.ab.2021.114388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/22/2021] [Accepted: 09/15/2021] [Indexed: 02/08/2023]
Abstract
Myocardial dysfunction in end stage cirrhotic liver disease, termed cirrhotic cardiomyopathy, is a long known, but little understood comorbidity seen in ∼50% of adults and children who present for liver transplantation. Structural, functional, hemodynamic and electrocardiographic aberrations that occur in the heart as a direct consequence of a damaged liver, is associated with multi-organ failure and increased mortality and morbidity in patients undergoing surgical procedures such as porto-systemic shunt placement and liver transplantation. Despite its clinical significance and rapid advances in science and pharmacotherapy, there is yet no specific treatment for this disease. This may be due to a lack of understanding of the pathogenesis and mechanisms behind how a cirrhotic liver causes cardiac pathology. This review will focus specifically on insights into the molecular mechanisms that drive this liver-heart interaction. Deeper understanding of the etio-pathogenesis of cirrhotic cardiomyopathy will allow us to design and test treatments that can be targeted to prevent and/or reverse this co-morbid consequence of liver failure and improve health care delivery and outcomes in patients with cirrhosis.
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Affiliation(s)
- Moreshwar S Desai
- Department of Pediatrics, Section of Pediatric Critical Care Medicine and Liver ICU. Baylor College of Medicine, Houston, TX, 77030, USA.
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Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction. Abdom Radiol (NY) 2021; 46:2458-2466. [PMID: 33078245 PMCID: PMC8205876 DOI: 10.1007/s00261-020-02822-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
Purpose Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that leads to severe fibrosis and cirrhosis. The aim of this study was to determine the diagnostic value of T1 and T2 mapping as well as extracellular volume fraction (ECV) for non-invasive assessment of liver fibrosis in AIH patients. Methods In this prospective study, 27 patients (age range: 19–77 years) with AIH underwent liver MRI. T1 and T2 relaxation times as well as ECV were quantified by mapping techniques. The presence of significant fibrosis (≥ F2) was defined as magnetic resonance elastography (MRE)-based liver stiffness ≥ 3.66 kPa. MRE was used as reference standard, against which the diagnostic performance of MRI-derived mapping parameters was tested. Diagnostic performance was compared by utilizing receiver-operating characteristic (ROC) analysis. Results MRE-based liver stiffness correlated with both, hepatic native T1 (r = 0.69; P < 0.001) as well as ECV (r = 0.80; P < 0.001). For the assessment of significant fibrosis, ECV yielded a sensitivity of 85.7% (95% confidence interval (CI): 60.1–96.0%) and a specificity of 84.6% (CI 60.1–96.0%); hepatic native T1 yielded a sensitivity of 85.7% (CI 60.1–96.0%); and a specificity of 76.9% (CI 49.7–91.8%). Diagnostic performance of hepatic ECV (area under the curve (AUC): 0.885), native hepatic T1 (AUC: 0.846) for assessment of significant fibrosis was similar compared to clinical fibrosis scores (APRI (AUC: 0.852), FIB-4 (AUC: 0.758), and AAR (0.654) (P > 0.05 for each comparison)). Conclusion Quantitative mapping parameters such as T1 and ECV can identify significant fibrosis in AIH patients. Future studies are needed to explore the value of parametric mapping for the evaluation of different disease stages.
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Abstract
PURPOSE OF REVIEW Cirrhotic cardiomyopathy (CCM) is a well-recognized entity. When patients with CCM encounter challenges such as liver transplantation, overt cardiac dysfunction manifests, leading to morbidity and mortality. Although revised diagnostic criteria for CCM have recently been proposed, these still need to be validated. RECENT FINDINGS Previous reviews have summarized the mechanisms of CCM, such as abnormalities of the β-adrenergic pathway, cardiac plasma membrane biophysical and biochemical properties, and electrophysiological changes. Cardiomyocyte apoptosis, inflammation, and oxidative stress also play important roles. The present review details further mechanisms of CCM, which include myosin heavy chain isoform shifts and abnormalities in cellular calcium transients. Additionally, we review recent studies on therapeutic strategies. Recent work underscores the importance of CCM in the natural history of the immediate and medium-term postoperative period after liver transplantation. Appropriate management strategies for CCM remain the area of greatest unmet need, requiring much further research. SUMMARY CCM is a clinically relevant syndrome affecting patients with cirrhosis, leading to increased morbidity and mortality. New diagnostic criteria have been recently proposed by an expert working group. The pathogenic mechanisms remain incompletely clarified and optimal management strategies need much further study.
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Hepatocardiac or Cardiohepatic Interaction: From Traditional Chinese Medicine to Western Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6655335. [PMID: 33777158 PMCID: PMC7981187 DOI: 10.1155/2021/6655335] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 12/16/2022]
Abstract
There is a close relationship between the liver and heart based on "zang-xiang theory," "five-element theory," and "five-zang/five-viscus/five-organ correlation theory" in the theoretical system of Traditional Chinese Medicine (TCM). Moreover, with the development of molecular biology, genetics, immunology, and others, the Modern Medicine indicates the existence of the essential interorgan communication between the liver and heart (the heart and liver). Anatomically and physiologically, the liver and heart are connected with each other primarily via "blood circulation." Pathologically, liver diseases can affect the heart; for example, patients with end-stage liver disease (liver failure/cirrhosis) may develop into "cirrhotic cardiomyopathy," and nonalcoholic fatty liver disease (NAFLD) may promote the development of cardiovascular diseases via multiple molecular mechanisms. In contrast, heart diseases can affect the liver, heart failure may lead to cardiogenic hypoxic hepatitis and cardiac cirrhosis, and atrial fibrillation (AF) markedly alters the hepatic gene expression profile and induces AF-related hypercoagulation. The heart can also influence liver metabolism via certain nonsecretory cardiac gene-mediated multiple signals. Moreover, organokines are essential mediators of organ crosstalk, e.g., cardiomyokines link the heart to the liver, while hepatokines link the liver to the heart. Therefore, both TCM and Western Medicine, and both the basic research studies and the clinical practices, all indicate that there exist essential "heart-liver axes" and "liver-heart axes." To investigate the organ interactions between the liver and heart (the heart and liver) will help us broaden and deepen our understanding of the pathogenesis of both liver and heart diseases, thus improving the strategies of prevention and treatment in the future.
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Luetkens JA, Isaak A, Öztürk C, Mesropyan N, Monin M, Schlabe S, Reinert M, Faron A, Heine A, Velten M, Dabir D, Boesecke C, Strassburg CP, Attenberger U, Zimmer S, Duerr GD, Nattermann J. Cardiac MRI in Suspected Acute COVID-19 Myocarditis. Radiol Cardiothorac Imaging 2021; 3:e200628. [PMID: 33969316 PMCID: PMC8098091 DOI: 10.1148/ryct.2021200628] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Keywords: COVID-19; coronavirus; myocarditis; cardiac MRI; T1 mapping; T2 mapping
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Affiliation(s)
- Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Can Öztürk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Malte Monin
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Sefan Schlabe
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Matthäus Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Annkristin Heine
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Markus Velten
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Christoph Boesecke
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Christian P Strassburg
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Sebastian Zimmer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Georg D Duerr
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
| | - Jacob Nattermann
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (J.A.L., A.I., N.M., M.R., A.F., D.D., U.A.); Quantitative Imaging Lab Bonn (QILaB) (J.A.L., A.I., N.M., M.R., A.F., D.D.); Department of Internal Medicine II - Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (C.O., S.Z.); Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.M., S.S., C.B., C.P.S., J.N.); Department of Internal Medicine III-Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (A.H.); Department of Anesthesiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (M.V.); Department of Cardiac Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (G.D.D.)
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Praktiknjo M, Abu-Omar J, Chang J, Thomas D, Jansen C, Kupczyk P, Schepis F, Garcia-Pagan JC, Merli M, Meyer C, Strassburg CP, Pieper CC, Trebicka J. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. JHEP Rep 2021; 3:100264. [PMID: 34013182 PMCID: PMC8113713 DOI: 10.1016/j.jhepr.2021.100264] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022] Open
Abstract
Background & Aims Smaller 8-mm diameter transjugular intrahepatic portosystemic shunts (TIPS) appear to be more beneficial than larger 10-mm TIPS stent-grafts, but lack the ability for secondary dilation in cases of clinical ineffectiveness. Underdilated VIATORR® TIPS stent grafts (VTS) expand passively, whereas novel VIATORR Controlled Expansion (VCX) stent grafts do not. This study evaluated the impact on survival of underdilated VCX compared with VTS in patients with decompensated cirrhosis. Methods This was a prospective case-control study including patients with cirrhosis receiving TIPS using 10-mm VCX underdilated to 8 mm. Patients with cirrhosis receiving 10-mm VTS underdilated to 8 mm were matched for age, sex, indication for TIPS, and liver function. Results A total of 114 patients (47 VCX, 47 VTS, and 20 fully dilated VCX/VTS) were included. After TIPS implantation, underdilated VCX diameter was 8.0 (7.8-9.2) mm at a median time of 359 (87-450) days, compared with VTS at 9.9 (9.7-10.0) mm (p <0.001). The portosystemic pressure gradient immediately after TIPS procedure and after 7 days did not change significantly in VCX [mean 9.4 (± 0.8) vs. 10.4 (± 0.7) mmHg, p = 0.115). Hospital readmission rates for hepatic encephalopathy were 23% (n = 11) vs 51% (n = 24) for VCX and VTS (p <0.001), respectively. Patients with VCX had significantly lower rates of large-volume paracentesis (n = 5 [11%] vs. n = 10 [21%], p = 0.017) and heart failure (n = 1 [2%] vs. n = 7 [15%], p = 0.015). One-year mortality for underdilated VCX and VTS was 15% (n = 7) and 30% (n = 14) and, for fully dilated VCX/VTS, was 45% (n = 9) (log-rank p = 0.008), respectively. Conclusions This study demonstrated that VCX stent grafts underdilated to 8 mm do not passively expand to nominal diameter and suggests reduced hospital readmissions because of hepatic encephalopathy, uncontrolled ascites, and heart failure, and improved 1-year survival compared with underdilated VTS. Lay summary Transjugular intrahepatic portosystemic shunt (TIPS) improves survival in selected patients with liver cirrhosis and acute variceal bleeding or refractory ascites. Smaller 8-mm diameter TIPS stent grafts appear to improve patient outcome compared with larger 10-mm diameter stent grafts. Novel VIATORR® Controlled Expansion (VCX) stent grafts facilitate safe and stable underdilation to 8 mm of large 10-mm diameter stent grafts with improved patient outcome (survival, hepatic encephalopathy, ascites and heart failure) compared with legacy VIATORR TIPS stent graft (VTS). Thus, the use of underdilated VCX could preserve heart function. Clinical Trials Registration The study is registered at Clinicaltrials.govNCT03628807.
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Key Words
- Acute decompensation
- Ascites
- CT, computed tomography
- Cirrhosis
- HE, hepatic encephalopathy
- HF, heart failure
- Hepatic encephalopathy
- LV, left ventricular
- LV-GLS, LV global longitudinal strain
- LVP, large-volume paracentesis
- Liver
- MELD, model of end-stage liver disease
- NEPTUN, Non-invasive Evaluation Program for TIPS and follow Up Network
- PSPG, portosystemic pressure gradient
- PTFE, polytetrafluorethylene
- RA, recurrent/refractory ascites
- RAAS, renin-angiotensin-aldosterone system
- SPSS, spontaneous portosystemic shunt
- TIPS
- TIPS, transjugular intrahepatic portosystemic shunt
- TTE, transthoracic echocardiography
- Transjugular intrahepatic portosystemic shunt
- VB, variceal bleeding
- VCX, VIATORR controlled expansion
- VTS, VIATORR TIPS stent
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Affiliation(s)
- Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Jasmin Abu-Omar
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Patrick Kupczyk
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Filippo Schepis
- Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Juan Carlos Garcia-Pagan
- Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Carsten Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | | | - Claus C Pieper
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany.,European Foundation for the Study of Chronic Liver Failure - EF CLIF, Barcelona, Spain
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Abstract
Cirrhotic cardiomyopathy (CCM), cardiac dysfunction in end-stage liver disease in the absence of prior heart disease, is an important clinical entity that contributes significantly to morbidity and mortality. The original definition for CCM, established in 2005 at the World Congress of Gastroenterology (WCG), was based upon known echocardiographic parameters to identify subclinical cardiac dysfunction in the absence of overt structural abnormalities. Subsequent advances in cardiovascular imaging and in particular myocardial deformation imaging have rendered the WCG criteria outdated. A number of investigations have explored other factors relevant to CCM, including serum markers, electrocardiography, and magnetic resonance imaging. CCM characteristics include a hyperdynamic circulatory state, impaired contractility, altered diastolic relaxation, and electrophysiological abnormalities, particularly QT interval prolongation. It is now known that cardiac dysfunction worsens with the progression of cirrhosis. Treatment for CCM has traditionally been limited to supportive efforts, but new pharmacological studies appear promising. Left ventricular diastolic dysfunction in CCM can be improved by targeted heart rate reduction. Ivabradine combined with carvedilol improves left ventricular diastolic dysfunction through targeted heart rate reduction, and this regimen can improve survival in patients with cirrhosis. Orthotopic liver transplantation also appears to improve CCM. Here, we canvass diagnostic challenges associated with CCM, introduce cardiac physiology principles and the application of echocardiographic techniques, and discuss the evidence behind therapeutic interventions in CCM.
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Isaak A, Bischoff LM, Faron A, Endler C, Mesropyan N, Sprinkart AM, Pieper CC, Kuetting D, Dabir D, Attenberger U, Luetkens JA. Multiparametric cardiac magnetic resonance imaging in pediatric and adolescent patients with acute myocarditis. Pediatr Radiol 2021; 51:2470-2480. [PMID: 34435226 PMCID: PMC8599260 DOI: 10.1007/s00247-021-05169-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/10/2021] [Accepted: 07/31/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The diagnostic value of cardiac magnetic resonance imaging (MRI) employing the 2018 Lake Louise criteria in pediatric and adolescent patients with acute myocarditis is undefined. OBJECTIVE To evaluate the diagnostic value of the Lake Louise criteria in pediatric and adolescent patients with suspected acute myocarditis and to show the utility of cardiac MRI for follow-up in this patient cohort. MATERIALS AND METHODS Forty-three patients (age range: 8-21 years) with suspected acute myocarditis and 13 control patients who underwent cardiac MRI were retrospectively analyzed. T2-weighted and late gadolinium enhancement imaging were performed in all patients. T1 and T2 mapping were available in 26/43 patients (60%). The Lake Louise criteria were assessed. In 27/43 patients (63%), cardiac MRI follow-up was available. Receiver operating characteristic analysis, Pearson's correlation coefficient and paired Student's t-test were used for statistical analysis. RESULTS In the total cohort, the Lake Louise criteria achieved a sensitivity of 86% (95% confidence interval [CI]: 72-95%) and a specificity of 100% (95% CI: 79-100%) for the diagnosis of acute myocarditis. In the subgroup of patients with available mapping parameters, the diagnostic performance of the Lake Louise criteria was higher when mapping parameters were implemented into the score (area under the receiver operating characteristic curve: 0.944 vs. 0.870; P=0.033). T2 relaxation times were higher in patients with admission to the intermediate care unit and were associated with the length of intermediate care unit stay (r=0.879, P=0.049). Cardiac MRI markers of active inflammation decreased on follow-up examinations (e.g., T1 relaxation times: 1,032±39 ms vs. 975±33 ms, P<0.001; T2 relaxation times: 58±5 ms vs. 54±5 ms, P=0.003). CONCLUSION The Lake Louise criteria have a high diagnostic performance for the diagnosis of acute myocarditis and are a valuable tool for follow-up in pediatric and adolescent patients. The mapping techniques enhance the diagnostic performance of the 2018 Lake Louise criteria.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Leon M. Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Alois M. Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Claus C. Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
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Prolonged QT-interval in cirrhosis: is it reversible? Int J Cardiol 2020; 329:113-114. [PMID: 33279590 DOI: 10.1016/j.ijcard.2020.11.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022]
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de Roos A, Lamb HJ. Exploring the Interaction between Liver and Heart Disease. Radiology 2020; 297:62-63. [PMID: 32813598 DOI: 10.1148/radiol.2020203112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Albert de Roos
- From the Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, the Netherlands
| | - Hildo J Lamb
- From the Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333ZA, the Netherlands
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