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Fernández-Friera L, García-Alvarez A, Oliva B, García-Lunar I, García I, Moreno-Arciniegas A, Gómez-Talavera S, Pérez-Herreras C, Sánchez-González J, de Vega VM, Rossello X, Bueno H, Fernández-Ortiz A, Ibañez B, Sanz J, Fuster V. Association between subclinical atherosclerosis burden and unrecognized myocardial infarction detected by cardiac magnetic resonance in middle-aged low-risk adults. Eur Heart J Cardiovasc Imaging 2024; 25:968-975. [PMID: 38426763 PMCID: PMC11210973 DOI: 10.1093/ehjci/jeae044] [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: 07/22/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS Evidence on the association between subclinical atherosclerosis (SA) and cardiovascular (CV) events in low-risk populations is scant. To study the association between SA burden and an ischaemic scar (IS), identified by cardiac magnetic resonance (CMR), as a surrogate of CV endpoint, in a low-risk population. METHODS AND RESULTS A cohort of 712 asymptomatic middle-aged individuals from the Progression of Early SA (PESA-CNIC-Santander) study (median age 51 years, 84% male, median SCORE2 3.37) were evaluated on enrolment and at 3-year follow-up with 2D/3D vascular ultrasound (VUS) and coronary artery calcification scoring (CACS). A cardiac magnetic study (CMR) was subsequently performed and IS defined as the presence of subendocardial or transmural late gadolinium enhancement (LGE). On CMR, 132 (19.1%) participants had positive LGE, and IS was identified in 20 (2.9%) participants. Individuals with IS had significantly higher SCORE2 at baseline and higher CACS and peripheral SA burden (number of plaques by 2DVUS and plaque volume by 3DVUS) at both SA evaluations. High CACS and peripheral SA (number of plaques) burden were independently associated with the presence of IS, after adjusting for SCORE2 [OR for 3rd tertile, 8.31; 95% confidence interval (CI) 2.85-24.2; P < 0.001; and 2.77; 95% CI, 1.02-7.51; P = 0.045, respectively] and provided significant incremental diagnostic value over SCORE2. CONCLUSION In a low-risk middle-aged population, SA burden (CAC and peripheral plaques) was independently associated with a higher prevalence of IS identified by CMR. These findings reinforce the value of SA evaluation to early implement preventive measures. CLINICAL TRIAL REGISTRATION Progression of Early Subclinical Atherosclerosis (PESA) Study Identifier: NCT01410318.
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Affiliation(s)
- Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), Hospital Universitario HM Monteprincipe, HM Hospitales, Av. de Montepríncipe, 25, 28660 Boadilla del Monte, Madrid, Spain
- CIBERCV, Madrid, Spain
- Universidad Camilo Jose Cela, Castillo de Alarcón, 49, 28692 Villafranca del Castillo, Madrid, Spain
| | - Ana García-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clinic Barcelona-IDIBAPS. Universitat de Barcelona, Barcelona, Spain
| | - Belen Oliva
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario La Moraleja, Madrid, Spain
| | - Iris García
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Andrea Moreno-Arciniegas
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Cardiology Department, IIS-Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, 28040 Madrid, Spain
| | - Sandra Gómez-Talavera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Cardiology Department, IIS-Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, 28040 Madrid, Spain
| | | | | | | | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Cardiology Department, Hospital Universitari Son Espases-IDISBA, Palma de Mallorca, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, and i+12 Research Institute, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, IIS-Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, 28040 Madrid, Spain
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Mount Sinai Fuster Heart Hospital, New York, NY, USA
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Mount Sinai Fuster Heart Hospital, New York, NY, USA
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2
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Antiochos P, Ge Y, Steel K, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol 2020; 76:945-957. [DOI: 10.1016/j.jacc.2020.06.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
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4
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Amier RP, Smulders MW, van der Flier WM, Bekkers SC, Zweerink A, Allaart CP, Demirkiran A, Roos ST, Teunissen PF, Appelman Y, van Royen N, Kim RJ, van Rossum AC, Nijveldt R. Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction. JACC Cardiovasc Imaging 2018; 11:1773-1781. [DOI: 10.1016/j.jcmg.2018.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 11/29/2022]
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Øhrn AM, Schirmer H, von Hanno T, Mathiesen EB, Arntzen KA, Bertelsen G, Njølstad I, Løchen ML, Wilsgaard T, Bairey Merz CN, Lindekleiv H. Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007-2008. Int J Cardiol 2018; 253:14-19. [PMID: 29306455 DOI: 10.1016/j.ijcard.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease. METHODS 6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex. RESULTS Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05-2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35-0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37-0.69). No significant sex interaction was present. CONCLUSIONS Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.
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Affiliation(s)
- Andrea Milde Øhrn
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.
| | - Henrik Schirmer
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Therese von Hanno
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Bodø, Norway
| | - Ellisiv B Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Kjell Arne Arntzen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Geir Bertelsen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - C Noel Bairey Merz
- NBM Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Haakon Lindekleiv
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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6
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Stillman AE, Oudkerk M, Bluemke DA, de Boer MJ, Bremerich J, Garcia EV, Gutberlet M, van der Harst P, Hundley WG, Jerosch-Herold M, Kuijpers D, Kwong RY, Nagel E, Lerakis S, Oshinski J, Paul JF, Slart RHJA, Thourani V, Vliegenthart R, Wintersperger BJ. Imaging the myocardial ischemic cascade. Int J Cardiovasc Imaging 2018; 34:1249-1263. [PMID: 29556943 DOI: 10.1007/s10554-018-1330-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/05/2018] [Indexed: 01/25/2023]
Abstract
Non-invasive imaging plays a growing role in the diagnosis and management of ischemic heart disease from its earliest manifestations of endothelial dysfunction to myocardial infarction along the myocardial ischemic cascade. Experts representing the North American Society for Cardiovascular Imaging and the European Society of Cardiac Radiology have worked together to organize the role of non-invasive imaging along the framework of the ischemic cascade. The current status of non-invasive imaging for ischemic heart disease is reviewed along with the role of imaging for guiding surgical planning. The issue of cost effectiveness is also considered. Preclinical disease is primarily assessed through the coronary artery calcium score and used for risk assessment. Once the patient becomes symptomatic, other imaging tests including echocardiography, CCTA, SPECT, PET and CMR may be useful. CCTA appears to be a cost-effective gatekeeper. Post infarction CMR and PET are the preferred modalities. Imaging is increasingly used for surgical planning of patients who may require coronary artery bypass.
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Affiliation(s)
- Arthur E Stillman
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Matthijs Oudkerk
- Center of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - David A Bluemke
- Department of Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Menko Jan de Boer
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Jens Bremerich
- Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Pim van der Harst
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - W Gregory Hundley
- Departments of Internal Medicine & Radiology, Wake Forest University, Winston-Salem, NC, USA
| | | | - Dirkjan Kuijpers
- Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Raymond Y Kwong
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital, Frankfurt/Main, Germany
| | | | - John Oshinski
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA
| | | | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vinod Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
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Weir-McCall JR, Fitzgerald K, Papagiorcopulo CJ, Gandy SJ, Lambert M, Belch JJ, Cavin I, Littleford R, Macfarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan FM, Waugh SA, White RD, Houston JG. Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis. Eur Heart J Cardiovasc Imaging 2017; 18:657-662. [PMID: 27550660 PMCID: PMC5439404 DOI: 10.1093/ehjci/jew155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/29/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI). METHODS AND RESULTS A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m2, P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function. CONCLUSION Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.
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Affiliation(s)
- Jonathan R. Weir-McCall
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Kerrie Fitzgerald
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Carla J. Papagiorcopulo
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Matthew Lambert
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Jill J.F. Belch
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Ian Cavin
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
| | - Roberta Littleford
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Shona Z. Matthew
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | | | - Allan D. Struthers
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
| | - Frank M. Sullivan
- Department of Research and Innovation, North York General Hospital, University of Toronto, Toronto, UK
| | | | - Richard D. White
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - J. Graeme Houston
- Department of Cardiovascular and Diabetes Medicine, College of Medicine, Ninewells Hospital, University of Dundee, Level 7, Dundee DD1 9SY, UK
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8
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Cardiac MRI left ventricular global function index and quantitative late gadolinium enhancement in unrecognized myocardial infarction. Eur J Radiol 2017. [PMID: 28624007 DOI: 10.1016/j.ejrad.2017.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare left ventricular global function index (LVGFI) and quantitative late gadolinium enhancement (LGE) in patients with unrecognized myocardial infarction (UMI), recognized myocardial infarction (RMI) and without myocardial infarction (MI). MATERIAL AND METHODS Under waiver of the Institutional Review Board 235 patients (age 63.5±10.5years, 57 female) were retrospectively evaluated. All patients had undergone cardiac MRI at 1.5T for symptoms of CAD. 67 patients (29%) had suffered a known RMI before. Functional imaging and full-intensity late gadolinium enhancement (LGE) imaging were evaluated for LVGFI and quantitative LGE mass. RESULTS Of 168 patients without history of RMI, 48 patients (29%) had UMI, 120 patients had no MI. LVGFI was lower in RMI patients (34±8% [range 16;52]), and UMI patients (35±8% [range 10;51]), compared to patients with no MI (38±7% [range 16;55]) respectively and similar between RMI and UMI patients. RMI patients had full-intensity LGE in 11±6% of left ventricular myocardial mass (LVMM). UMI patients had LGE in 9±5% of LVMM. RMI patients had significantly more LGE than UMI patients (p=0.0096). CONCLUSION LGE quantification is effective to assess infarction scar size in RMI and UMI patients. LVGFI provides information on cardiac function and morphology but does not allow for a reliable differentiation between patients with and without history of MI, due small differences and wide overlap of LVGFI values for all three patient groups. This may be a reason why LVGFI is not applied in clinical routine.
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Barbier CE, Themudo R, Bjerner T, Johansson L, Lind L, Ahlström H. Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population. J Cardiovasc Magn Reson 2016; 18:43. [PMID: 27430315 PMCID: PMC4950686 DOI: 10.1186/s12968-016-0264-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. However, increasing evidence indicate that these individuals may be at considerable cardiovascular risk. The aim of the present study was to investigate the prognostic impact of CMR detected UMIs for major adverse cardiac events (MACE) in community living elderly individuals. METHODS Late gadolinium enhancement CMR was performed in 248 randomly chosen 70-year-olds. Individuals with myocardial infarction (MI) scars, with or without a hospital diagnosis of MI were classified as recognized MI (RMI) or UMI, respectively. Medical records and death certificates were scrutinized. MACE was defined as cardiac death, non-fatal MI, a new diagnosis of angina pectoris, or symptom-driven coronary artery revascularization. RESULTS During follow-up (mean 11 years) MACE occurred in 10 % (n = 18/182) of the individuals without MI scars, in 20 % (n = 11/55) of the individuals with UMI, and in 45 % (n = 5/11) of the individuals with RMI, with a significant difference between the UMI group and the group without MI scars (p = 0.045), and between the RMI group and the group without MI scars (p = 0.0004). Cardiac death and/or non-fatal MI occurred in 15, 5, and 3 of the individuals in the NoMI, UMI, and RMI group respectively. Hazards ratios for MACE adjusted for risk factors and sex were 2.55 (95 % CI 1.20-5.42; p = 0.015) for UMI and 3.28 (95 % CI1.16-9.22; p = 0.025) for RMI. CONCLUSIONS The presence of a CMR detected UMI entailed a more than double risk for MACE in community living 70-year-old individuals.
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Affiliation(s)
| | - Raquel Themudo
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
| | - Tomas Bjerner
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
| | - Lars Johansson
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
| | - Lars Lind
- />Department of Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Ahlström
- />Department of Radiology, Uppsala University Hospital, Uppsala, 751 85 Sweden
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10
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Themudo R, Johansson L, Ebeling-Barbier C, Lind L, Ahlström H, Bjerner T. The number of unrecognized myocardial infarction scars detected at DE-MRI increases during a 5-year follow-up. Eur Radiol 2016; 27:715-722. [DOI: 10.1007/s00330-016-4439-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
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11
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Weir-McCall JR, Duce SL, Gandy SJ, Matthew SZ, Martin P, Cassidy DB, McCormick L, Belch JJF, Struthers AD, Colhoun HM, Houston JG. Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease. BMC Med Imaging 2016; 16:18. [PMID: 26923316 PMCID: PMC4770697 DOI: 10.1186/s12880-016-0121-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study was to use whole body cardiovascular magnetic resonance imaging (WB CVMR) to assess the heart and arterial network in a single examination, so as to describe the burden of atherosclerosis and subclinical disease in participants with symptomatic single site vascular disease. Methods 64 patients with a history of symptomatic single site vascular disease (38 coronary artery disease (CAD), 9 cerebrovascular disease, 17 peripheral arterial disease (PAD)) underwent whole body angiogram and cardiac MR in a 3 T scanner. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cine and late gadolinium enhancement images of the left ventricle were obtained. Results Asymptomatic atherosclerotic disease with greater than 50 % stenosis in arteries other than that responsible for their presenting complain was detected in 37 % of CAD, 33 % of cerebrovascular and 47 % of PAD patients. Unrecognised myocardial infarcts were observed in 29 % of PAD patients. SAS was significantly higher in PAD patients 24 (17.5-30.5) compared to CAD 4 (2–11.25) or cerebrovascular disease patients 6 (2-10) (ANCOVA p < 0.001). Standardised atheroma score positively correlated with age (β 0.36 p = 0.002), smoking status (β 0.34 p = 0.002), and LV mass (β -0.61 p = 0.001) on multiple linear regression. Conclusion WB CVMR is an effective method for the stratification of cardiovascular disease. The high prevalence of asymptomatic arterial disease, and silent myocardial infarctions, particularly in the peripheral arterial disease group, demonstrates the importance of a systematic approach to the assessment of cardiovascular disease.
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Affiliation(s)
- Jonathan R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK. .,NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK. .,Division of Cardiovascular and Diabetic Medicine, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Suzanne L Duce
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Stephen J Gandy
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK.,NHS Tayside Medical Physics, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Shona Z Matthew
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Patricia Martin
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Deirdre B Cassidy
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Lynne McCormick
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Jill J F Belch
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Allan D Struthers
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK
| | - Helen M Colhoun
- Division of Population Health Sciences, Medical Research Institute, The Mackenzie Building, University of Dundee, ᅟ, DD2 4BF, UK
| | - J Graeme Houston
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, ᅟ, DD1 9SY, UK.,NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK
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Turkbey EB, Nacif MS, Guo M, McClelland RL, Teixeira PBRP, Bild DE, Barr RG, Shea S, Post W, Burke G, Budoff M, Folsom AR, Liu CY, Lima JA, Bluemke DA. Prevalence and Correlates of Myocardial Scar in a US Cohort. JAMA 2015; 314:1945-54. [PMID: 26547466 PMCID: PMC4774246 DOI: 10.1001/jama.2015.14849] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Myocardial scarring leads to cardiac dysfunction and poor prognosis. The prevalence of and factors associated with unrecognized myocardial infarction and scar have not been previously defined using contemporary methods in a multiethnic US population. OBJECTIVE To determine prevalence of and factors associated with myocardial scar in middle- and older-aged individuals in the United States. DESIGN, SETTING, AND PARTICIPANTS The Multi-Ethnic Study of Atherosclerosis (MESA) study is a population-based cohort in the United States. Participants were aged 45 through 84 years and free of clinical cardiovascular disease (CVD) at baseline in 2000-2002. In the 10th year examination (2010-2012), 1840 participants underwent cardiac magnetic resonance (CMR) imaging with gadolinium to detect myocardial scar. Cardiovascular disease risk factors and coronary artery calcium (CAC) scores were measured at baseline and year 10. Logistic regression models were used to estimate adjusted odds ratios (ORs) for myocardial scar. EXPOSURES Cardiovascular risk factors, CAC scores, left ventricle size and function, and carotid intima-media thickness. MAIN OUTCOMES AND MEASURES Myocardial scar detected by CMR imaging. RESULTS Of 1840 participants (mean [SD] age, 68 [9] years, 52% men), 146 (7.9%) had myocardial scars, of which 114 (78%) were undetected by electrocardiogram or by clinical adjudication. In adjusted models, age, male sex, body mass index, hypertension, and current smoking at baseline were associated with myocardial scar at year 10. The OR per 8.9-year increment was 1.61 (95% CI, 1.36-1.91; P < .001); for men vs women: OR, 5.76 (95% CI, 3.61-9.17; P < .001); per 4.8-SD body mass index: OR, 1.32 (95% CI, 1.09-1.61, P = .005); for hypertension: OR, 1.61 (95% CI, 1.12-2.30; P = .009); and for current vs never smokers: 2.00 (95% CI, 1.22-3.28; P = .006). Age-, sex-, and ethnicity-adjusted CAC scores at baseline were also associated with myocardial scar at year 10. Compared with a CAC score of 0, the OR for scores from 1 through 99 was 2.4 (95% CI, 1.5-3.9); from 100 through 399, 3.0 (95% CI, 1.7-5.1), and 400 or higher, 3.3 (95% CI, 1.7-6.1) (P ≤ .001). The CAC score significantly added to the association of myocardial scar with age, sex, race/ethnicity, and traditional CVD risk factors (C statistic, 0.81 with CAC vs 0.79 without CAC, P = .01). CONCLUSIONS AND RELEVANCE The prevalence of myocardial scars in a US community-based multiethnic cohort was 7.9%, of which 78% were unrecognized by electrocardiography or clinical evaluation. Further studies are needed to understand the clinical consequences of these undetected scars.
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Affiliation(s)
- Evrim B. Turkbey
- Radiology and Imaging Sciences, National Institutes of Health,
Maryland, MD
- Department of Radiology and Radiological Sciences, Johns Hopkins
University, Maryland, MD
| | - Marcelo S. Nacif
- Radiology and Imaging Sciences, National Institutes of Health,
Maryland, MD
| | - Mengye Guo
- Department of Biostatistics, University of Washington, Washington,
WA
| | | | | | - Diane E. Bild
- Patient-Centered Outcomes Research Institute, Washington, DC
| | - R. Graham Barr
- Departments of Medicine and Epidemiology, Columbia University, New
York, NY
| | - Steven Shea
- Departments of Medicine and Epidemiology, Columbia University, New
York, NY
| | - Wendy Post
- Department of Cardiology, Johns Hopkins University Maryland,
MD
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University Health
Sciences, Winston-Salem, NC
| | - Matthew Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at
Harbor-UCLA Medical Center, Torrance, CA
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of
Minnesota, Minneapolis, MN
| | - Chia-Ying Liu
- Radiology and Imaging Sciences, National Institutes of Health,
Maryland, MD
| | - João A Lima
- Department of Radiology and Radiological Sciences, Johns Hopkins
University, Maryland, MD
- Department of Cardiology, Johns Hopkins University Maryland,
MD
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health,
Maryland, MD
- Department of Radiology and Radiological Sciences, Johns Hopkins
University, Maryland, MD
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13
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Mantel Ä, Holmqvist M, Jernberg T, Wållberg-Jonsson S, Askling J. Rheumatoid arthritis is associated with a more severe presentation of acute coronary syndrome and worse short-term outcome. Eur Heart J 2015; 36:3413-22. [PMID: 26400826 DOI: 10.1093/eurheartj/ehv461] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/19/2015] [Indexed: 12/18/2022] Open
Abstract
AIMS Despite a wealth of studies describing an increased incidence of acute coronary syndromes (ACSs) in rheumatoid arthritis (RA), considerably less is known about the clinical characteristics and their association with short-term outcome of such ACS. The aims of this study were therefore to investigate clinical characteristics and case-fatality rates following ACS in patients with RA. METHODS AND RESULTS We compared the clinical presentation of incident ACS between 2007 and 2010 and their short-term mortality in a cohort of 1135 subjects with prevalent RA and in a cohort of 3184 matched general population comparators. Rheumatoid arthritis subjects more frequently presented with sudden cardiac death, ST-segment elevation myocardial infarctions, had higher levels of troponin and higher frequencies of in-hospital complications compared with the general population comparators. Furthermore, the short-term mortality was higher among RA-associated ACS (7-day hazard ratio (HR) = 1.65 [95% CI 1.32-2.08]; 30-day HR = 1.57 [95% CI 1.30-1.89]), which were somewhat attenuated but remained statistically significantly increased following adjustment for previous comorbidities, demographics, and educational level (7-day HR = 1.50 [95% CI 1.19-1.90]; 30-day HR = 1.43 [95% CI 1.18-1.72]), and for ACS type (7-day HR = 1.44 [95% CI 1.14-1.82]; 30-day HR = 1.36 [95% CI 1.13-1.64]). CONCLUSION Patients with prevalent RA suffer more severe ACSs compared with the general population and also have poorer outcomes after the events, which can only partly be explained by increased event severity.
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Affiliation(s)
- Ängla Mantel
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm SE-171 76, Sweden
| | - Marie Holmqvist
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm SE-171 76, Sweden
| | - Tomas Jernberg
- Section of Cardiology, Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | | | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm SE-171 76, Sweden
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14
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Nance JW, Khurram IM, Nazarian S, DeWire J, Calkins H, Zimmerman SL. Prevalence, Patterns, and Clinical Predictors of Left Ventricular Late Gadolinium Enhancement in Patients Undergoing Cardiac Magnetic Resonance Prior to Pulmonary Vein Antral Isolation for Atrial Fibrillation: A Cross-Sectional Observational Study. Medicine (Baltimore) 2015; 94:e1384. [PMID: 26376379 PMCID: PMC4635793 DOI: 10.1097/md.0000000000001384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is increasingly used to evaluate patients with atrial fibrillation (AF) before pulmonary vein antral isolation (PVAI). The purpose of this study was to assess the incidence and pattern of left ventricular (LV) late gadolinium enhancement (LGE) in patients undergoing CMR before PVAI and compare the clinical and demographic differences of patients with and without LV LGE. Clinical and demographic data on 62 patients (mean age 61 ± 7.9, 69% male) undergoing CMR before PVAI for AF were collected. Two observers, masked to clinical histories, independently recorded the prevalence, extent (number of myocardial segments), and pattern (subendocardial, midmyocardial, or subepicardial) of LV LGE in each patient. Clinical and demographic predictors of LV LGE were determined using logistic regression. Twenty-three patients (37%) demonstrated LV LGE affecting a mean of 3.0 ± 2.1 myocardial segments. There was no difference in LV ejection fraction between patients with and without LGE, and most (65%) patients with LGE had normal wall motion. Only age (P = 0.04) and a history of congestive heart failure (P = .03) were statistically significant independent predictors of LGE. The most common LGE pattern was midmyocardial, seen in 17 of 23 (74%) patients. Only 4 of 23 (17%) patients had LGE in an "expected" pattern based on clinical history. Of the remaining 19 patients, 4 had known congestive heart failure, 5 nonischemic cardiomyopathy, 4 known coronary artery disease, and 2 prior aortic valve replacement. Six of 23 (26%) patients had no known coronary artery, valvular, or myocardial disease. There is a high prevalence of unexpected LV scar in patients undergoing CMR before PVAI for AF, with most patients demonstrating a nonischemic pattern of LV LGE and no wall motion abnormalities (ie, subclinical disease). The high prevalence of unexpected LGE in these patients may argue for CMR as the modality of choice for imaging integration before PVAI, especially given the demonstrated prognostic value of LGE in this and other patient populations.
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Affiliation(s)
- John W Nance
- From the Department of Radiology (JWNJ, SLZ); and Department of Medicine/Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD (IMK, SN, JD, HC)
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15
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van der Meer RW, Lamb HJ, Smit JWA, de Roos A. MR Imaging Evaluation of Cardiovascular Risk in Metabolic Syndrome. Radiology 2012; 264:21-37. [DOI: 10.1148/radiol.12110772] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Omerovic E, Brohall G, Müller M, Råmunddal T, Matejka G, Waagstein F, Fagerberg B. Silent myocardial infarction in women with type II diabetes mellitus and microalbuminuria. Ther Clin Risk Manag 2011; 4:705-12. [PMID: 19209251 PMCID: PMC2621377 DOI: 10.2147/tcrm.s2826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: The aim of this study was to investigate whether asymptomatic women with diabetes mellitus (DM) without previous history of ischemic heart disease (IHD) and normal electrocardiogram (ECG) have suffered silent myocardial infarction (MI). Methods: The study population consisted of 64-years old women with DM and albuminuria (n = 15) and aged- and body mass index-matched controls (n = 16). The patients were selected after screening of 240 women with previously known or unknown DM. The individuals with previous history of IHD and ECG suggesting the presence of IHD were excluded. All subjects were investigated with magnetic resonance imaging (MRI). Results: MRI investigation has revealed the presence of subendocardial MI in the two DM women (13%). No MI was detected in the control group. MR coronary angiography detected the presence of significant stenosis in the proximal segment of left anterior descending (LAD) coronary artery in one DM woman. This patient developed unstable angina 1 week after the MRI investigation. The conventional angiography has confirmed the presence of significant stenosis in LAD demanding invasive revascularization by percutaneous coronary angioplasty. No difference was found in indices of left ventricular (LV) systolic function while diastolic function was disturbed in the DM group. There was a tendency for increased LV mass in the DM group. No difference was found in the LV volumes. Conclusion: Clinically significant proportion of the women with DM and albuminuria without previous history of IHD have had silent MI. MRI screening of these high risk female patient is valuable diagnostic tool which may increase diagnostic accuracy and improve prognosis in DM patients with IHD.
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Affiliation(s)
- Elmir Omerovic
- The Wallenburg Laboratory at Sahlgrenska Academy, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg University, 413 45, Gothenburg, Sweden Department of Cardiology and Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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17
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Barbier CE, Nylander R, Themudo R, Ahlström H, Lind L, Larsson EM, Bjerner T, Johansson L. Prevalence of unrecognized myocardial infarction detected with magnetic resonance imaging and its relationship to cerebral ischemic lesions in both sexes. J Am Coll Cardiol 2011; 58:1372-7. [PMID: 21920267 DOI: 10.1016/j.jacc.2011.06.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 04/26/2011] [Accepted: 06/07/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prevalence of unrecognized myocardial infarction (UMI) detected with magnetic resonance imaging (MRI) and whether it is related to cerebral ischemic lesions on MRI in an elderly population-based cohort. BACKGROUND There is a correlation between stroke and recognized myocardial infarction (RMI) and between stroke and UMI detected with electrocardiography, whereas the prevalence of stroke in subjects with MRI-detected UMI is unknown. METHODS Cerebral MRI and cardiac late-enhancement MRI were performed on 394 randomly selected 75-year-old subjects (188 women, 206 men). Images were assessed for cerebral ischemic lesions and myocardial infarction (MI) scars. Medical records were scrutinized. Subjects with MI scars, with or without a hospital diagnosis of MI, were classified as RMI or UMI, respectively. RESULTS UMIs were found in 120 subjects (30%) and RMIs in 21 (5%). The prevalence of UMIs (p = 0.004) and RMIs (p = 0.02) was greater in men than in women. Men with RMI displayed an increased prevalence of cortical and lacunar cerebral infarctions, whereas women with UMI more frequently had cortical cerebral infarctions (p = 0.003). CONCLUSIONS MI scars are more frequent in men than in women at 75 years of age. The prevalence of RMI is related to that of cerebral infarctions.
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18
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Khan AM, Litt H, Ferrari V, Han Y. Cardiac Magnetic Resonance Imaging in Ischemic Heart Disease. PET Clin 2011; 6:453-73. [DOI: 10.1016/j.cpet.2011.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Holmström M, Kivistö S, Heliö T, Jurkko R, Kaartinen M, Antila M, Reissell E, Kuusisto J, Kärkkäinen S, Peuhkurinen K, Koikkalainen J, Lötjönen J, Lauerma K. Late gadolinium enhanced cardiovascular magnetic resonance of lamin A/C gene mutation related dilated cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:30. [PMID: 21689390 PMCID: PMC3135551 DOI: 10.1186/1532-429x-13-30] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify early features of lamin A/C gene mutation related dilated cardiomyopathy (DCM) with cardiovascular magnetic resonance (CMR). We characterise myocardial and functional findings in carriers of lamin A/C mutation to facilitate the recognition of these patients using this method. We also investigated the connection between myocardial fibrosis and conduction abnormalities. METHODS Seventeen lamin A/C mutation carriers underwent CMR. Late gadolinium enhancement (LGE) and cine images were performed to evaluate myocardial fibrosis, regional wall motion, longitudinal myocardial function, global function and volumetry of both ventricles. The location, pattern and extent of enhancement in the left ventricle (LV) myocardium were visually estimated. RESULTS Patients had LV myocardial fibrosis in 88% of cases. Segmental wall motion abnormalities correlated strongly with the degree of enhancement. Myocardial enhancement was associated with conduction abnormalities. Sixty-nine percent of our asymptomatic or mildly symptomatic patients showed mild ventricular dilatation, systolic failure or both in global ventricular analysis. Decreased longitudinal systolic LV function was observed in 53% of patients. CONCLUSIONS Cardiac conduction abnormalities, mildly dilated LV and depressed systolic dysfunction are common in DCM caused by a lamin A/C gene mutation. However, other cardiac diseases may produce similar symptoms. CMR is an accurate tool to determine the typical cardiac involvement in lamin A/C cardiomyopathy and may help to initiate early treatment in this malignant familiar form of DCM.
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MESH Headings
- Adolescent
- Adult
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/physiopathology
- Chi-Square Distribution
- Contrast Media
- Electrocardiography
- Female
- Fibrosis
- Finland
- Genetic Predisposition to Disease
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/genetics
- Lamin Type A/genetics
- Magnetic Resonance Imaging, Cine
- Male
- Meglumine
- Middle Aged
- Mutation
- Myocardium/pathology
- Organometallic Compounds
- Phenotype
- Predictive Value of Tests
- Severity of Illness Index
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/genetics
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Miia Holmström
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Sari Kivistö
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Tiina Heliö
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Raija Jurkko
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Maija Kaartinen
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Margareta Antila
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Eeva Reissell
- Boehringer Ingelheim Finland Ky Tammasaarenkatu 5, FI-00180 Helsinki, Finland
| | - Johanna Kuusisto
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Satu Kärkkäinen
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Keijo Peuhkurinen
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Juha Koikkalainen
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Jyrki Lötjönen
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Kirsi Lauerma
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
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Yamamura J, Frisch M, Ecker H, Graessner J, Hecher K, Adam G, Wedegärtner U. Self-gating MR imaging of the fetal heart: comparison with real cardiac triggering. Eur Radiol 2010; 21:142-9. [PMID: 20676652 DOI: 10.1007/s00330-010-1911-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 06/04/2010] [Accepted: 06/14/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the self-gating technique for MR imaging of the fetal heart in a sheep model. MATERIAL AND METHODS MR images of 6 fetal sheep heart were obtained at 1.5 T. For self-gating MRI of the fetal heart a cine SSFP in short axis, two and four chamber view was used. Self-gated images were compared with real cardiac triggered MR images (pulse-wave triggering). MRI of the fetal heart was performed using both techniques simultaneously. Image quality was assessed and the left ventricular volume and function were measured and compared. RESULTS Compared with pulse-wave triggering, the self-gating technique produced slightly inferior images with artifacts. Especially the atrial septum could not be so clearly depicted. The contraction of the fetal heart was shown in cine sequences in both techniques. The average blood volumes could be measured with both techniques with no significant difference: at end-systole 3.1 ml (SD±0.2), at end-diastole 4.9 ml (±0.2), with ejection fractions at 38.6%, respectively 39%. CONCLUSION Both self-gating and pulse-wave triggered cardiac MRI of the fetal heart allowed the evaluation of anatomical structures and functional information. Images obtained by self-gating technique were slightly inferior than the pulse-wave triggered MRI.
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Affiliation(s)
- Jin Yamamura
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Hedén B, Persson E, Carlsson M, Pahlm O, Arheden H. Disappearance of myocardial perfusion defects on prone SPECT imaging: comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease. BMC Med Imaging 2009; 9:16. [PMID: 19664252 PMCID: PMC2738665 DOI: 10.1186/1471-2342-9-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 08/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT) in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. METHODS In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR) with delayed-enhancement technique to confirm or exclude myocardial infarction. RESULTS There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR. CONCLUSION Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.
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Affiliation(s)
- Bo Hedén
- Department of Clinical Physiology, Lund University Hospital, Lund, Sweden.
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High resolution MR imaging of the fetal heart with cardiac triggering: a feasibility study in the sheep fetus. Eur Radiol 2009; 19:2383-90. [DOI: 10.1007/s00330-009-1420-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/02/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
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Turkbey EB, Dombroski DA. Cardiac Magnetic Resonance Imaging: Techniques and Clinical Applications. Semin Roentgenol 2009; 44:67-83. [PMID: 19233083 DOI: 10.1053/j.ro.2008.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Systemic Cardiovascular Complications in Patients With Long-Standing Diabetes Mellitus. Invest Radiol 2009; 44:242-50. [DOI: 10.1097/rli.0b013e31819a60d3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gibbons RJ, Araoz PA, Williamson EE. The year in cardiac imaging. J Am Coll Cardiol 2009; 53:54-70. [PMID: 19118725 DOI: 10.1016/j.jacc.2008.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 09/25/2008] [Indexed: 02/06/2023]
Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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