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Zhang Y, Xie W, Dai Y, Wu Z, Lin Y, Yang M, Hong H. Influencing and prognostic factors of end-stage hypertrophic cardiomyopathy. ESC Heart Fail 2024. [PMID: 39092527 DOI: 10.1002/ehf2.15010] [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: 02/25/2024] [Revised: 06/22/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
AIMS End-stage hypertrophic cardiomyopathy (ES-HCM) is a disease with severe complications and a poor prognosis. This study aimed to explore the influencing and prognostic factors of ES-HCM. METHODS AND RESULTS A total of 1282 patients with HCM who were hospitalized for the first time at Fujian Medical University Union Hospital between 1 January 2013 and 30 September 2021 were recorded. The patients with HCM and left ventricular ejection fraction (LVEF) < 50% were defined as having ES-HCM, and a control group (LVEF ≥ 50%) was generated from the collected medical records of HCM. The patients were matched in a ratio of 4:1 based on age and sex. Logistic regression analysis was used to determine the influencing factors of ES-HCM. Kaplan-Meier survival analysis was performed to analyse the clinical outcomes of ES-HCM patients. A total of 250 inpatients with HCM were enrolled in the study; 50 patients had ES-HCM, and 200 had HCM with LVEF ≥ 50%. The mean age of the patients at enrolment was 62.5 ± 10.3 years, and 215 patients (215/250, 86.0%) were male. The median follow-up time of the patients was 2.8 (1.4-5.4) years. The incidence of all-cause death and cardiovascular death in patients with ES-HCM was higher than those in patients with HCM and LVEF ≥ 50% (22/50 [44.0%] vs. 13/200 [6.5%]; 12/50 [24.0%] vs. 4/200 [2.0%], all P < 0.001). Multivariate logistic regression analysis showed that the influencing factors associated with ES-HCM included age at first symptom onset (odds ratio [OR] = 0.95, 95% CI [0.90, 1.00], P = 0.042), New York Heart Association (NYHA) class (OR = 7.73, 95% CI [2.93, 20.41], P < 0.001), heart rate (OR = 1.07, 95% CI [1.02, 1.12], P = 0.003), QRS duration (OR = 1.03, 95% CI [1.00, 1.05], P = 0.020), left ventricular end-diastolic diameter (LVEDD) (OR = 1.15, 95% CI [1.04, 1.28], P = 0.006), left atrial anteroposterior diameter (LAD) (OR = 1.13, 95% CI [1.03, 1.24], P = 0.012), and maximum left ventricular wall thickness (MLVWT) (OR = 0.80, 95% CI [0.68, 0.93], P = 0.005). Among the 50 patients with ES-HCM, NYHA class (P < 0.001) and heart rate (P = 0.017) were each associated with a higher likelihood and earlier occurrence of heart transplantation or all-cause mortality in univariate analyses. CONCLUSIONS The influencing factors for ES-HCM included the age at first symptom onset, NYHA class, heart rate, QRS duration, LVEDD, LAD, and MLVWT. Both NYHA class and heart rate were related to the prognosis of ES-HCM.
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Affiliation(s)
- Yisen Zhang
- Department of Cardiac Surgery, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenhui Xie
- Department of Geriatrics, Department of Cardiology, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yaqing Dai
- Department of Geriatrics, Department of Cardiology, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zefeng Wu
- Department of Geriatrics, Department of Cardiology, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuping Lin
- Department of Geriatrics, Department of Cardiology, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ming Yang
- Department of Geriatrics, Department of Cardiology, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huashan Hong
- Department of Geriatrics, Department of Cardiology, Fujian Key Laboratory of Vascular Aging (Fujian Medical University), Fujian Institute of Geriatrics, Fujian Heart Disease Center, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
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Aromiwura AA, Cavalcante JL, Kwong RY, Ghazipour A, Amini A, Bax J, Raman S, Pontone G, Kalra DK. The role of artificial intelligence in cardiovascular magnetic resonance imaging. Prog Cardiovasc Dis 2024:S0033-0620(24)00092-6. [PMID: 38925255 DOI: 10.1016/j.pcad.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
Cardiovascular magnetic resonance (CMR) imaging is the gold standard test for myocardial tissue characterization and chamber volumetric and functional evaluation. However, manual CMR analysis can be time-consuming and is subject to intra- and inter-observer variability. Artificial intelligence (AI) is a field that permits automated task performance through the identification of high-level and complex data relationships. In this review, we review the rapidly growing role of AI in CMR, including image acquisition, sequence prescription, artifact detection, reconstruction, segmentation, and data reporting and analysis including quantification of volumes, function, myocardial infarction (MI) and scar detection, and prediction of outcomes. We conclude with a discussion of the emerging challenges to widespread adoption and solutions that will allow for successful, broader uptake of this powerful technology.
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Affiliation(s)
| | | | - Raymond Y Kwong
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Aryan Ghazipour
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
| | - Amir Amini
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
| | - Jeroen Bax
- Department of Cardiology, Leiden University, Leiden, the Netherlands
| | - Subha Raman
- Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gianluca Pontone
- Department of Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Dinesh K Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA.
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3
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Zhao Q, Zhang Q, Zhao X, Tian Z, Sun M, He L. MG53: A new protagonist in the precise treatment of cardiomyopathies. Biochem Pharmacol 2024; 222:116057. [PMID: 38367817 DOI: 10.1016/j.bcp.2024.116057] [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: 10/16/2023] [Revised: 01/18/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
Cardiomyopathies (CMs) are highly heterogeneous progressive heart diseases characterised by structural and functional abnormalities of the heart, whose intricate pathogenesis has resulted in a lack of effective treatment options. Mitsugumin 53 (MG53), also known as Tripartite motif protein 72 (TRIM72), is a tripartite motif family protein from the immuno-proteomic library expressed primarily in the heart and skeletal muscle. Recent studies have identified MG53 as a potential cardioprotective protein that may play a crucial role in CMs. Therefore, the objective of this review is to comprehensively examine the underlying mechanisms mediated by MG53 responsible for myocardial protection, elucidate the potential role of MG53 in various CMs as well as its dominant status in the diagnosis and prognosis of human myocardial injury, and evaluate the potential therapeutic value of recombinant human MG53 (rhMG53) in CMs. It is expected to yield novel perspectives regarding the clinical diagnosis and therapeutic treatment of CMs.
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Affiliation(s)
- Qianru Zhao
- College of Exercise and Health, Shenyang Sport University, Shenyang 110102, Liaoning, PR China
| | - Qingya Zhang
- Innovation Institute, China Medical University, Shenyang 110122, Liaoning, PR China
| | - Xiaopeng Zhao
- College of Exercise and Health, Shenyang Sport University, Shenyang 110102, Liaoning, PR China
| | - Zheng Tian
- College of Exercise and Health, Shenyang Sport University, Shenyang 110102, Liaoning, PR China
| | - Mingli Sun
- College of Exercise and Health, Shenyang Sport University, Shenyang 110102, Liaoning, PR China.
| | - Lian He
- Department of Pathology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang 110042, Liaoning, PR China.
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Koo HJ, Lee SA, Jung SH, Kang JW, Yang DH. Tailored Planning of Surgical Myectomy in Obstructive Hypertrophic Cardiomyopathy. Radiographics 2024; 44:e230050. [PMID: 38060425 DOI: 10.1148/rg.230050] [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: 12/18/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease characterized by abnormal thickening of the myocardium caused by myocardial disarray and interstitial fibrosis. HCM is associated with sudden cardiac-related events, such as ventricular fibrillation, tachycardia, and syncope. Moreover, left ventricular or midcavity obstruction due to the thickened myocardium can result in severe heart failure and mortality in patients with HCM. Surgical myectomy is a standard treatment option for patients with symptomatic obstructive HCM; however, it is a complex procedure that requires careful planning and execution to avoid complications, such as residual flow obstruction, persistent obliteration of the left ventricular cavity in systole, or iatrogenic ventricular septal defects. Therefore, a thorough understanding of the mechanics of HCM and precise evaluation of the location and extent of the hypertrophic myocardium to be removed are crucial for preoperative planning. Multiphase cardiac CT postprocessing is important for preoperative evaluation and planning of surgical myectomy in patients with HCM. In this review, the authors highlight use of multiphase cardiac CT with step-by-step postprocessing methods to simulate successful surgical myectomy. The transaortic surgeon's view on end-diastolic phase images accurately represents the surgical field. Moreover, myocardial segmentation can be used to generate volume-rendered images and three-dimensional printing. CT evaluation can also assist in identifying concurrent abnormalities, such as mitral valve or papillary muscle abnormalities. In addition to CT, other imaging modalities for preoperative evaluation of HCM and postmyectomy evaluation methods are presented. ©RSNA, 2023 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Hyun Jung Koo
- From the Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center (H.J.K., J.W.K., D.H.Y.), Division of Cardiology, Internal Medicine, Cardiac Imaging Center (S.A.L.), and Department of Thoracic and Cardiovascular Surgery (S.H.J.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Seung-Ah Lee
- From the Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center (H.J.K., J.W.K., D.H.Y.), Division of Cardiology, Internal Medicine, Cardiac Imaging Center (S.A.L.), and Department of Thoracic and Cardiovascular Surgery (S.H.J.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Sung Ho Jung
- From the Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center (H.J.K., J.W.K., D.H.Y.), Division of Cardiology, Internal Medicine, Cardiac Imaging Center (S.A.L.), and Department of Thoracic and Cardiovascular Surgery (S.H.J.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Joon-Won Kang
- From the Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center (H.J.K., J.W.K., D.H.Y.), Division of Cardiology, Internal Medicine, Cardiac Imaging Center (S.A.L.), and Department of Thoracic and Cardiovascular Surgery (S.H.J.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Dong Hyun Yang
- From the Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center (H.J.K., J.W.K., D.H.Y.), Division of Cardiology, Internal Medicine, Cardiac Imaging Center (S.A.L.), and Department of Thoracic and Cardiovascular Surgery (S.H.J.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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Ananthamohan K, Stelzer JE, Sadayappan S. Hypertrophic cardiomyopathy in MYBPC3 carriers in aging. THE JOURNAL OF CARDIOVASCULAR AGING 2024; 4:9. [PMID: 38406555 PMCID: PMC10883298 DOI: 10.20517/jca.2023.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by abnormal thickening of the myocardium, leading to arrhythmias, heart failure, and elevated risk of sudden cardiac death, particularly among the young. This inherited disease is predominantly caused by mutations in sarcomeric genes, among which those in the cardiac myosin binding protein-C3 (MYBPC3) gene are major contributors. HCM associated with MYBPC3 mutations usually presents in the elderly and ranges from asymptomatic to symptomatic forms, affecting numerous cardiac functions and presenting significant health risks with a spectrum of clinical manifestations. Regulation of MYBPC3 expression involves various transcriptional and translational mechanisms, yet the destiny of mutant MYBPC3 mRNA and protein in late-onset HCM remains unclear. Pathogenesis related to MYBPC3 mutations includes nonsense-mediated decay, alternative splicing, and ubiquitin-proteasome system events, leading to allelic imbalance and haploinsufficiency. Aging further exacerbates the severity of HCM in carriers of MYBPC3 mutations. Advancements in high-throughput omics techniques have identified crucial molecular events and regulatory disruptions in cardiomyocytes expressing MYBPC3 variants. This review assesses the pathogenic mechanisms that promote late-onset HCM through the lens of transcriptional, post-transcriptional, and post-translational modulation of MYBPC3, underscoring its significance in HCM across carriers. The review also evaluates the influence of aging on these processes and MYBPC3 levels during HCM pathogenesis in the elderly. While pinpointing targets for novel medical interventions to conserve cardiac function remains challenging, the emergence of personalized omics offers promising avenues for future HCM treatments, particularly for late-onset cases.
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Affiliation(s)
- Kalyani Ananthamohan
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Julian E. Stelzer
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH 45267, USA
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH 45267, USA
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Turesh K, Tanisha, Soojal, Rajani D. Comment on: Impact of Pulmonary Hypertension in Patients With Hypertrophic Cardiomyopathy Presented With Cardiogenic Shock/Acute Decompensated Heart Failure. Curr Probl Cardiol 2024; 49:102091. [PMID: 37734692 DOI: 10.1016/j.cpcardiol.2023.102091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Kashish Turesh
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Tanisha
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Soojal
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Deepak Rajani
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
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7
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Zhao Y, Li C, Tang D, Luo Y, Xiang C, Huang L, Zhou X, Fang J, Wei X, Xia L. Early reverse remodeling of left heart morphology and function evaluated by cardiac magnetic resonance in hypertrophic obstructive cardiomyopathy after transapical beating-heart septal myectomy. J Cardiovasc Magn Reson 2023; 25:70. [PMID: 38008762 PMCID: PMC10680272 DOI: 10.1186/s12968-023-00987-0] [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: 11/12/2023] [Indexed: 11/28/2023] Open
Abstract
PURPOSE This study aimed to evaluate the early morphology and function of the left heart in hypertrophic obstructive cardiomyopathy (HOCM) after transapical beating-heart septal myectomy (TA-BSM) using cardiovascular magnetic resonance (CMR). MATERIALS AND METHODS Between April 2022 and January 2023, HOCM patients who underwent CMR before and 3 months after TA-BSM were prospectively and consecutively enrolled in the study. Preoperative and postoperative cardiac morphological and functional parameters, including those for the left atrium (LA) and left ventricle (LV), were compared. The left ventricular remodeling index (LVRI) was defined as the ratio between left ventricular mass (LVM) and left ventricular end-diastolic volume (LVEDV). Healthy participants with a similar age and sex distribution were enrolled for comparison. Pearson or Spearman correlation analysis was used to investigate the relationships between the parameters and LVRI. Last, univariate and multivariate linear regression identified variables associated with the LVM index (LVMI) and LVRI. RESULTS Forty-one patients (mean age ± standard deviation, 46 ± 2 years; 27 males) and 41 healthy control participants were evaluated. Eighteen (44%) HOCM patients were classified as having a sigmoid septum, and 23 patients had a reverse septal curvature. LA volume, diameter and function were significantly improved postoperatively, but still worse than healthy controls (all p < 0.001). Compared to before the operation, left ventricular wall thickness, left ventricular ejection fraction (LVEF), LVMI, and LVRI decreased after TA-BSM (all p < 0.001). The left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-diastolic diameter (LVEDD) decreased in patients with a sigmoid septum. However, LVEDVI and LVEDD increased in those with a reverse septal curvature (both p < 0.001). In addition, both preoperative and postoperative LVRI was positively correlated with LVMI (r = 0.734 and 0.853, both p < 0.001) and maximum wall thickness (r = 0.679 and 0.676, both p < 0.001), respectively. In the multivariable analysis, the weight of the resected myocardium (adjusted β = 0.476, p = 0.005) and △mitral regurgitation degree (adjusted β = - 0.245, p = 0.040) were associated with △LVRI. Last, the △LVOTG (adjusted β = 0.436, p = 0.018) and baseline LVMI (adjusted β = 0.323, p = 0.040) were independently associated with greater left ventricular mass regression after TA-BSM. CONCLUSION CMR confirmed early reverse remodeling of left heart morphology and function in HOCM patients following TA-BSM.
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Affiliation(s)
- Yun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenhe Li
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Luo
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Jing Fang
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Salmanipour A, Ghaffari Jolfayi A, Sabet Khadem N, Rezaeian N, Chalian H, Mazloomzadeh S, Adimi S, Asadian S. The predictive value of cardiac MRI strain parameters in hypertrophic cardiomyopathy patients with preserved left ventricular ejection fraction and a low fibrosis burden: a retrospective cohort study. Front Cardiovasc Med 2023; 10:1246759. [PMID: 37781305 PMCID: PMC10533925 DOI: 10.3389/fcvm.2023.1246759] [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: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Prompt interventions prevent adverse events (AE) in hypertrophic cardiomyopathy (HCM). We evaluated the pattern and the predictive role of feature tracking (FT)-cardiac magnetic resonance (CMR) imaging parameters in an HCM population with a normal left ventricular ejection fraction (LVEF) and a low fibrosis burden. Methods The CMR and clinical data of 170 patients, consisting of 142 HCM (45 ± 15.7 years, 62.7% male) and 28 healthy (42.2 ± 11.26 years, 50% male) subjects, who were enrolled from 2015 to 2020, were evaluated. HCM patients had a normal LVEF with a late gadolinium enhancement (LGE) percentage below 15%. Between-group differences were described, and the potent predictors of AE were determined. A P-value below 0.05 was considered significant. Results LV global longitudinal, circumferential, and radial strains (GLS, GCS, and GRS, respectively) and the LV myocardial mass index (MMI) were different between the healthy and HCM cases (all Ps < 0.05). Strains were significantly impaired in the HCM patients with a normal MMI. A progressive decrease in LVGLS and a distinct fall in LVGCS were noted with a rise in MMI. AE were predicted by LVGLS, LVGCS, and the LGE percentage, and LVGCS was the single robust predictor (HR, 1.144; 95% CI, 1.080-1.212; P = 0.001). An LVGCS below 16.2% predicted AE with 77% specificity and 58% sensitivity. Conclusions LV strains were impaired in HCM patients with a normal EF and a low fibrosis burden, even in the presence of a normal MMI. CMR parameters, especially FT-CMR values, predicted AE in our HCM patients.
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Affiliation(s)
- Alireza Salmanipour
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ghaffari Jolfayi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nazanin Sabet Khadem
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Chalian
- Department of Radiology, Cardiothoracic Imaging, University of Washington, Seattle, WA, United States
| | - Saeideh Mazloomzadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Adimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Mushtaq S, Monti L, Rossi A, Pontone G, Conte E, Nicoli F, di Odoardo L, Guglielmo M, Indolfi E, Bombace S, Baggiano A, Gripari P, Pepi M, Bartorelli A, Oliveira M, Santos A, Francone M, Andreini D. The prognostic role of right ventricular dysfunction in patients with hypertrophic cardiomyopathy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1515-1523. [PMID: 37147451 DOI: 10.1007/s10554-023-02852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 04/15/2023] [Indexed: 05/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) primarily affects the left ventricle (LV) sparing the right ventricle (RV) in vast majority of cases. However, several studies employing CMR have revealed that myocardial hypertrophy may also involve the RV. To assess RV size and function in a large prospectively cohort of HCM patients and to evaluate whether these parameters in association with other MR findings can predict cardiac events. Two participating centers prospectively included patients with known or suspected HCM between 2011 and 2017. CMR studies were performed with three different scanners. Outcome measures were a composite of ventricular arrhythmias, hospitalization for HF and cardiac death. Of 607 consecutive patients with known or suspected HCM, 315 had complete follow-up information (mean 65 ± 20 months). Among them, 115 patients developed major cardiac events (MACE) during follow-up. At CMR evaluation, patients with events had higher left atrium (LA) diameter (41.5 ± 8 mm vs. 37.17 ± 7.6 mm, p < 0.0001), LV mass (156.7 vs. 144 g, p = 0.005) and myocardial LGE (4.3% vs. 1.9%, p = 0.001). Similarly, patients with events had lower RV stroke volume index (42.7 vs. 47.0, p = 0.0003) and higher prevalence of both RV hypertrophy (16.4% vs. 4.7%, p = 0.0005) and reduced RV ejection fraction (12.2% vs. 4.4%, p = 0.006). In the multivariate analysis, LA diameter and RV stroke volume index were the strongest predictors of events (p < 0.001 and p = 0.0006, respectively). Anatomic and functional RV anomalies detected and characterized with CMR may have may have a major role in predicting the prognosis of HCM patients.
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Affiliation(s)
- Saima Mushtaq
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Edoardo Conte
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Flavia Nicoli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Luca di Odoardo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Marco Guglielmo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Eleonora Indolfi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Sara Bombace
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Baggiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
| | - Antonio Bartorelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Margarida Oliveira
- Cardiology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Ana Santos
- Radiology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Daniele Andreini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
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10
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He Y, Yu C, Zhou L, Zhang H, Ma H, Liu M, Tao J, Hua W, Liu T, Li X. Prognosis of patients with familial hypertrophic cardiomyopathy: A single-center cohort study with ten-year follow-up by propensity score matching analysis. Heliyon 2023; 9:e17629. [PMID: 37455958 PMCID: PMC10338351 DOI: 10.1016/j.heliyon.2023.e17629] [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: 10/19/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives Hypertrophic cardiomyopathy (HCM) is the most common hereditary cardiomyopathy. However, few studies have investigated the prognosis of familial HCM (FHCM) through clinical data. The purpose of this study was to compare the clinical outcomes of FHCM and non-FHCM through propensity score matching analysis. Methods and results The cohort study included 1243 patients with HCM between 1996 and 2013 in Fuwai Hospital, Chinese Academy of Medical Sciences, among whom 125 patients had FHCM. During a mean follow-up of 7.6 ± 3.8 years (interquartile range: (IQR) 5.0-10.0 years), 217 (16.57%) of the 1243 patients had died, including 3 patients who underwent cardiac transplantation. Using 30 demographic and clinical variables, a 4:1 propensity score matched cohort for FHCM was established. The stepwise variable selection procedure for the Cox proportional hazards model was performed to identify the factors associated with mortality and competing risk regression analysis was performed to analyze the competitive risk of cardiovascular and non-cardiovascular mortality. The results showed that FHCM patients had a higher risk of cardiovascular mortality/cardiac transplantation (log-rank χ2 = 6.8, P = 0.0084) and an increased tendency of sudden cardiac death (SCD) (log-rank χ2 = 3.2, P = 0.074) compared with non-FHCM patients, but there was no difference in all-cause mortality (log-rank χ2 = 2.7, P = 0.1) between the two groups. Moreover, the Cox model showed that FHCM was an independent prognostic predictor for cardiovascular mortality/cardiac transplantation in HCM patients. Conclusion FHCM patients had a higher risk of cardiovascular mortality/cardiac transplantation and a higher tendency of SCD than non-FHCM patients, but there was no difference in all-cause mortality. Moreover, FHCM was an independent prognostic predictor for cardiovascular mortality/cardiac transplantation in HCM patients.
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Affiliation(s)
- Ye He
- Visual Computing and Virtual Reality Key Laboratory of Sichuan Province, Sichuan Normal University, Chengdu, Sichuan, 610066, China
| | - Chaoping Yu
- Department of Cardiology, Pidu District People's Hospital, Chengdu, Sichuan, 611730, China
| | - Ling Zhou
- Center of Statistical Research and School of Statistics, Southwestern University of Finance and Economics, Chengdu, Sichuan, 611130, China
| | - Hongmei Zhang
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Huihui Ma
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Mingjiang Liu
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Jianhong Tao
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Tianhu Liu
- Department of Cardiology, Pidu District People's Hospital, Chengdu, Sichuan, 611730, China
| | - Xiaoping Li
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
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11
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Pu C, Hu X, Lv S, Wu Y, Yu F, Zhu W, Zhang L, Fei J, He C, Ling X, Wang F, Hu H. Identification of fibrosis in hypertrophic cardiomyopathy: a radiomic study on cardiac magnetic resonance cine imaging. Eur Radiol 2023; 33:2301-2311. [PMID: 36334102 PMCID: PMC10017609 DOI: 10.1007/s00330-022-09217-0] [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: 04/07/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy (HCM) often requires repeated enhanced cardiac magnetic resonance (CMR) imaging to detect fibrosis. We aimed to develop a practical model based on cine imaging to help identify patients with high risk of fibrosis and screen out patients without fibrosis to avoid unnecessary injection of contrast. METHODS A total of 273 patients with HCM were divided into training and test sets at a ratio of 7:3. Logistic regression analysis was used to find predictive image features to construct CMR model. Radiomic features were derived from the maximal wall thickness (MWT) slice and entire left ventricular (LV) myocardium. Extreme gradient boosting was used to build radiomic models. Integrated models were established by fusing image features and radiomic models. The model performance was validated in the test set and assessed by ROC and calibration curve and decision curve analysis (DCA). RESULTS We established five prediction models, including CMR, R1 (based on the MWT slice), R2 (based on the entire LV myocardium), and two integrated models (ICMR+R1 and ICMR+R2). In the test set, ICMR+R2 model had an excellent AUC value (0.898), diagnostic accuracy (89.02%), sensitivity (92.54%), and F1 score (93.23%) in identifying patients with positive late gadolinium enhancement. The calibration plots and DCA indicated that ICMR+R2 model was well-calibrated and presented a better net benefit than other models. CONCLUSIONS A predictive model that fused image and radiomic features from the entire LV myocardium had good diagnostic performance, robustness, and clinical utility. KEY POINTS • Hypertrophic cardiomyopathy is prone to fibrosis, requiring patients to undergo repeated enhanced cardiac magnetic resonance imaging to detect fibrosis over their lifetime follow-up. • A predictive model based on the entire left ventricular myocardium outperformed a model based on a slice of the maximal wall thickness. • A predictive model that fused image and radiomic features from the entire left ventricular myocardium had excellent diagnostic performance, robustness, and clinical utility.
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Affiliation(s)
- Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Xi Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Sangying Lv
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Feidan Yu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Wenchao Zhu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Lingjie Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Jingle Fei
- Department of Radiology, Lishui Municipal Central Hospital, Lishui, Zhejiang Province, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Xiaoli Ling
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Fuyan Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang Province, China.
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12
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Thakkar K, Karajgi AR, Kallamvalappil AM, Avanthika C, Jhaveri S, Shandilya A, Anusheel, Al-Masri R. Sudden cardiac death in childhood hypertrophic cardiomyopathy. Dis Mon 2023; 69:101548. [PMID: 36931945 DOI: 10.1016/j.disamonth.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The most prevalent cause of mortality in children with hypertrophic cardiomyopathy (HCM) is sudden cardiac death (SCD), which happens more frequently than in adult patients. Risk stratification tactics have generally been drawn from adult practice, however emerging data has revealed significant disparities between children and adult cohorts, implying the need for pediatric-specific risk stratification methodologies. We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until October 2021. The following search strings and Medical Subject Heading (MeSH) terms were used: "HCM," "SCD," "Sudden Cardiac Death," and "Childhood Onset HCM." We explored the literature on the risk of SCD in HCM for its epidemiology, pathophysiology, the role of various genes and their influence, associated complications leading to SCD and preventive and treatment modalities. Childhood-onset HCM is linked to significant life-long morbidity and mortality, including a higher SCD rate in children than in adults. The present focus is on symptom relief and avoiding illness-related consequences, but the prospect of future disease-modifying medicines offers an intriguing opportunity to alter disease expression and outcomes in these young individuals. Current preventive recommendations promote implantable cardioverter defibrillator placement based on cumulative risk factor thresholds, although they have been demonstrated to have weak discriminating capacity. This article addresses questions and discusses the etiology, risk factors, and method to risk stratification for SCD in children with HCM.
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Affiliation(s)
- Keval Thakkar
- G.M.E.R.S. Medical College and General Hospital, Gandhinagar, India
| | | | | | - Chaithanya Avanthika
- Karnataka Institute of Medical /Sciences, PB Rd, Vidya Nagar, Hubli, Karnataka, India.
| | | | | | - Anusheel
- Ryazan State I P Pavlov Medical Institute, Ryazan, Russia
| | - Rayan Al-Masri
- Jordan University of Science and technology, Irbid, Jordan
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13
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Shi K, Huang S, Li X, Xu HY, Yang MX, Li Y, Guo YK, Yang ZG. Effect of Obesity on Left Ventricular Remodeling and Clinical Outcome in Chinese Patients With Hypertrophic Cardiomyopathy: Assessed by Cardiac MRI. J Magn Reson Imaging 2023; 57:800-809. [PMID: 35715897 DOI: 10.1002/jmri.28306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Obesity is highly prevalent in patients with hypertrophic cardiomyopathy (HCM) and believed to influence its phenotype. PURPOSE To explore the effects of obesity on left ventricular (LV) remodeling and long-term clinical course in Chinese patients with HCM. STUDY TYPE Longitudinal. POPULATION A total of 247 patients with HCM classified according to body mass index (BMI) (normal weight: BMI = 18.0-22.9 kg/m2 [N = 90]; overweight: BMI = 23.0-24.9 kg/m2 [N = 58]; and obese: BMI ≥ 25 kg/m2 [N = 99]). FIELD STRENGTH/SEQUENCE 3.0 T/Balanced steady-state free precession sequence and phase-sensitive inversion recovery late gadolinium enhancement (LGE) sequence. ASSESSMENT LV function and geometry were measured. LV peak strain analysis was performed. The presence and percentage of LGE in the LV were recorded. The endpoints including heart failure, sudden cardiac death, and overall composite outcome were assessed during a median follow-up of 4.1 years (interquartile range, 3.0-6.2 years). STATISTICAL TESTS One-way analysis of variance, Kruskal-Wallis test, or chi-square test; Pearson correlation coefficient (r); multivariable linear regression analysis; Kaplan-Meier survival analysis; and Cox proportional hazards model analysis were conducted. A two-tailed P-value < 0.05 was considered statistically significant. RESULTS Obese patients exhibited a significant progressive increase in LV mass compared with normal-weight patients. The magnitude of all LV strain indices gradually and significantly decreased as BMI increased, whereas LV ejection fraction was not significantly different among BMI groups (P = 0.364). Multivariable linear regression analysis showed that obesity had a significant association with impaired strain indices as well as with indexed LV mass. Multivariable Cox model analysis retained obesity as an independent marker for future endpoints, and conveyed a > 3-fold increase in risk compared with patients with normal weight (hazard ratio, 3.04; 95% confidence interval, 1.07-6.57). DATA CONCLUSION Obesity is an important environmental modifier that is associated with adverse LV remodeling and is independently associated with future clinical outcomes in Chinese patients with HCM. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ke Shi
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shan Huang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng-Xi Yang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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14
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Goyal N, Keir G, Esterson YB, Saba SG, Cohen S, Rowin E, Romashko M, Chusid J. Hypertrophic cardiomyopathy - phenotypic variations beyond wall thickness. Clin Imaging 2023; 95:80-89. [PMID: 36680913 DOI: 10.1016/j.clinimag.2023.01.003] [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: 07/05/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (LVH) in the absence of another causal disease. Several morphologic and histologic changes have been described. Given the morbidity and mortality associated with HCM, understanding these anatomic variations is key to interpreting imaging. This is especially important since many patients exhibit these associated findings in the absence of LVH and prompt early detection of these variations may lead to early diagnosis and treatment. This article describes the appearance of morphologic variations seen in HCM beyond myocardial thickening including: papillary muscle and mitral valve variants, myocardial crypts, left ventricular myocardial bands, and dystrophic calcification related to increased wall tension.
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Affiliation(s)
- Nikhil Goyal
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Graham Keir
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Yonah B Esterson
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Shahryar G Saba
- Department of Cardiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Stuart Cohen
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Ethan Rowin
- Department of Cardiology, New England Medical Center, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Mikhail Romashko
- Department of Cardiology, New England Medical Center, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA
| | - Jesse Chusid
- Department of Radiology, Northwell Health System, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
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15
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Zhao X, Jin F, Wang J, Zhao X, Wang L, Wei H. Entropy of left ventricular late gadolinium enhancement and its prognostic value in hypertrophic cardiomyopathy a new CMR assessment method. Int J Cardiol 2023; 373:134-141. [PMID: 36395920 DOI: 10.1016/j.ijcard.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE As a novel metric, entropy generated from late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can be utilized to assess tissue heterogeneity. However, it is unknown if it can be utilized for risk stratification in hypertrophic cardiomyopathy (HCM). In addition, it is unknown if LGE entropy correlates with LGE mass%, which is commonly utilized for fibrosis assessment. This research was done to investigate these issues. MATERIALS AND METHODS Patients with HCM who underwent 3.0-T CMR between January 2015 and January 2020 were prospectively enrolled and classified into low- and high-risk groups according to the AHA/ACC risk stratification guideline for 2020. The LGE entropy was automatically estimated using a generic Python package algorithm. On CMR imaging, the LGE mass% was determined using the CVI 42 software. Endpoint events included sudden cardiac death (SCD), hospital readmission owing to heart failure, and implantable cardioverter defibrillator (ICD) treatment for ventricular arrhythmias. RESULTS A total of 109 HCM participants (70 males) were included. During the follow-up (23 ± 7 months), the patients in the high-risk group had higher LGE entropy (p < 0.001) and LGE mass% (p < 0.001) than those in the low-risk group, and patients with endpoint events had higher LGE entropy (p < 0.001) and LGE mass% (p < 0.001) than those without endpoint events. In all participants, there was a link between LGE entropy and LGE mass%, according to the Spearman rank correlation analysis (p < 0.001; r = 0.667). In ROC analysis, the area under the curve (AUC) of LGE entropy was 0.893 (95% CI, 0.794-0.993; P<0.001), AUC of LGE mass% was 0.826 (95% CI, 0.737-0.914; P<0.001), AUC of LVEF was 0.610 (95% CI, 0.473-0.748; P = 0.117) and AUC of 2020 AHA/ACC guideline for risk stratification was 0.716 (95% CI, 0.617-0.815; P = 0.002). According to Kaplan-Meier curves, HCM with a higher LGE entropy (≥cutoff value (<5.873) or ≥ thied tertile (5.540)) were more likely to experience the endpoint events. Following adjustment for the 2020 AHA/ACC guideline for risk categorization, LGE mass%, or decreased LVEF, Cox analysis showed that LGE entropy was independently linked with endpoint events. CONCLUSIONS The variability and extent of LGE pictures can be reflected by LGE entropy, which is a reliable, usable, and repeatable metric for risk classification in HCM. It is a prognostic indicator of endpoint events that is independent of other risk indicators.
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Affiliation(s)
- Xiaoying Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China
| | - Fuwei Jin
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China
| | - Jin Wang
- Department of Radiology, Yanan Hospital of Kunming City, Renmin Dong Lu No. 245, Kunming, Yunnan 650000, China.
| | - Xinxiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China.
| | - Lujing Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Dianmiandadao No. 374, Kunming, Yunnan 650000, China
| | - Hua Wei
- Department of Information, The Second Affiliated Hospital of Kunming Medical University,Dianmiandadao No. 374, Kunming, Yunnan 650000, China
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16
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El Hadi H, Freund A, Desch S, Thiele H, Majunke N. Hypertrophic, Dilated, and Arrhythmogenic Cardiomyopathy: Where Are We? Biomedicines 2023; 11:biomedicines11020524. [PMID: 36831060 PMCID: PMC9953324 DOI: 10.3390/biomedicines11020524] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Cardiomyopathies are a heterogeneous group of structural, mechanical, and electrical heart muscle disorders which often correlate with life-threatening arrhythmias and progressive heart failure accounting for significant cardiovascular morbidity and mortality. Currently, cardiomyopathies still represent a leading reason for heart transplantation worldwide. The last years have brought remarkable advances in the field of cardiomyopathies especially in terms of understanding the molecular basis as well as the diagnostic evaluation and management. Although most cardiomyopathy treatments had long focused on symptom management, much of the current research efforts aim to identify and act on the disease-driving mechanisms. Regarding risk assessment and primary prevention of sudden cardiac death, additional data are still pending in order to pave the way for a more refined and early patient selection for defibrillator implantation. This review summarizes the current knowledge of hypertrophic, dilated and arrhythmogenic cardiomyopathy with a particular emphasis on their pathophysiology, clinical features, and diagnostic approach. Furthermore, the relevant ongoing studies investigating novel management approaches and main gaps in knowledge are highlighted.
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Affiliation(s)
- Hamza El Hadi
- Correspondence: (H.E.H.); (N.M.); Tel.: +49-341-865-142 (H.E.H. & N.M.); Fax: +49-341-865-1461 (N.M.)
| | | | | | | | - Nicolas Majunke
- Correspondence: (H.E.H.); (N.M.); Tel.: +49-341-865-142 (H.E.H. & N.M.); Fax: +49-341-865-1461 (N.M.)
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17
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Collinearity and Dimensionality Reduction in Radiomics: Effect of Preprocessing Parameters in Hypertrophic Cardiomyopathy Magnetic Resonance T1 and T2 Mapping. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010080. [PMID: 36671652 PMCID: PMC9854492 DOI: 10.3390/bioengineering10010080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023]
Abstract
Radiomics and artificial intelligence have the potential to become a valuable tool in clinical applications. Frequently, radiomic analyses through machine learning methods present issues caused by high dimensionality and multicollinearity, and redundant radiomic features are usually removed based on correlation analysis. We assessed the effect of preprocessing-in terms of voxel size resampling, discretization, and filtering-on correlation-based dimensionality reduction in radiomic features from cardiac T1 and T2 maps of patients with hypertrophic cardiomyopathy. For different combinations of preprocessing parameters, we performed a dimensionality reduction of radiomic features based on either Pearson's or Spearman's correlation coefficient, followed by the computation of the stability index. With varying resampling voxel size and discretization bin width, for both T1 and T2 maps, Pearson's and Spearman's dimensionality reduction produced a slightly different percentage of remaining radiomic features, with a relatively high stability index. For different filters, the remaining features' stability was instead relatively low. Overall, the percentage of eliminated radiomic features through correlation-based dimensionality reduction was more dependent on resampling voxel size and discretization bin width for textural features than for shape or first-order features. Notably, correlation-based dimensionality reduction was less sensitive to preprocessing when considering radiomic features from T2 compared with T1 maps.
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18
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Kumar P, Bhatia M, Arora N. Computed Tomographic Evaluation of Congenital Left Ventricular Outflow Obstruction. Curr Cardiol Rev 2023; 19:31-49. [PMID: 37231752 PMCID: PMC10636799 DOI: 10.2174/1573403x19666230525144602] [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: 08/29/2022] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Congenital left ventricular outflow obstruction represents a multilevel obstruction with several morphological forms. It can involve the subvalvular, valvar, or supravalvular portion of the aortic valve complex, and may coexist. Computed tomography (CT) plays an important supplementary role in the evaluation of patients with congenital LVOT obstruction. Unlike transthoracic echocardiography and cardiovascular magnetic resonance (CMR) imaging, it is not bounded by a small acoustic window, needs for anaesthesia or sedation, and metallic devices. Current generations of CT scanners with excellent spatial and temporal resolution, high pitch scanning, wide detector system, dose reduction algorithms, and advanced 3-dimensional postprocessing techniques provide a high-quality alternative to CMR or diagnostic cardiac catheterization. Radiologists performing CT in young children should be familiar with the advantages and disadvantages of CT and with the typical morphological imaging features of congenital left ventricular outflow obstruction.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
- Convener, Cardiac Imaging, Cardiological Society of India, Kolkata, 700054, India
| | - Natisha Arora
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India
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19
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Qin L, Zhu S, Liu P, Zhu L, Chen C, Gu S, Yang W, Zhou M, Yan F. Additional prognostic values of strain and strain rate over late gadolinium enhancement in hypertrophic cardiomyopathy patients. Int J Cardiol 2023; 370:427-434. [PMID: 36332750 DOI: 10.1016/j.ijcard.2022.10.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) has some shortcomings in the risk stratification in hypertrophic cardiomyopathy (HCM). Myocardial strain/strain rate (SR) can be acquired from unenhanced cardiovascular magnetic resonance (CMR) images and detect cardiac dysfunction sensitively. The present study aimed to evaluate the additional prognostic values of myocardial strain/SR beyond LGE for the risk stratification in patients with HCM. METHODS 293 patients with HCM who underwent CMR were enrolled in this prospective study. LGE/left ventricular (LV) mass, LV global strain, and SR were acquired based on CMR. Also, conventional clinical, echocardiography, and CMR parameters and established risk factors for HCM were evaluated. RESULTS 14/293 patients had major adverse cardiovascular events (MACEs) during the median follow-up of 15.0 months, including eight all-cause deaths, four resuscitated cardiac arrests and two cardiac transplantations. Peak systolic (PS)-global longitudinal SR (GLSR) was independently associated with MACEs (hazard ratio: 15.297, P < 0.001) after adjusting for conventional clinical characteristics, echocardiography, and CMR parameters. The model constructed by conventional variables plus PS-GLSR had significantly stronger predictive ability than the model constructed by conventional variables plus LGE/LV mass (C-statistic: 0.850 vs 0.708, P = 0.030). The addition of PS-GLSR to the conventional model also significantly improved the sensitivity (92.9% vs 71.4%) and specificity (71.0% vs 57.3%), and lowered false positives (81 patients vs 119 patients) compared to the addition of LGE/LV mass. CONCLUSION LV PS-GLSR derived from CMR has the potential to be a novel biomarker for risk stratification of HCM and provide additional prognostic value over LGE/LV mass.
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Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siqi Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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20
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Raj V, Gowda S, Kothari R. Myocardial tissue characterization by cardiac magnetic resonance: A primer for the clinician. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2023. [DOI: 10.4103/jiae.jiae_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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21
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Fakadej T, Hathaway QA, Balar AB, Amin MS, Lakhani DA, Kim C. Eosinophilic myocarditis: Case report and brief review of the literature. Radiol Case Rep 2023; 18:306-311. [PMID: 36388617 PMCID: PMC9664397 DOI: 10.1016/j.radcr.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
Eosinophilic myocarditis (EM) is a cardiac manifestation of hypereosinophilic syndrome with a high mortality rate. EM shares imaging features similar to other restrictive cardiopathies, and include patchy intramural late gadolinium enhancement on cardiac magnetic resonance with or without presence of biventricular thrombus. Diagnosis is confirmed on histopathology, and is the current gold standard. Here we report clinical presentation and imaging findings of EM in a 70-year-old woman who presented with fever and chills.
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22
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Myocardial bridging in adult with hypertrophic cardiomyopathy: Imaging findings with coronary computed tomography angiography. Radiol Case Rep 2022; 17:4627-4631. [PMID: 36204398 PMCID: PMC9530407 DOI: 10.1016/j.radcr.2022.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Myocardial bridgin in an adult with hypertrophic cardiomyopathy is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. Myocardial bridging may cause compression of a coronary artery, and it has been suggested that myocardial ischemia may result. Symptoms of myocardial bridging in the adult with hypertrophic cardiomyopathy are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. We present a case of a 48-year-old male with hypertrophic cardiomyopathy and myocardial bridging detected by coronary computed tomography angiography who complained of chest pain.
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23
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Yang Y, Wu D, Wang H, Wang Y. Prognostic value of global longitudinal strain in hypertrophic cardiomyopathy: A systematic review and meta-analysis. Clin Cardiol 2022; 45:1184-1191. [PMID: 36177652 DOI: 10.1002/clc.23928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As previously reported, impairment of left ventricular global longitudinal strain (LVGLS) is associated with myocardial fibrosis, arrhythmias, and heart failure in hypertrophic cardiomyopathy (HCM) patients. HYPOTHESIS This study aimed to estimate the association between LVGLS measured by echocardiography and major adverse cardiovascular events (MACE) in patients with HCM. METHODS Pubmed, Embase, Scopus, and Cochrane Library databases were systematically searched for evaluating the difference of LVGLS between MACE and non-MACE and the relevance of LVGLS and MACE in HCM patients, mean difference (MD), and pooled hazard ratios (HR) with 95% confidence interval (CI) were calculated. Publication bias was detected by funnel plots and Egger's test, and trim-and-fill analysis was employed when publication bias existed. RESULTS A total of 13 studies reporting 2441 HCM patients were included in this meta-analysis. Absolute value of LVGLS was lower in the group of HCM with MACE (MD = 2.74, 95% CI: 2.50-2.99, p < .001; I2 = 0, p = .48). In the pooled unadjusted model, LVGLS was related to MACE (HR = 1.14, 95% CI: 1.06-1.22, p < .05, I2 = 58.4%, p < .01) and there is a mild heterogeneity, and sensitivity analysis showed stable results. In the pooled adjusted model, LVGLS was related to MACE (HR = 1.12, 95% CI: 1.08-1.16, p < .05; I2 = 0%, p = .442). Egger's tests showed publication bias, and trim-and-fill analysis was applied, with final results similar to the previous and still statistically significant. CONCLUSION The meta-analysis suggested that impaired LVGLS was associated with poor prognosis in HCM patients.
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Affiliation(s)
- Ying Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Dong Wu
- Department of Radiology, The First Bethune Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yanting Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Tschöpe C, Elsanhoury A, Diekmann S, Kühl U. Hypertrophe Kardiomyopathien und die kardiale ATTR-Amyloidose – eine aktuelle Übersicht für den klinischen Alltag. Dtsch Med Wochenschr 2022; 147:1127-1134. [DOI: 10.1055/a-1744-3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Was ist neu?
Hypertrophe obstruktive Kardiomyopathie Mavacamten, der erste Myosin-Aktivator, konnte erfolgreich in dem EXPLORER-HCM-Studienprogramm getestet werden. Lebensqualität und linksventrikuläre Druckgradienten-Abnahme wurden optimiert. Ob damit jedoch auch die Überlebensrate und Prognose der betroffenen Patienten verbessert wird, kann bis heute noch nicht gesagt werden. Die europäischen Zulassungsbehörden sehen allerdings bisher die Ergebnisse als so bedeutsam an, dass mit einer Führung der Substanzklasse vielleicht schon in den nächsten 6–8 Monaten zu rechnen ist. In den USA ist die Substanz bereits seit April 2022 zugelassen. Der Einsatz der Substanz bei HCM-Patienten ohne Obstruktion wird ebenfalls zurzeit untersucht.
Kardiale Transthyretin-Amyloidosen Kardiale Amyloidosen haben meist eine gute Ejektionsfraktion, jedoch sind auch EF mit 40 oder < 30 % möglich. Das Auftreten einer kardialen Amyloidose bei Patienten mit der Symptomatik einer Herzinsuffizienz mit erhaltener Ejektionsfraktion (HFpEF) ist in bis zu 15 % der Fälle nachzuweisen. Tafamidis ist die einzige zurzeit zugelassene erfolgreiche Therapiemöglichkeit bei Patienten mit kardialer ATTR-Amyloidose. Dies wurde auch durch weitere Beobachtungsregister der ATTR-ACT-Studie gezeigt. Für die Klinik ist zusätzlich wichtig, dass die Amyloidose auch die Aortenklappe befällt. Zahlreiche Patienten entwickeln somit auch eine Aortenstenose, die erkannt und meist interventionell zu behandeln ist.
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Affiliation(s)
- Carsten Tschöpe
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Ahmed Elsanhoury
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Sonja Diekmann
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Uwe Kühl
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
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25
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Coscarella IL, Landim-Vieira M, Pinto JR, Chelko SP. Arrhythmogenic Cardiomyopathy: Exercise Pitfalls, Role of Connexin-43, and Moving beyond Antiarrhythmics. Int J Mol Sci 2022; 23:ijms23158753. [PMID: 35955883 PMCID: PMC9369094 DOI: 10.3390/ijms23158753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/11/2022] Open
Abstract
Arrhythmogenic Cardiomyopathy (ACM), a Mendelian disorder that can affect both left and right ventricles, is most often associated with pathogenic desmosomal variants that can lead to fibrofatty replacement of the myocardium, a pathological hallmark of this disease. Current therapies are aimed to prevent the worsening of disease phenotypes and sudden cardiac death (SCD). Despite the use of implantable cardioverter defibrillators (ICDs) there is no present therapy that would mitigate the loss in electrical signal and propagation by these fibrofatty barriers. Recent studies have shown the influence of forced vs. voluntary exercise in a variety of healthy and diseased mice; more specifically, that exercised mice show increased Connexin-43 (Cx43) expression levels. Fascinatingly, increased Cx43 expression ameliorated the abnormal electrical signal conduction in the myocardium of diseased mice. These findings point to a major translational pitfall in current therapeutics for ACM patients, who are advised to completely cease exercising and already demonstrate reduced Cx43 levels at the myocyte intercalated disc. Considering cardiac dysfunction in ACM arises from the loss of cardiomyocytes and electrical signal conduction abnormalities, an increase in Cx43 expression-promoted by low to moderate intensity exercise and/or gene therapy-could very well improve cardiac function in ACM patients.
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Affiliation(s)
- Isabella Leite Coscarella
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
| | - Maicon Landim-Vieira
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
| | - José Renato Pinto
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
| | - Stephen P. Chelko
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21215, USA
- Correspondence: ; Tel.: +1-850-644-2215
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26
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Marfisi D, Tessa C, Marzi C, Del Meglio J, Linsalata S, Borgheresi R, Lilli A, Lazzarini R, Salvatori L, Vignali C, Barucci A, Mascalchi M, Casolo G, Diciotti S, Traino AC, Giannelli M. Image resampling and discretization effect on the estimate of myocardial radiomic features from T1 and T2 mapping in hypertrophic cardiomyopathy. Sci Rep 2022; 12:10186. [PMID: 35715531 PMCID: PMC9205876 DOI: 10.1038/s41598-022-13937-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022] Open
Abstract
Radiomics is emerging as a promising and useful tool in cardiac magnetic resonance (CMR) imaging applications. Accordingly, the purpose of this study was to investigate, for the first time, the effect of image resampling/discretization and filtering on radiomic features estimation from quantitative CMR T1 and T2 mapping. Specifically, T1 and T2 maps of 26 patients with hypertrophic cardiomyopathy (HCM) were used to estimate 98 radiomic features for 7 different resampling voxel sizes (at fixed bin width), 9 different bin widths (at fixed resampling voxel size), and 7 different spatial filters (at fixed resampling voxel size/bin width). While we found a remarkable dependence of myocardial radiomic features from T1 and T2 mapping on image filters, many radiomic features showed a limited sensitivity to resampling voxel size/bin width, in terms of intraclass correlation coefficient (> 0.75) and coefficient of variation (< 30%). The estimate of most textural radiomic features showed a linear significant (p < 0.05) correlation with resampling voxel size/bin width. Overall, radiomic features from T2 maps have proven to be less sensitive to image preprocessing than those from T1 maps, especially when varying bin width. Our results might corroborate the potential of radiomics from T1/T2 mapping in HCM and hopefully in other myocardial diseases.
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Affiliation(s)
- Daniela Marfisi
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Carlo Tessa
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Apuane Hospital, 54100, Massa, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Carrara", Italian National Research Council, 50019, Sesto Fiorentino, Italy
| | - Jacopo Del Meglio
- Unit of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Stefania Linsalata
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Rita Borgheresi
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Alessio Lilli
- Unit of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Riccardo Lazzarini
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Luca Salvatori
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Claudio Vignali
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Andrea Barucci
- Institute of Applied Physics "Nello Carrara", Italian National Research Council, 50019, Sesto Fiorentino, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50121, Florence, Italy
| | - Giancarlo Casolo
- Unit of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 47522, Cesena, Italy
| | - Antonio Claudio Traino
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy.
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27
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Cha MJ, Kim C, Park CH, Hong YJ, Shin JM, Kim TH, Cha YJ, Park CH. Differential Diagnosis of Thick Myocardium according to Histologic Features Revealed by Multiparametric Cardiac Magnetic Resonance Imaging. Korean J Radiol 2022; 23:581-597. [PMID: 35555885 PMCID: PMC9174501 DOI: 10.3348/kjr.2021.0815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/16/2022] Open
Abstract
Left ventricular (LV) wall thickening, or LV hypertrophy (LVH), is common and occurs in diverse conditions including hypertrophic cardiomyopathy (HCM), hypertensive heart disease, aortic valve stenosis, lysosomal storage disorders, cardiac amyloidosis, mitochondrial cardiomyopathy, sarcoidosis and athlete’s heart. Cardiac magnetic resonance (CMR) imaging provides various tissue contrasts and characteristics that reflect histological changes in the myocardium, such as cellular hypertrophy, cardiomyocyte disarray, interstitial fibrosis, extracellular accumulation of insoluble proteins, intracellular accumulation of fat, and intracellular vacuolar changes. Therefore, CMR imaging may be beneficial in establishing a differential diagnosis of LVH. Although various diseases share LV wall thickening as a common feature, the histologic changes that underscore each disease are distinct. This review focuses on CMR multiparametric myocardial analysis, which may provide clues for the differentiation of thickened myocardium based on the histologic features of HCM and its phenocopies.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Min Shin
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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28
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Fadl SA, Revels JW, Rezai Gharai L, Hanneman K, Dana F, Proffitt EK, Grizzard JD. Cardiac MRI of Hereditary Cardiomyopathy. Radiographics 2022; 42:625-643. [PMID: 35275782 DOI: 10.1148/rg.210147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hereditary cardiomyopathy comprises a heterogeneous group of diseases of the cardiac muscle that are characterized by the presence of genetic mutations. Cardiac MRI is central to evaluation of patients with cardiomyopathy owing to its ability to allow evaluation of many different tissue properties in a single examination. For example, cine MRI is the standard of care for assessment of myocardial structure and function. It clearly shows regions of asymmetric wall thickening that are typical of hypertrophic cardiomyopathy and allows it to be differentiated from other hereditary disorders such as Fabry disease or transthyretin cardiac amyloidosis that produce concentric hypertrophy. Late gadolinium enhancement provides a different tissue property and allows these latter two causes of concentric hypertrophy to be distinguished on the basis of their enhancement appearances (Fabry disease shows midwall basal inferolateral enhancement, and amyloidosis shows global subendocardial enhancement). Native T1 mapping may similarly allow differentiation between Fabry disease and amyloidosis without the use of contrast material. T2*-weighted MRI is important in the detection and quantification of iron overload cardiomyopathy. Other hereditary entities for which comprehensive MRI has proven essential include Danon disease, familial dilated cardiomyopathy, hereditary muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy, and ventricular noncompaction. As a result of the diagnostic power of cardiac MRI, cardiac MRI examinations are being requested with increasing frequency, not only in academic centers but also in community practices. The genetic background, pathophysiologic characteristics, and clinical presentation of patients with hereditary cardiomyopathy are described; the characteristic cardiac MRI features of hereditary cardiomyopathy are discussed; and the role of MRI in risk stratification, treatment, and prognostication in patients with cardiomyopathy is reviewed. ©RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Shaimaa A Fadl
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Jonathan W Revels
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Leila Rezai Gharai
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Kate Hanneman
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Franklin Dana
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Elizabeth Kate Proffitt
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - John D Grizzard
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
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29
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Liang L, Wang X, Yu Y, Zhang Y, Liu J, Chen M, Zhang L, Jiang T. T1 Mapping and Extracellular Volume in Cardiomyopathy Showing Left Ventricular Hypertrophy: Differentiation Between Hypertrophic Cardiomyopathy and Hypertensive Heart Disease. Int J Gen Med 2022; 15:4163-4173. [PMID: 35465304 PMCID: PMC9030388 DOI: 10.2147/ijgm.s350673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Lu Liang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Xin Wang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yang Yu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yuan Zhang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Jiamei Liu
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Mulei Chen
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Lin Zhang
- Heart Center and Beijing Key Laboratory of Hypertension Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
- Correspondence: Tao Jiang, Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86 10 6593 5237, Email
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30
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Wu Y, Pu C, Zhu W, He C, Fei J, Hu H. A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis. Front Cardiovasc Med 2022; 9:817456. [PMID: 35355963 PMCID: PMC8959494 DOI: 10.3389/fcvm.2022.817456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
Background Cardiac light-chain amyloidosis (AL CA) portends poor prognosis. Contrast cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging is an important tool in recognizing AL CA. But contraindications to contrast CMR would significantly restrict its clinical application value. Our study aims to construct a convenient risk score to help identify cardiac involvement in patients at risk of AL CA. Moreover, we also investigate whether this risk score could provide prognosis information. Materials and Methods Sixty-three patients at risk of AL CA were retrospectively included in our study. Basic clinical characters, lab results, 12-lead electrocardiogram data, and cardiac magnetic resonance image data were collected. AL CA was diagnosed according to typical CA LGE pattern. Logistic analysis was used to figure out predictive parameters of AL CA and their β coefficients, further constructing the risk score. Receiver operating characteristics (ROC) curve was used to find the cut-off point best distinguishing AL CA+ from AL CA–patients. Bootstrapping was used for internal validation. All patients were divided into high-risk and low-risk group according to the diagnostic cut-off point, and followed up for survival information. Kaplan-Meier plots and log-rank test were performed to analyze if this score had prognostic value. Results The risk score finally consisted of 4 parameters: pericardial effusion (PE) (1 point), low electrocardiographic QRS voltages (LQRSV) (1 point), CMR-derived impaired global radial strain (GRS) (<15.14%) (1 point) and increased left ventricular maximum wall thickness (LVMWT) (>13 mm) (2 points). Total score ranged from 0 to 5 points. A cut-off point of 1.5 showed highest accuracy in diagnosing AL CA with an AUC of 0.961 (95% CI: 0.924–0.997, sensitivity: 90.6%, specificity: 83.9%). Kaplan-Meier plots and log-rank test showed that the high-risk group had significantly poor overall survival rates. Conclusion In patients at risk of AL CA, a risk score incorporating the presence of PE, LQRSV, and CMR-derived impaired GRS and increased LVMWT is predictive of a diagnosis of AL CA by LGE criteria. This risk score may be helpful especially when contrast CMR is not available or contraindicated, and further studies should be considered to validate this score.
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Affiliation(s)
- Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenchao Zhu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingle Fei
- Department of Radiology, Lishui Central Hospital, Lishui, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hongjie Hu
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31
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Chen X, Pan J, Shu J, Zhang X, Ye L, Chen L, Hu Y, Yu R. Prognostic value of regional strain by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Quant Imaging Med Surg 2022; 12:627-641. [PMID: 34993107 PMCID: PMC8666725 DOI: 10.21037/qims-21-42] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few studies have demonstrated the performance of regional strain by cardiovascular magnetic resonance (CMR) feature tracking in hypertrophic cardiomyopathy (HCM) patients, and the prognostic value of segmental strain remains unknown. This study aimed to explore the prognostic implications of strain parameters generated by CMR feature tracking analysis in HCM patients. METHODS In total, 104 clinically diagnosed HCM patients and 30 healthy volunteers were enrolled in this study, and all patients underwent a standard CMR examination. Global and regional strain was computed by short axis, 2-, 3-, and 4-chamber view cine MR imaging using specialized software. Cardiac structure, function, and myocardial strain were compared between the control group and HCM patients, and the event and event-free groups. Univariate and multivariate Cox regression analyses were performed to evaluate the correlations between clinical and CMR parameters and poor prognosis. RESULTS During the follow-up time, 8 patients reached the primary end points and 14 patients reached secondary end points. Regional radial strain of hypertrophic segments (RRS) and regional circumferential strain of hypertrophic segments (RCS) were worse in HCM patients with primary and secondary end points. In univariate Cox regression analysis of RRS, RCS were associated with primary and secondary end points. Regional radial strain of hypertrophic segments [hazard ratio (HR) 1.64, 95% confidence interval (CI): 1.13-2.38] and RCS (HR 2.35, 95% CI: 1.20-4.59) were independent predictors of primary end points, and RRS (HR 1.71, 95% CI: 1.09-2.66) and RCS (HR 2.63, 95% CI: 1.20-5.75) remained independent predictors of secondary end points in multivariate analysis. Kaplan-Meier survival curves indicated patients with RRS <10.0% and RCS ≥-8.5% had a higher rate of primary end points, and patients with RRS <17.9% and RCS ≥-12.1% experienced a higher rate of secondary end points. CONCLUSIONS In HCM patients, RRS and RCS were associated with primary and secondary end points and remained independent predictors in multivariate analysis. Impaired regional strain may potentially predict poor prognosis in HCM patients. KEYWORDS Prognosis; hypertrophic cardiomyopathy (HCM); cardiovascular magnetic resonance (CMR); regional strain.
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Affiliation(s)
- Xiaorong Chen
- Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China;,Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiangfeng Pan
- Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jiner Shu
- Department of Radiology, Jinhua People’s Hospital, Jinhua, China
| | - Xiaoru Zhang
- Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Limei Ye
- Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lin Chen
- Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yi Hu
- Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Risheng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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32
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Savariya U, Aponte MMP, Nathan S, Zhao B, Radovancevic R, de Armas IAS, Kar B, Gregoric ID, Buja LM. HYPERTROPHIC CARDIOMYOPATHY WITH A COMPLEX CLINICAL COURSE LEADING TO HEART TRANSPLANTATION. Cardiovasc Pathol 2021; 58:107406. [PMID: 34979248 DOI: 10.1016/j.carpath.2021.107406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 12/25/2022] Open
Abstract
The purpose of this report is to present clinicopathological features of two cases of hypertrophic cardiomyopathy (HCM) who underwent orthotopic heart transplantation (OHT) because of an unusually complex clinical course. One case is that of a 37-year-old man with HCM who underwent OHT because of a combination of recurrent severe ventricular arrhythmias and progressive heart failure that were refractory to medical treatment. The second case is that of a 43-year-old woman who underwent OHT because of progressive heart failure following two myomectomy myectomy procedures. Both patients have had an uneventful post-OHT course. These cases highlight the variable spectrum of disease progression of HCM and the clinical challenges in the management of these patients.
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Affiliation(s)
- Uttam Savariya
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Maria M Patarroyo Aponte
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
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33
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Vriz O, AlSergani H, Elshaer AN, Shaik A, Mushtaq AH, Lioncino M, Alamro B, Monda E, Caiazza M, Mauro C, Bossone E, Al-Hassnan ZN, Albert-Brotons D, Limongelli G. A complex unit for a complex disease: the HCM-Family Unit. Monaldi Arch Chest Dis 2021; 92. [PMID: 34964577 DOI: 10.4081/monaldi.2021.2147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a group of heterogeneous disorders that are most commonly passed on in a heritable manner. It is a relatively rare disease around the globe, but due to increased rates of consanguinity within the Kingdom of Saudi Arabia, we speculate a high incidence of undiagnosed cases. The aim of this paper is to elucidate a systematic approach in dealing with HCM patients and since HCM has variable presentation, we have summarized differentials for diagnosis and how different subtypes and genes can have an impact on the clinical picture, management and prognosis. Moreover, we propose a referral multi-disciplinary team HCM-Family Unit in Saudi Arabia and an integrated role in a network between King Faisal Hospital and Inherited and Rare Cardiovascular Disease Unit-Monaldi Hospital, Italy (among the 24 excellence centers of the European Reference Network (ERN) GUARD-Heart). Graphical Abstract.
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Affiliation(s)
- Olga Vriz
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Hani AlSergani
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | | | | | | | - Michele Lioncino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
| | - Bandar Alamro
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
| | - Ciro Mauro
- Department of Cardiology, Cardarelli Hospital, Naples.
| | | | - Zuhair N Al-Hassnan
- Cardiovascular Genetics Program and Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh.
| | - Dimpna Albert-Brotons
- Department of Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples.
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34
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Stachera M, Przybyło P, Sznajder K, Gierlotka M. Cardiac magnetic resonance in the assessment of hypertrophic cardiomyopathy phenotypes and stages - pictorial review. Pol J Radiol 2021; 86:e672-e684. [PMID: 35059060 PMCID: PMC8757040 DOI: 10.5114/pjr.2021.112310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/22/2021] [Indexed: 01/10/2023] Open
Abstract
The aim of this paper is to present recent advances in hypertrophic cardiomyopathy (HCM) diagnosis and treatment based on a literature review. Special emphasis has been placed on the role of cardiac magnetic resonance imaging (CMR) for the assessment of morphological and functional consequences of different stages of HCM including prognostication. The text is illustrated with the images and data of the HCM patients diagnosed with CMR study in our hospital. CMR is an important tool, particularly relevant in novel risk factors and LV dysfunction groups. The HCM group with overt left ventricular dysfunction is underrecognized, often labelled by clinicians as dilated cardiomyopathy. Advanced diagnostic and management strategies effectively influence the natural history of HCM.
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Affiliation(s)
- Magdalena Stachera
- Clinical Department of Diagnostic Imaging, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - Paweł Przybyło
- Department of Cardiology, University Hospital in Opole, Poland
| | - Katarzyna Sznajder
- Clinical Department of Diagnostic Imaging, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
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35
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Shahzadi SK, Naidoo N, Alsheikh-Ali A, Rizzo M, Rizvi AA, Santos RD, Banerjee Y. Reconnoitering the Role of Long-Noncoding RNAs in Hypertrophic Cardiomyopathy: A Descriptive Review. Int J Mol Sci 2021; 22:ijms22179378. [PMID: 34502285 PMCID: PMC8430576 DOI: 10.3390/ijms22179378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common form of hereditary cardiomyopathy. It is characterized by an unexplained non-dilated hypertrophy of the left ventricle with a conserved or elevated ejection fraction. It is a genetically heterogeneous disease largely caused by variants of genes encoding for cardiac sarcomere proteins, including MYH7, MYBPC3, ACTC1, TPM1, MYL2, MYL3, TNNI3, and TNNT23. Preclinical evidence indicates that the enhanced calcium sensitivity of the myofilaments plays a key role in the pathophysiology of HCM. Notably, this is not always a direct consequence of sarcomeric variations but may also result from secondary mutation-driven alterations. Long non-coding RNAs (lncRNAs) are a large class of transcripts ≥200 nucleotides in length that do not encode proteins. Compared to coding mRNAs, most lncRNAs are not as well-annotated and their functions are greatly unexplored. Nevertheless, increasing evidence shows that lncRNAs are involved in a variety of biological processes and diseases including HCM. Accumulating evidence has indicated that lncRNAs are dysregulated in HCM, and closely related to sarcomere construction, calcium channeling and homeostasis of mitochondria. In this review, we have summarized the known regulatory and functional roles of lncRNAs in HCM.
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Affiliation(s)
- Syeda K. Shahzadi
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates; (S.K.S.); (A.A.-A.)
| | - Nerissa Naidoo
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates; (S.K.S.); (A.A.-A.)
- Correspondence: (N.N.); (Y.B.); Tel.: +971-4383-8728 (N.N.); +971-4383-8710 (Y.B.)
| | - Alawi Alsheikh-Ali
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates; (S.K.S.); (A.A.-A.)
- Dubai Health Authority, Dubai 66566, United Arab Emirates
| | - Manfredi Rizzo
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Ali A. Rizvi
- Division of Endocrinology, Metabolism, and Lipids, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Raul D. Santos
- The Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo 01000, Brazil;
| | - Yajnavalka Banerjee
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates; (S.K.S.); (A.A.-A.)
- Centre of Medical Education, School of Medicine, University of Dundee, Dundee DD1 4HN, UK
- Correspondence: (N.N.); (Y.B.); Tel.: +971-4383-8728 (N.N.); +971-4383-8710 (Y.B.)
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36
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Sabbadini A, Caenen A, Keijzer LBH, van Neer PLMJ, Vos HJ, de Jong N, Verweij MD. Tapering of the interventricular septum can affect ultrasound shear wave elastography: An in vitro and in silico study. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:428. [PMID: 34340474 DOI: 10.1121/10.0005646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Shear wave elastography (SWE) has the potential to determine cardiac tissue stiffness from non-invasive shear wave speed measurements, important, e.g., for predicting heart failure. Previous studies showed that waves traveling in the interventricular septum (IVS) may display Lamb-like dispersive behaviour, introducing a thickness-frequency dependency in the wave speed. However, the IVS tapers across its length, which complicates wave speed estimation by introducing an additional variable to account for. The goal of this work is to assess the impact of tapering thickness on SWE. The investigation is performed by combining in vitro experiments with acoustic radiation force (ARF) and 2D finite element simulations, to isolate the effect of the tapering curve on ARF-induced and natural waves in the heart. The experiments show a 11% deceleration during propagation from the thick to the thin end of an IVS-mimicking tapered phantom plate. The numerical analysis shows that neglecting the thickness variation in the wavenumber-frequency domain can introduce errors of more than 30% in the estimation of the shear modulus, and that the exact tapering curve, rather than the overall thickness reduction, determines the dispersive behaviour of the wave. These results suggest that septal geometry should be accounted for when deriving cardiac stiffness with SWE.
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Affiliation(s)
- A Sabbadini
- Applied Sciences, Delft University of Technology, Lorentzweg 1, Delft, 2628 CJ, The Netherlands
| | - A Caenen
- Biomedical Engineering, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - L B H Keijzer
- Biomedical Engineering, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - P L M J van Neer
- Ultrasone Lab, Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek, Oude Waalsdorperweg 63, Den Haag, 2597 AK, The Netherlands
| | - H J Vos
- Biomedical Engineering, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - N de Jong
- Applied Sciences, Delft University of Technology, Lorentzweg 1, Delft, 2628 CJ, The Netherlands
| | - M D Verweij
- Applied Sciences, Delft University of Technology, Lorentzweg 1, Delft, 2628 CJ, The Netherlands
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Qin L, Min J, Chen C, Zhu L, Gu S, Zhou M, Yang W, Yan F. Incremental Values of T1 Mapping in the Prediction of Sudden Cardiac Death Risk in Hypertrophic Cardiomyopathy: A Comparison With Two Guidelines. Front Cardiovasc Med 2021; 8:661673. [PMID: 34169099 PMCID: PMC8217449 DOI: 10.3389/fcvm.2021.661673] [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] [Received: 01/31/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background: MRI native T1 mapping and extracellular volume fraction (ECV) are quantitative values that could reflect various myocardial tissue characterization. The role of these parameters in predicting the risk of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is still poorly understood. Aim: This study aims to investigate the ability of native T1 mapping and ECV values to predict major adverse cardiovascular events (MACE) in HCM, and its incremental values over the 2014 European Society of Cardiology (ESC) and enhanced American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Methods: Between July 2016 and October 2020, HCM patients and healthy individuals with sex and age matched who underwent cardiac MRI were prospectively enrolled. The native T1 and ECV parameters were measured. The SCD risk was evaluated by the 2014 ESC guidelines and enhanced ACC/AHA guidelines. MACE included cardiac death, transplantation, heart failure admission, and implantable cardioverter-defibrillator implantation. Results: A total of 203 HCM patients (54.2 ± 14.9 years) and 101 healthy individuals (53.2 ± 14.7 years) were evaluated. During a median follow-up of 15 months, 25 patients (12.3%) had MACE. In multivariate Cox regression analysis, global native T1 mapping (hazard ratio (HR): 1.446; 95% confidence interval (CI): 1.195–1.749; P < 0.001) and non-sustained ventricular tachycardia (NSVT) (HR: 4.949; 95% CI, 2.033–12.047; P < 0.001) were independently associated with MACE. Ten of 86 patients (11.6%) with low SCD risk assessed by the two guidelines had MACE. In this subgroup of patients, multivariate Cox regression analysis showed that global native T1 mapping was independently associated with MACE (HR: 1.532; 95% CI: 1.221–1.922; P < 0.001). In 85 patients with conflicting results assessed by the two guidelines, end-stage systolic dysfunction was independently associated with MACE (HR: 7.942, 95% CI: 1.322–47.707, P = 0.023). In 32 patients with high SCD risk assessed by the two guidelines, NSVT was independently associated with MACE (HR: 9.779, 95% CI: 1.953–48.964, P = 0.006). Conclusion: The global native T1 mapping could provide incremental values and serve as potential supplements to the current guidelines in the prediction of MACE.
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Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiehua Min
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mi Zhou
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pu C, Fei J, Lv S, Wu Y, He C, Guo D, Mabombo PU, Chooah O, Hu H. Global Circumferential Strain by Cardiac Magnetic Resonance Tissue Tracking Associated With Ventricular Arrhythmias in Hypertrophic Cardiomyopathy Patients. Front Cardiovasc Med 2021; 8:670361. [PMID: 34124201 PMCID: PMC8193949 DOI: 10.3389/fcvm.2021.670361] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is prone to myocardial heterogeneity and fibrosis, which are the substrates of ventricular arrhythmias (VAs). Cardiac magnetic resonance tissue tracking (CMR-TT) can quantitatively reflect global and regional left ventricular strain from different directions. It is uncertain whether the change of myocardial strain detected by CMR-TT is associated with VAs. The aim of the study is to explore the differential diagnostic value of VAs in HCM by CMR-TT. Materials and Methods: We retrospectively included 93 HCM patients (38 with VAs and 55 without VAs) and 30 healthy cases. Left ventricular function, myocardial strain parameters and percentage of late gadolinium enhancement (%LGE) were evaluated. Results: Global circumferential strain (GCS) and %LGE correlated moderately (r = 0.51, P < 0.001). HCM patients with VAs had lower left ventricular ejection fraction (LVEF), global radial strain (GRS), GCS, and global longitudinal strain (GLS), but increased %LGE compared with those without VAs (P < 0.01 for all). %LGE and GCS were indicators of VAs in HCM patients by multivariate logistic regression analysis. HCM patients with %LGE >5.35% (AUC 0.81, 95% CI 0.70–0.91, P < 0.001) or GCS >-14.73% (AUC 0.79, 95% CI 0.70–0.89, P < 0.001) on CMR more frequently had VAs. %LGE + GCS were able to better identify HCM patients with VAs (AUC 0.87, 95% CI 0.79–0.95, P < 0.001). Conclusion: GCS and %LGE were independent risk indicators of VAs in HCM. GCS is expected to be a good potential predictor in identifying HCM patients with VAs, which may provide important values to improve risk stratification in HCM in clinical practice.
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Affiliation(s)
- Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingle Fei
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sangying Lv
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danling Guo
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Pierre Umba Mabombo
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Outesh Chooah
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Qin L, Chen C, Gu S, Zhou M, Xu Z, Ge Y, Yan F, Yang W. A radiomic approach to predict myocardial fibrosis on coronary CT angiography in hypertrophic cardiomyopathy. Int J Cardiol 2021; 337:113-118. [PMID: 33961944 DOI: 10.1016/j.ijcard.2021.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) derived from cardiac magnetic resonance (CMR) represents myocardial fibrosis (MF) and is associated with prognosis in hypertrophic cardiomyopathy (HCM). However, it cannot be evaluated when CMR is unavailable. Hence, we aimed to investigate the ability of radiomic features derived from coronary computed tomography angiography (CCTA) to detect the presence and extent of MF in HCM, with LGE as references. METHODS 161 patients with HCM who underwent CCTA and CMR were retrospectively enrolled and randomly divided into training (107 patients, 1712 segments) and testing cohorts (54 patients, 864 segments). Segments were obtained according to AHA 17-segment method. Radiomic features were extracted from per-segment and entire myocardium regions, and multiple machine-learning algorithms were used for radiomic signatures (Rad-sig) generation and model building. Four models were established by multivariable logistic regression using Rad-sig (R-model), clinical characteristic (C-model), echocardiography parameters (E-model), and all features integrated (Integ-model) to identify LGE/left ventricular mass ≥ 15%. RESULTS The model achieved good diagnostic accuracy in both training (area under the curve [AUC]:0.81, 95% confidence interval [CI]: 0.78-0.83) and testing cohort (AUC: 0.78, 95%CI: 0.75-0.81) on a per-segment basis for the presence of MF. The Integ-model owned the highest discriminative ability for patients with LGE/left ventricular mass ≥ 15% in both training and testing cohorts with AUC of 0.94 (95%CI: 0.89-0.98) and 0.92 (95%CI: 0.85-0.99), respectively. CONCLUSIONS Our radiomic models were considered as useful and complementary biomarkers for the evaluation of the presence and extent of MF on CCTA, facilitating clinical decision-making and risk stratification in HCM patients.
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Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Zhihan Xu
- Siemens Healthcare Ltd., No. 278 Zhouzhu Road, Shanghai 201318, China
| | - Yingqian Ge
- Siemens Healthcare Ltd., No. 278 Zhouzhu Road, Shanghai 201318, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai 200025, China.
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Rajiah P, Kirsch J, Bolen MA, Batlle JC, Brown RKJ, Francois CJ, Galizia MS, Hanneman K, Inacio JR, Johri AM, Lee DC, Singh SP, Villines TC, Wann S, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded). J Am Coll Radiol 2021; 18:S83-S105. [PMID: 33651982 DOI: 10.1016/j.jacr.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
Nonischemic cardiomyopathies encompass a broad spectrum of myocardial disorders with mechanical or electrical dysfunction without evidence of ischemia. There are five broad variants of nonischemic cardiomyopathies; hypertrophic cardiomyopathy (Variant 1), restrictive or infiltrative cardiomyopathy (Variant 2), dilated or unclassified cardiomyopathy (Variant 3), arrhythmogenic cardiomyopathy (Variant 4), and inflammatory cardiomyopathy (Variant 5). For variants 1, 3, and 4, resting transthoracic echocardiography, MRI heart function and morphology without and with contrast, and MRI heart function and morphology without contrast are the usually appropriate imaging modalities. For variants 2 and 5, resting transthoracic echocardiography and MRI heart function and morphology without and with contrast are the usually appropriate imaging modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | - Michael A Bolen
- Panel Vice-Chair, Cleveland Clinic, Cleveland, Ohio, Radiology Fellowship Director for Cardiovascular CT/MRI Cleveland Clinic Main Campus
| | - Juan C Batlle
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida
| | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah
| | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada, Director, Cardiac Imaging Research, Department of Medical Imaging, University of Toronto
| | - Joao R Inacio
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada, Cardiology expert
| | - Daniel C Lee
- Northwestern University Feinberg School of Medicine Chicago, Illinois, Society for Cardiovascular Magnetic Resonance, Co-Director, Cardiovascular Magnetic Resonance Imaging, Northwestern University Feinberg School of Medicine
| | | | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia, Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Wisconsin Heart Hospital, Milwaukee, Wisconsin, Nuclear cardiology expert
| | | | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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41
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Sinha M, Pandey NN, Sharma A, Parashar N, Kumar S, Sharma G. Aneurysmal and obstructive lesions of the left ventricular outflow: evaluation on multidetector computed tomography angiography. Pol J Radiol 2021; 86:e195-e203. [PMID: 34093915 PMCID: PMC8147719 DOI: 10.5114/pjr.2021.105588] [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: 05/23/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
The left ventricular outflow is an anatomically complex region situated between the anterior leaflet of the mitral valve and the left ventricular aspect of the muscular and membranous interventricular septum. It gives rise to the aorta, provides support to the aortic valvular cusps, and houses important components of the conduction system. The left ventricular outflow handles high pressures and pressure variations and is subsequently affected by a variety of aetio-pathological conditions. Diseases involving the left ventricular outflow can be intraluminal, mural, or extramural, and the consequent complications of the lesions can be local, loco-regional, or even systemic. Appropriate evaluation requires comprehensive multimodality imaging with each modality contributing to assessment of different aspects of diagnosis, lesion characterization, local extension, prognostication for systemic complications and mortality, and the decision for the approach and type of intervention and aggressive follow-up in case non-interventional management is decided. In this review, we briefly describe the relevant anatomy and the gamut of structural abnormalities pertaining to the left ventricular outflow on multidetector computed tomography angiography.
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Affiliation(s)
| | | | - Arun Sharma
- Correspondence address: Dr. Arun Sharma, 148, The Foothills, New Chandigarh (Pb), India, e-mail:
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42
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Kim W, Lim M, Jang YJ, Koo HJ, Kang JW, Jung SH, Yang DH. Novel Resectable Myocardial Model Using Hybrid Three-Dimensional Printing and Silicone Molding for Mock Myectomy for Apical Hypertrophic Cardiomyopathy. Korean J Radiol 2021; 22:1054-1065. [PMID: 33856135 PMCID: PMC8236372 DOI: 10.3348/kjr.2020.1164] [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: 09/25/2020] [Revised: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022] Open
Abstract
Objective We implemented a novel resectable myocardial model for mock myectomy using a hybrid method of three-dimensional (3D) printing and silicone molding for patients with apical hypertrophic cardiomyopathy (ApHCM). Materials and Methods From January 2019 through May 2020, 3D models from three patients with ApHCM were generated using the end-diastolic cardiac CT phase image. After computer-aided designing of measures to prevent structural deformation during silicone injection into molding, 3D printing was performed to reproduce anatomic details and molds for the left ventricular (LV) myocardial mass. We compared the myocardial thickness of each cardiac segment and the LV myocardial mass and cavity volumes between the myocardial model images and cardiac CT images. The surgeon performed mock surgery, and we compared the volume and weight of the resected silicone and myocardium. Results During the mock surgery, the surgeon could determine an ideal site for the incision and the optimal extent of myocardial resection. The mean differences in the measured myocardial thickness of the model (0.3, 1.0, 6.9, and 7.3 mm in the basal, midventricular, apical segments, and apex, respectively) and volume of the LV myocardial mass and chamber (36.9 mL and 14.8 mL, 2.9 mL and −9.4 mL, and 6.0 mL and −3.0 mL in basal, mid-ventricular and apical segments, respectively) were consistent with cardiac CT. The volume and weight of the resected silicone were similar to those of the resected myocardium (6 mL [6.2 g] of silicone and 5 mL [5.3 g] of the myocardium in patient 2; 12 mL [12.5 g] of silicone and 11.2 mL [11.8 g] of the myocardium in patient 3). Conclusion Our 3D model created using hybrid 3D printing and silicone molding may be useful for determining the extent of surgery and planning surgery guided by a rehearsal platform for ApHCM.
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Affiliation(s)
- Wooil Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | | | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Ho Jung
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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43
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Cardiac-CT with the newest CT scanners: An incoming screening tool for competitive athletes? Clin Imaging 2021; 78:74-92. [PMID: 33773447 DOI: 10.1016/j.clinimag.2021.03.001] [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: 05/19/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 11/20/2022]
Abstract
Competitive athletes of all skill levels are at risk of sudden cardiac death (SCD) due to certain heart conditions. Prior to engagement in high-intensity athletics, it is necessary to screen for these conditions in order to prevent sudden cardiac death. Cardiac-CT angiography (CCTA) is a reliable tool to rule out the leading causes of SCD by providing an exceptional overview of vascular and cardiac morphology. This allows CCTA to be a powerful resource in identifying cardiac anomalies in selected patients (i.e. unclear symptoms or findings at ECG or echocardiography) as well as to exclude significant coronary artery disease (CAD). With the advancement of technology over the last few years, the latest generations of computed tomography (CT) scanners provide better image quality at lower radiation exposures. With the amount of radiation exposure per scan now reaching the sub-millisievert range, the number of CT examinations it is supposed to increase greatly, also in the athlete's population. It is thus necessary for radiologists to have a clear understanding of how to make and interpret a CCTA examination so that these studies may be performed in a responsible and radiation conscious manner especially when used in the younger populations. Our work aims to illustrate the main radiological findings of CCTAs and highlight their clinical impact with some case studies. We also briefly describe critical features of state-of-the-art CT scanners that optimize different acquisitions to obtain the best quality at the lowest possible dose.
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44
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Shi RY, Wu R, An DAL, Chen BH, Wu CW, Du L, Jiang M, Xu JR, Wu LM. Texture analysis applied in T1 maps and extracellular volume obtained using cardiac MRI in the diagnosis of hypertrophic cardiomyopathy and hypertensive heart disease compared with normal controls. Clin Radiol 2020; 76:236.e9-236.e19. [PMID: 33272531 DOI: 10.1016/j.crad.2020.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
AIM To assess the potential of texture analysis (TA) applied in T1 maps and extracellular volume (ECV) obtained using cardiac magnetic resonance (CMR) in the diagnosis of hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) compared with normal controls (NC). Strain parameters were analysed to compare with final TA models. MATERIALS AND METHODS This retrospective study included 66 HCM patients, 39 HHD patients, and 41 NC. Step-wise dimension reduction and feature selection were performed by reproducibility, machine learning, collinearity, and multivariable regression analysis to select the texture features that enable diagnosis of and differentiation between HCM and HHD. Strain parameters were calculated by short-axis and three long-axis cine sequences. RESULTS Independent features in T1 maps and ECV analysis allowed for the differentiation between patients (HCM and HHD) and NC. Of the best-calculated model, the areas under the receiver operating curve (AUCs) were as follows: 0.969 for T1 map and 0.964 for ECV. To distinguish HCM from HHD, two independent features were screened out for both T1 and ECV maps. The AUCs were as follows: 0.793 for T1 map and 0.894 for ECV. Radial, circumferential, and longitudinal strain parameters could differentiate patients from NC, but only longitudinal strain parameters was significantly different between HCM and HHD. CONCLUSIONS Texture analysis of T1 maps and ECV shows high accuracy in differentiating hypertrophic myocardium from NC, and HCM from HHD. Strain parameters are able to demonstrate the difference between patients and NC, but were less impressive in differentiating HCM and HHD.
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Affiliation(s)
- R-Y Shi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - R Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - D-A L An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - B-H Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - C-W Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - L Du
- Department of Robotics, Ritsumeikan University, Shiga, Japan
| | - M Jiang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - J-R Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - L-M Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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45
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Ünlü S, Özden Tok Ö, Avcı Demir F, Papadopoulos K, Monaghan MJ. Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view. Echocardiography 2020; 38:103-113. [PMID: 33067903 DOI: 10.1111/echo.14895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022] Open
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) and apical displacement of papillary muscles (ADPM) are two different pathologies with a number of similar imaging findings that may hamper adequate diagnosis. While ApHCM is associated with increased rate of mortality, ADPM commonly presents with a benign course and differential diagnosis is of great importance. Clinical assessment and 2D echocardiography cannot sufficiently differentiate these conditions, however, and advanced echocardiographic methods may facilitate diagnosis. Although echocardiography is the first-line imaging method in the diagnostic algorithm, cardiac magnetic resonance imaging (CMRI) is the gold standard for evaluating patients due to good spatial resolution and myocardial tissue characterization abilities. When CMRI is contraindicated, cardiac computed tomography may be an alternative reliable method that can also give information about the coronary anatomy. Nuclear imaging may also provide supplementary data regarding hypertrophy and coronary arteries when there is a suspicion of ischemia.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey
| | - Özge Özden Tok
- Cardiology Department, Memorial Bahçelievler Hospital, İstanbul, Turkey
| | - Fulya Avcı Demir
- Cardiology Department, Private Antalya Anatolia Hospital, Antalya, Turkey
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Pradella S, Grazzini G, De Amicis C, Letteriello M, Acquafresca M, Miele V. Cardiac magnetic resonance in hypertrophic and dilated cardiomyopathies. Radiol Med 2020; 125:1056-1071. [PMID: 32946001 DOI: 10.1007/s11547-020-01276-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Cardiomyopathies are a heterogeneous entity. The progress in the field of genetics has allowed over the years to determine its origin more and more often. The classification of these pathologies has changed over the years; it has been updated with new knowledge. Imaging allows to define the phenotypic characteristics of the different forms of cardiomyopathy. Cardiac magnetic resonance (CMR) allows a morphological evaluation of the associated (and sometimes pathognomonic) cardiac findings of any form of cardiomyopathy. The tissue characterization sequences also make magnetic resonance imaging unique in its ability to detect changes in myocardial tissue. This review aims to define the features that can be highlighted by CMR in hypertrophic and dilated forms and the possible differential diagnoses. In hypertrophic forms, CMR provides: precise evaluation of wall thickness in all segments, ventricular function and size and evaluation of possible presence of areas of fibrosis as well as changes in myocardial tissue (measurement of T1 mapping and extracellular volume values). In dilated forms, cardiac resonance is the gold standard in the assessment of ventricular volumes. CMR highlights also the potential alterations of the myocardial tissue.
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Affiliation(s)
- Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Cristian De Amicis
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Mayla Letteriello
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Manlio Acquafresca
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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Abstract
HistoryA 47-year-old Sudanese man without a known remarkable medical history presented to the emergency department for a syncopal episode. The patient denied chest pain, dyspnea, focal weakness, or prior similar episodes. He was originally from north Sudan and eventually moved to Saudi Arabia, where he worked as a farm manager before emigrating to the United States years ago. Physical examination findings and routine laboratory values, including complete blood count and basic metabolic panels, were normal. Electrocardiography revealed nonspecific T-wave inversions, and a series of cardiac biomarkers were negative. A contrast material-enhanced CT angiography pulmonary embolism protocol and cardiac MRI were performed for further evaluation.
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Affiliation(s)
- Chauncy B Handran
- From the Department of Radiology, Duke University Hospital, 2300 Erwin Rd, DUMC Box 3808, Durham, NC 27710
| | - Lynne M Hurwitz Koweek
- From the Department of Radiology, Duke University Hospital, 2300 Erwin Rd, DUMC Box 3808, Durham, NC 27710
| | - Joseph G Mammarappallil
- From the Department of Radiology, Duke University Hospital, 2300 Erwin Rd, DUMC Box 3808, Durham, NC 27710
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48
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She JQ, Guo JJ, Yu YF, Zhao SH, Chen YY, Ge MY, Zeng MS, Jin H. Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking. J Magn Reson Imaging 2020; 53:51-60. [PMID: 32798304 DOI: 10.1002/jmri.27307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Myocardial strain for assessment of hypertrophic cardiomyopathy (HCM) is of importance and may play a role in identifying obstruction in HCM patients. PURPOSE To evaluate the utility of myocardial strain for detecting left ventricular (LV) outflow tract (LVOT) obstruction in HCM patients based on magnetic resonance tissue tracking. STUDY TYPE Retrospective. POPULATION In all, 44 adult HCM patients with LVOT obstruction and 108 adult HCM patients without LVOT obstruction. FIELD STRENGTH/SEQUENCE 1.5 T; Steady-state free-precession cine sequence; phase-sensitive inversion-prepared segmented gradient echo sequence for late gadolinium enhancement (LGE) imaging. ASSESSMENT Strain parameters including the local and global levels of LV myocardium and the subtraction (Sub) of myocardial strain variables between interventricular septal segments (IVSS) and noninterventricular septal segments (NIVSS) were measured for differentiating HCM with obstruction from nonobstruction. Average and maximum LV wall thickness (Average and Maximum LVWT) were also analyzed. STATISTICAL TESTS Univariate and multivariate logistic regression analysis, area under the receiver operating characteristic (ROC) curve (AUC), intraclass correlation coefficient. RESULTS In multivariate analysis, Average LVWT, Maximum LVWT, and the subtraction of radial peak strain (Sub Radial PS) between NIVSS and IVSS were independently associated with LVOT obstruction. The AUCs were 0.731, 0.840, and 0.890 for Average LVWT, Maximum LVWT, and Sub Radial PS, respectively. Sub Radial PS (cutoff value: 8.1%) demonstrated the highest sensitivity of 75.0% and a high specificity of 87.9% for identifying LVOT; Maximum LVWT (cutoff value: 22.9 mm) showed good sensitivity (72.7%) and specificity (83.3%). Combining Maximum LVWT >22.9 mm and Sub Radial PS > 8.1% achieved a better diagnostic performance (specificity 95.4%, sensitivity 70.5%). DATA CONCLUSION Combining Maximum LVWT >22.9 mm and Sub Radial PS >8.1% holds promise for objectively evaluating LVOT obstruction in HCM patients with very high specificity and acceptable sensitivity. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Jia-Qi She
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Jia-Jun Guo
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yun-Fei Yu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shi-Hai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Mei-Ying Ge
- Department of Radiology, The 5th People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China
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49
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Antunes MDO, Scudeler TL. Hypertrophic cardiomyopathy. IJC HEART & VASCULATURE 2020; 27:100503. [PMID: 32309534 PMCID: PMC7154317 DOI: 10.1016/j.ijcha.2020.100503] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. The disease is characterized by marked variability in morphological expression and natural history, ranging from asymptomatic to heart failure or sudden cardiac death. Left ventricular hypertrophy and abnormal ventricular configuration result in dynamic left ventricular outflow obstruction in most patients. The goal of pharmacological therapy in HCM is to alleviate the symptoms, and it includes pharmacotherapies and septal reduction therapies. In this review, we summarize the relevant clinical issues and treatment options of HCM.
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Affiliation(s)
- Murillo de Oliveira Antunes
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Universidade São Francisco (USF), Bragança Paulista, São Paulo, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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50
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Abstract
Hypertrophic cardiomyopathy (HCM) is the most common cardiovascular disease with genetic transmission, characterized by the hypertrophy of any segment of the left ventricle (LV), not totally explained by improper loading conditions, with LV systolic function preserved, increased, or reduced. The histopathological mechanism involved in HCM refers to the primary injury of the myocardium, as follows: disorganized array of myocytes, extracellular matrix modification, microvascular dysfunction, with subsequent appearance of myocardial fibrosis. Multiple sarcomere proteins mutations are responsible for HCM, but two of them are involved in 70% of the cases of HCM: β-myosin heavy chain (MYH7) and myosin-binding protein C (MYBPC3). The development of new genetic techniques involving genome editing is promising to discover a gene therapy for patients with HCM. Clinical presentation may differ from asymptomatic to sudden cardiac death (SCD), the last one targeting younger adults. In this case, the diagnosis and evaluation of SCD risk factors is extremely important. The common method of diagnosis is transthoracic echocardiography, but cardiac magnetic resonance (CMR) imaging represents "gold standard" in the evaluation of HCM patients. Treatment includes pharmacological therapy, surgery, alcohol ablation, and not least SCD prevention.
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Affiliation(s)
- Ioana Danuta Muresan
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor, 400006, Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor, 400006, Cluj-Napoca, Romania.
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