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Roset-Altadill A, Wat D, Radike M. Cardiovascular and pulmonary complications of recreational drugs: A pictorial review. Eur J Radiol 2024; 178:111648. [PMID: 39089058 DOI: 10.1016/j.ejrad.2024.111648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/03/2024]
Abstract
Recreational drug abuse constitutes a serious health problem worldwide. Consumption of cocaine, amphetamine-type stimulants, opioids and cannabis can lead to multiple acute and chronic cardiopulmonary complications, resulting in high morbidity and mortality. These complications may be first detected at imaging, since clinical presentation is usually non-specific. Cardiovascular complications include myocardial infarction, endocarditis, aortic dissection, infectious pseudoaneurysm, retained needle fragments, cardiomyopathy and pulmonary arterial hypertension. Pulmonary complications encompass pulmonary oedema, crack lung, pneumonia, septic emboli, barotrauma, airway disease, emphysema and excipient lung disease. Knowledge of the cardiopulmonary imaging manifestations of illicit drug use in conjunction with clinical history and a high grade of suspicion enable an accurate diagnosis and appropriate management plan. In this article we aim to provide a pictorial review of the most frequent cardiopulmonary manifestations of recreational drugs, emphasizing the underlying pathophysiologic mechanisms and the various imaging appearances.
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Affiliation(s)
- Adria Roset-Altadill
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain.
| | - Dennis Wat
- Respiratory Medicine Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom.
| | - Monika Radike
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom; Cardiovascular Research Center-ICCC, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Karur GR, Aneja A, Stojanovska J, Hanneman K, Latchamsetty R, Kersting D, Rajiah PS. Imaging of Cardiac Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329870. [PMID: 37753860 DOI: 10.2214/ajr.23.29870] [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] [Indexed: 09/28/2023]
Abstract
Myocardial fibrosis (MF) is defined as excessive production and deposition of extra-cellular matrix proteins that result in pathologic myocardial remodeling. Three types of MF have been identified: replacement fibrosis from tissue necrosis, reactive fibrosis from myocardial stress, and infiltrative interstitial fibrosis from progressive deposition of nondegradable material such as amyloid. Although echocardiography, nuclear medicine, and CT play important roles in the assessment of MF, MRI is pivotal in the evaluation of MF, with the late gadolinium enhancement (LGE) technique used as a primary end point. The LGE technique focuses on the pattern and distribution of gadolinium accumulation in the myocardium and assists in the diagnosis and establishment of the cause of both ischemic and nonischemic cardiomyopathy. LGE MRI also aids prognostication and risk stratification. In addition, LGE MRI is used to guide the management of patients considered for ablation for arrhythmias. Parametric mapping techniques, including T1 mapping and extracellular volume measurement, allow detection and quantification of diffuse fibrosis, which may not be detected by LGE MRI. These techniques also allow monitoring of disease progression and therapy response. This review provides an update on the imaging of MF, including prognostication and risk stratification tools, electrophysiologic considerations, and disease monitoring.
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Affiliation(s)
- Gauri R Karur
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Ashish Aneja
- Department of Cardiology, MetroHealth System, Cleveland, OH
| | | | - Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON, Canada
| | | | - David Kersting
- Department of Nuclear Medicine and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
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Goyal A, Ekelmans A, Frishman W. Exploring the Intersection of Dementia and Myocardial Infarction: Vascular Perspectives. Cardiol Rev 2024:00045415-990000000-00272. [PMID: 38771949 DOI: 10.1097/crd.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Emerging evidence underscores the relationship between myocardial infarction and dementia, implicating a profound influence on patient health. The bidirectional relationship between myocardial infarction and dementia is highlighted by pathophysiological changes in vasculature function, lifestyle factors, and environmental influences. Our literature review aims to explore the complex relationship between these 2 pathologies and highlight the pathways by which they mutually influence each other.
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Affiliation(s)
- Anjali Goyal
- From the School of Medicine, New York Medical College, Valhalla, NY
| | | | - William Frishman
- From the School of Medicine, New York Medical College, Valhalla, NY
- Department of Medicine, New York Medical College, Valhalla, NY
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Zhi Y, Gui FD, Xue M, Long YT, Miao W, Yi Y, Gao LC, Bing F, Pan SY. Focal ischemic myocardial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy. BMC Cardiovasc Disord 2024; 24:203. [PMID: 38594610 PMCID: PMC11003119 DOI: 10.1186/s12872-024-03859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND In patients with hypertrophic cardiomyopathy (HCM), ischemic myocardial fibrosis assessed by late gadolinium enhancement (I-LGE) using cardiovascular magnetic resonance (CMR) have been reported. However, the clinical significance of I-LGE has not been completely understood. We aim to evaluate the I-LGE differ phenotypically from HCM without LGE or nonischemic myocardial fibrosis assessed by late gadolinium enhancement (NI-LGE) in the left ventricle (LV). METHODS The patients with HCM whom was underwent CMR were enrolled, using cine cardiac magnetic resonance to evaluate LV function and LGE to detect the myocardial fibrosis. Three groups were assorted: 1) HCM without LGE; 2) HCM with LGE involved the subendocardial layer was defined as I-LGE; 3) HCM with LGE not involved the subendocardial layer was defined as NI-LGE. RESULTS We enrolled 122 patients with HCM in the present study. LGE was detected in 58 of 122 (48%) patients with HCM, and 22 (18%) of patients reported I-LGE. HCM with I-LGE had increased higher left ventricular mass index (LVMI) (P < 0.0001) than HCM with NI-LGE or without LGE. In addition, HCM with I-LGE had a larger LV end- systolic volume (P = 0.045), lower LV ejection fraction (LVEF) (P = 0.026), higher LV myocardial mass (P < 0.001) and thicker LV wall (P < 0.001) more than HCM without LGE alone. The I-LGE were significantly associated with LVEF (OR: 0.961; P = 0.016), LV mass (OR: 1.028; P < 0.001), and maximal end-diastolic LVWT (OR: 1.567; P < 0.001). On multivariate analysis, LVEF (OR: 0.948; P = 0.013) and maximal end-diastolic LVWT (OR: 1.548; P = 0.001) were associated with higher risk for I-LGE compared to HCM without LGE. Noticeably, the maximal end-diastolic LVWT (OR: 1.316; P = 0.011) was the only associated with NI-LGE compared to HCM without LGE. CONCLUSIONS I-LGE is not uncommon in patients with HCM. HCM with I-LGE was associated with significant LV hypertrophy, extensive LGE and poor LV ejection fraction. We should consider focal ischemic myocardial fibrosis when applying LGE to risk stratification for HCM.
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Affiliation(s)
- Yang Zhi
- Department of Radiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China
| | - Fu-Dan Gui
- Department of Cardiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China
| | - Meng Xue
- Department of Radiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China
| | - Yi-Tian Long
- Department of Radiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China
| | - Wen Miao
- Department of Radiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China
| | - You Yi
- Department of Radiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China
| | - Liang-Chao Gao
- Department of Rheumatology and Immunology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Fu Bing
- Department of Radiology, Chengdu Fifth People's Hospital, 33# Ma Shi Street, Chengdu, 611130, China.
| | - Shu-Yue Pan
- Department of Rheumatology and Immunology, Chengdu Fifth People's Hospital, Chengdu, China.
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Schon C, Felismino A, de Sá J, Corte R, Ribeiro T, Bruno S. Efficacy of early cardiac rehabilitation after acute myocardial infarction: Randomized clinical trial protocol. PLoS One 2024; 19:e0296345. [PMID: 38198457 PMCID: PMC10781044 DOI: 10.1371/journal.pone.0296345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
The acute myocardial infarction (AMI) present high mortality rate that may be reduced with cardiac rehabilitation. Despite its good establishment in outpatient care, few studies analyzed cardiac rehabilitation during hospitalization. Thus, this study aims to clarify the safety and efficacy of early cardiac rehabilitation after AMI. This will be a clinical, controlled, randomized trial with blind outcome evaluation and a superiority hypothesis. Twenty-four patients with AMI will be divided into two groups (1:1 allocation ratio). The intervention group will receive an individualized exercise-based cardiac rehabilitation protocol during hospitalization and a semi-supervised protocol after hospital discharge; the control group will receive conventional care. The primary outcomes will be the cardiac remodeling assessed by cardiac magnetic resonance imaging, functional capacity assessed by maximal oxygen consumption, and cardiac autonomic balance examined via heart rate variability. Secondary outcomes will include safety and the total exercise dose provided during the protocol. Statistical analysis will consider the intent-to-treat analysis. Trial registration. Trial registration number: Brazilian Registry of Clinical Trials (ReBEC) (RBR- 9nyx8hb).
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Affiliation(s)
- Caroline Schon
- University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Amanda Felismino
- University Hospital Onofre Lopes, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Joceline de Sá
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Renata Corte
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Tatiana Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Selma Bruno
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Gonzalez de Alba C, Moghari MH, Browne LP, Friesen RM, Fonseca B, Malone LJ. Feasibility of gray-blood late gadolinium enhancement evaluation in young patients with congenital and acquired heart disease. Front Cardiovasc Med 2023; 10:1269412. [PMID: 37915741 PMCID: PMC10616296 DOI: 10.3389/fcvm.2023.1269412] [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: 07/30/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) sequences have become common in pediatric cardiovascular magnetic resonance (CMR) to assess for myocardial fibrosis. Bright-blood late gadolinium enhancement (BB-LGE) by conventional phase-sensitive inversion recovery (PSIR) is commonly utilized, but similar inversion time (TI) value of fibrosis and left ventricular (LV) blood pool can make subendocardial areas difficult to assess. A gray-blood LGE (GB-LGE) technique has been described, targeting nulling of the LV blood pool and demonstrating improvement in ischemic scar detection over BB-LGE in adult patients. We sought to evaluate the feasibility of the GB-LGE technique in a young population with congenital and acquired heart disease and compare its ability to detect subendocardial scar to conventional BB-LGE. Methods Seventy-six consecutive patients referred for clinical CMR underwent both BB-LGE and GB-LGE on 1.5 T and 3 T scanners. Conventional PSIR sequences were obtained with TI to null the myocardium (BB-LGE) in short-axis and horizontal long-axis stacks. Same PSIR stacks were immediately repeated with TI to null the blood pool (GB-LGE). Both sequences were reviewed separately a week apart by two readers, blinded to the initial clinical interpretation. Studies were analyzed for overall image quality, confidence in scar detection, confidence in detection of LGE, LGE class, inter- and intra-observer agreement for the presence of scar, and intraclass correlation coefficient (ICC) for total scar burden. Results Overall confidence in myocardial scar detection by BB-LGE or GB-LGE as well as grading of image quality were not statistically different [(p = 1 and p = 1) and (p = 0.53, p = 0.18), respectively]. There was very good inter-observer agreement for the presence of scar on BB-LGE (K = 0.88, 95% CI 0.77-0.99) and GB-LGE (K = 0.84, 95% CI 0.7-0.96), as well as excellent intra-observer agreement for both readers (K = 0.93, 95% CI 0.87-0.99; and K = 0.81, 95% CI 0.69-0.95). Interclass correlation coefficient for total scar burden was excellent for BB-LGE (ICC = 0.98, 95% CI 0.96-0.99) and GB-LGE (ICC = 0.94, 95% CI 0.91-0.97). Conclusions The GB-LGE technique is feasible in the pediatric population with congenital and acquired heart disease. It can detect subendocardial/ischemic scar similar to conventional bright-blood PSIR sequences in the pediatric population.
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Affiliation(s)
- Cesar Gonzalez de Alba
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - Mehdi H. Moghari
- Department of Radiology, University of Colorado, Aurora, CO, United States
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO, United States
| | - Lorna P. Browne
- Department of Radiology, University of Colorado, Aurora, CO, United States
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO, United States
| | - Richard M. Friesen
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - Brian Fonseca
- Division of Cardiology, Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | - LaDonna J. Malone
- Department of Radiology, University of Colorado, Aurora, CO, United States
- Department of Radiology, Children’s Hospital Colorado, Aurora, CO, United States
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Coletti C, Fotaki A, Tourais J, Zhao Y, van de Steeg-Henzen C, Akçakaya M, Tao Q, Prieto C, Weingärtner S. Robust cardiac T 1 ρ $$ {\mathrm{T}}_{1_{\boldsymbol{\rho}}} $$ mapping at 3T using adiabatic spin-lock preparations. Magn Reson Med 2023; 90:1363-1379. [PMID: 37246420 PMCID: PMC10984724 DOI: 10.1002/mrm.29713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study is to develop and optimize an adiabaticT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ (T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ ) mapping method for robust quantification of spin-lock (SL) relaxation in the myocardium at 3T. METHODS Adiabatic SL (aSL) preparations were optimized for resilience againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities using Bloch simulations. OptimizedB 0 $$ {\mathrm{B}}_0 $$ -aSL, Bal-aSL andB 1 $$ {\mathrm{B}}_1 $$ -aSL modules, each compensating for different inhomogeneities, were first validated in phantom and human calf. MyocardialT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ mapping was performed using a single breath-hold cardiac-triggered bSSFP-based sequence. Then, optimizedT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ preparations were compared to each other and to conventional SL-preparedT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ maps (RefSL) in phantoms to assess repeatability, and in 13 healthy subjects to investigate image quality, precision, reproducibility and intersubject variability. Finally, aSL and RefSL sequences were tested on six patients with known or suspected cardiovascular disease and compared with LGE,T 1 $$ {\mathrm{T}}_1 $$ , and ECV mapping. RESULTS The highestT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ preparation efficiency was obtained in simulations for modules comprising 2 HS pulses of 30 ms each. In vivoT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ maps yielded significantly higher quality than RefSL maps. Average myocardialT 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ values were 183.28± $$ \pm $$ 25.53 ms, compared with 38.21± $$ \pm $$ 14.37 ms RefSL-preparedT 1 ρ $$ {\mathrm{T}}_{1\uprho} $$ .T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ maps showed a significant improvement in precision (avg. 14.47± $$ \pm $$ 3.71% aSL, 37.61± $$ \pm $$ 19.42% RefSL, p < 0.01) and reproducibility (avg. 4.64± $$ \pm $$ 2.18% aSL, 47.39± $$ \pm $$ 12.06% RefSL, p < 0.0001), with decreased inter-subject variability (avg. 8.76± $$ \pm $$ 3.65% aSL, 51.90± $$ \pm $$ 15.27% RefSL, p < 0.0001). Among aSL preparations,B 0 $$ {\mathrm{B}}_0 $$ -aSL achieved the better inter-subject variability. In patients,B 1 $$ {\mathrm{B}}_1 $$ -aSL preparations showed the best artifact resilience among the adiabatic preparations.T 1 ρ , adiab $$ {\mathrm{T}}_{1\uprho, \mathrm{adiab}} $$ times show focal alteration colocalized with areas of hyper-enhancement in the LGE images. CONCLUSION Adiabatic preparations enable robust in vivo quantification of myocardial SL relaxation times at 3T.
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Affiliation(s)
- Chiara Coletti
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Anastasia Fotaki
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
| | - Joao Tourais
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Yidong Zhao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | | | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minnesota, USA
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Claudia Prieto
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Milleniun Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - Sebastian Weingärtner
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
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Shalmon T, Hamad FMD, Jimenez-Juan L, Kirpalani A, Urzua Fresno CM, Folador L, Tan NS, Singh SM, Ge Y, Dorian P, Lima JAC, Wong KCK, Deva DP, Yan AT. Prognostic Value of Different Thresholds for Myocardial Scar Quantification on Cardiac MRI Late Gadolinium Enhancement Images in Patients Receiving Implantable Cardioverter Defibrillators. Radiol Cardiothorac Imaging 2023; 5:e210247. [PMID: 37404790 PMCID: PMC10316291 DOI: 10.1148/ryct.210247] [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: 09/10/2021] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 07/06/2023]
Abstract
Purpose To compare the predictive value of different myocardial scar quantification thresholds using cardiac MRI for appropriate implantable cardioverter defibrillator (ICD) shock and mortality. Materials and Methods In this retrospective, two-center observational cohort study, patients with ischemic or nonischemic cardiomyopathy underwent cardiac MRI prior to ICD implantation. Late gadolinium enhancement (LGE) was first determined visually and then quantified by blinded cardiac MRI readers using different SDs above the mean signal of normal myocardium, full-width half-maximum, and manual thresholding. The intermediate signal "gray zone" was calculated as the differences between different SDs. Results Among 374 consecutive eligible patients (mean age, 61 years ± 13 [SD]; mean left ventricular ejection fraction, 32% ± 14; secondary prevention, 62.7%), those with LGE had a higher rate of appropriate ICD shock or death than those without (37.5% vs 26.6%, log-rank P = .04) over a median follow-up of 61 months. In multivariable analysis, none of the thresholds for quantifying scar was a significant predictor of mortality or appropriate ICD shock, while the extent of gray zone was an independent predictor (adjusted hazard ratio per 1 g = 1.025; 95% CI: 1.008, 1.043; P = .005) regardless of the presence or absence of ischemic heart disease (P interaction = .57). Model discrimination was highest for the model incorporating the gray zone (between 2 SD and 4 SD). Conclusion Presence of LGE was associated with a higher rate of appropriate ICD shock or death. Although none of the scar quantification techniques predicted outcomes, the gray zone both in infarct and nonischemic scar was an independent predictor and may refine risk stratification.Keywords: MRI, Scar Quantification, Implantable Cardioverter Defibrillator, Sudden Cardiac Death Supplemental material is available for this article. © RSNA, 2023.
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El Gallazzi N, Mhani H, Lahnaoui F, Amlouk N, El Boussaadani B, Raissouni Z. L'infarctus du myocarde type 2. Ann Cardiol Angeiol (Paris) 2023; 72:101604. [PMID: 37187109 DOI: 10.1016/j.ancard.2023.101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Type 2 MI is a category of myocardial infarction according to the UDMI, frequently encountered in routine practice but still poorly understood in terms of prevalence, diagnostic and therapeutic approach, it affects a heterogeneous population at high risk of major cardiovascular events and non-cardiac death. It is due to an inadequacy between oxygen supply and demand in the absence of a primary coronary event, e.g. coronary artery spasm, coronary embolism, anemia, arrhythmias, hypertension or hypotension. Diagnosis has traditionally required an integrated history assessment, with some combination of indirect evidence of myocardial necrosis based on biochemical, electrocardiographic, and imaging modalities. Differentiation between type 1 and type 2 MI is more complicated than it appears. Treatment of the underlying pathology is the primary goal of treatment.
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Affiliation(s)
- Nomidia El Gallazzi
- Université de medecine abdelmalek essadi-Centre universitaire mohammed VI tanger tetouan al hoceima, Maroc.
| | - Hafida Mhani
- Université de medecine abdelmalek essadi-Centre universitaire mohammed VI tanger tetouan al hoceima, Maroc.
| | - Fadoua Lahnaoui
- Université de medecine abdelmalek essadi-Centre universitaire mohammed VI tanger tetouan al hoceima, Maroc.
| | - Nazha Amlouk
- Université de medecine abdelmalek essadi-Centre universitaire mohammed VI tanger tetouan al hoceima, Maroc.
| | - Badr El Boussaadani
- Université de medecine abdelmalek essadi-Centre universitaire mohammed VI tanger tetouan al hoceima, Maroc.
| | - Zainab Raissouni
- Université de medecine abdelmalek essadi-Centre universitaire mohammed VI tanger tetouan al hoceima, Maroc.
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Badaró R, Novaes G, Andrade AC, de Araujo Neto CA, Machado BA, Barbosa JDV, Soares MBP. Myocardial infarction or myocarditis? A case report and review of a myocardial adverse event associated with mRNA vaccine. Front Med (Lausanne) 2023; 10:1071239. [PMID: 36817791 PMCID: PMC9932914 DOI: 10.3389/fmed.2023.1071239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
A 23-year-old man started with chest pain 8 h after his first Pfizer-BioNTech COVID-19 vaccination. ECG evaluation showed sinus tachycardia with ST-segment elevation in D1, AVL, V5, and V6, the findings compatible with acute subepicardial myocardial damage. However, cardiac MRI documented myocardial fibrosis, with cardiac late enhancement non-ischemic pattern with diffuse edema. He had no other symptoms to suggest another etiology than the vaccination. The patient was hospitalized and received corticosteroid (prednisolone) daily. Then, 2 weeks after hospitalization, all laboratory parameters and ECG were normal and the patient was discharged from the hospital. The patient had a history of Wolf-Parkinson White that was corrected with ablation when he was 11 years old. This report calls attention to myocardial adverse reaction risk for mRNA COVID-19 vaccines for people with a previous cardiac disease history.
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Affiliation(s)
- Roberto Badaró
- SENAI Institute of Innovation (ISI) in Health Advanced Systems, University Center SENAI/CIMATEC, Salvador, Brazil,Allmed Specialized Clinic, Salvador, Brazil,*Correspondence: Roberto Badaró,
| | | | | | | | - Bruna Aparecida Machado
- SENAI Institute of Innovation (ISI) in Health Advanced Systems, University Center SENAI/CIMATEC, Salvador, Brazil
| | - Josiane Dantas Viana Barbosa
- SENAI Institute of Innovation (ISI) in Health Advanced Systems, University Center SENAI/CIMATEC, Salvador, Brazil
| | - Milena Botelho Pereira Soares
- SENAI Institute of Innovation (ISI) in Health Advanced Systems, University Center SENAI/CIMATEC, Salvador, Brazil,Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil,Milena Botelho Pereira Soares,
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11
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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12
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Qiu J, Li L, Wang S, Zhang K, Chen Y, Yang S, Zhuang X. MyoPS-Net: Myocardial pathology segmentation with flexible combination of multi-sequence CMR images. Med Image Anal 2023; 84:102694. [PMID: 36495601 DOI: 10.1016/j.media.2022.102694] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
Myocardial pathology segmentation (MyoPS) can be a prerequisite for the accurate diagnosis and treatment planning of myocardial infarction. However, achieving this segmentation is challenging, mainly due to the inadequate and indistinct information from an image. In this work, we develop an end-to-end deep neural network, referred to as MyoPS-Net, to flexibly combine five-sequence cardiac magnetic resonance (CMR) images for MyoPS. To extract precise and adequate information, we design an effective yet flexible architecture to extract and fuse cross-modal features. This architecture can tackle different numbers of CMR images and complex combinations of modalities, with output branches targeting specific pathologies. To impose anatomical knowledge on the segmentation results, we first propose a module to regularize myocardium consistency and localize the pathologies, and then introduce an inclusiveness loss to utilize relations between myocardial scars and edema. We evaluated the proposed MyoPS-Net on two datasets, i.e., a private one consisting of 50 paired multi-sequence CMR images and a public one from MICCAI2020 MyoPS Challenge. Experimental results showed that MyoPS-Net could achieve state-of-the-art performance in various scenarios. Note that in practical clinics, the subjects may not have full sequences, such as missing LGE CMR or mapping CMR scans. We therefore conducted extensive experiments to investigate the performance of the proposed method in dealing with such complex combinations of different CMR sequences. Results proved the superiority and generalizability of MyoPS-Net, and more importantly, indicated a practical clinical application. The code has been released via https://github.com/QJYBall/MyoPS-Net.
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Affiliation(s)
- Junyi Qiu
- School of Data Science, Fudan University, Shanghai, China
| | - Lei Li
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Sihan Wang
- School of Data Science, Fudan University, Shanghai, China
| | - Ke Zhang
- School of Data Science, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China.
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13
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Vignale D, Palmisano A, Colantoni C, Brunetti L, Nicoletti V, Gnasso C, Esposito A. Toward a One-Stop Shop CT Protocol in Acute Chest Pain Syndrome. Radiology 2023; 306:E3-E4. [PMID: 36165795 DOI: 10.1148/radiol.220844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60, 20132 Milan, Italy
| | - Caterina Colantoni
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lisa Brunetti
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60, 20132 Milan, Italy
| | - Valeria Nicoletti
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Gnasso
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60, 20132 Milan, Italy
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14
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Abdulkareem M, Kenawy AA, Rauseo E, Lee AM, Sojoudi A, Amir-Khalili A, Lekadir K, Young AA, Barnes MR, Barckow P, Khanji MY, Aung N, Petersen SE. Predicting post-contrast information from contrast agent free cardiac MRI using machine learning: Challenges and methods. Front Cardiovasc Med 2022; 9:894503. [PMID: 36051279 PMCID: PMC9426684 DOI: 10.3389/fcvm.2022.894503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Currently, administering contrast agents is necessary for accurately visualizing and quantifying presence, location, and extent of myocardial infarction (MI) with cardiac magnetic resonance (CMR). In this study, our objective is to investigate and analyze pre- and post-contrast CMR images with the goal of predicting post-contrast information using pre-contrast information only. We propose methods and identify challenges. Methods The study population consists of 272 retrospectively selected CMR studies with diagnoses of MI (n = 108) and healthy controls (n = 164). We describe a pipeline for pre-processing this dataset for analysis. After data feature engineering, 722 cine short-axis (SAX) images and segmentation mask pairs were used for experimentation. This constitutes 506, 108, and 108 pairs for the training, validation, and testing sets, respectively. We use deep learning (DL) segmentation (UNet) and classification (ResNet50) models to discover the extent and location of the scar and classify between the ischemic cases and healthy cases (i.e., cases with no regional myocardial scar) from the pre-contrast cine SAX image frames, respectively. We then capture complex data patterns that represent subtle signal and functional changes in the cine SAX images due to MI using optical flow, rate of change of myocardial area, and radiomics data. We apply this dataset to explore two supervised learning methods, namely, the support vector machines (SVM) and the decision tree (DT) methods, to develop predictive models for classifying pre-contrast cine SAX images as being a case of MI or healthy. Results Overall, for the UNet segmentation model, the performance based on the mean Dice score for the test set (n = 108) is 0.75 (±0.20) for the endocardium, 0.51 (±0.21) for the epicardium and 0.20 (±0.17) for the scar. For the classification task, the accuracy, F1 and precision scores of 0.68, 0.69, and 0.64, respectively, were achieved with the SVM model, and of 0.62, 0.63, and 0.72, respectively, with the DT model. Conclusion We have presented some promising approaches involving DL, SVM, and DT methods in an attempt to accurately predict contrast information from non-contrast images. While our initial results are modest for this challenging task, this area of research still poses several open problems.
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Affiliation(s)
- Musa Abdulkareem
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Asmaa A. Kenawy
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Elisa Rauseo
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Aaron M. Lee
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Karim Lekadir
- Artificial Intelligence in Medicine Lab (BCN-AIM), Faculty of Mathematics and Computer Science, University of Barcelona, Barcelona, Spain
| | - Alistair A. Young
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
| | - Michael R. Barnes
- Centre for Translational Bioinformatics, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Mohammed Y. Khanji
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Newham University Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Nay Aung
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Steffen E. Petersen
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
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15
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Addae-Mensah K, Revels J, Febbo J. Pitfalls and pearls in the imaging of cardiac ischemia. Semin Ultrasound CT MR 2022; 43:184-193. [PMID: 35688530 DOI: 10.1053/j.sult.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease is the most common cause of cardiac ischemia and a leading cause of death globally. There are multiple imaging modalities which can assess cardiac ischemia, in particular coronary CT calcium score, coronary CT angiography, and cardiac MRI. Each of these modalities offers insight into the overall patient picture. However, coronary CT and cardiac MRI are not free from limitations. This article will review the roles of CT and MRI in cardiac imaging, mimics, technical limitations, and potential pitfalls that may be encountered.
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Affiliation(s)
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, Albuquerque, NM..
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16
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Polacin M, Karolyi M, Eberhard M, Matziris I, Alkadhi H, Kozerke S, Manka R. Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences. BMC Cardiovasc Disord 2022; 22:226. [PMID: 35585495 PMCID: PMC9118592 DOI: 10.1186/s12872-022-02664-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams. Methods 57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. Results Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01). Conclusion Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available.
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Affiliation(s)
- Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
| | - Mihaly Karolyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ioannis Matziris
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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17
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Nguyen Nguyen N, Assad JG, Femia G, Schuster A, Otton J, Nguyen TL. Role of cardiac magnetic resonance imaging in troponinemia syndromes. World J Cardiol 2022; 14:190-205. [PMID: 35582465 PMCID: PMC9048277 DOI: 10.4330/wjc.v14.i4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/13/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is an evolving technology, proving to be a highly accurate tool for quantitative assessment. Most recently, it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia. Although an elevation in troponin is a nonspecific marker of myocardial tissue damage, it is a frequently ordered investigation leaving many patients without a specific diagnosis. Fortunately, the advent of newer cardiac MRI protocols can provide additional information. In this review, we discuss several conditions associated with an elevation in troponin such as myocardial infarction, myocarditis, Takotsubo cardiomyopathy, coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.
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Affiliation(s)
- Nhung Nguyen Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Joseph George Assad
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Campbelltown Hospital, Campbelltown 2560, NSW, Australia
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Göttingen 37075, Germany
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Tuan Le Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
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18
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Alkhatib D, Al-Sabeq B. Rare Coronary Embolism Secondary to Cardioversion of Atrial Fibrillation. Cureus 2022; 14:e24354. [PMID: 35611046 PMCID: PMC9124055 DOI: 10.7759/cureus.24354] [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] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
The diagnosis and management of myocardial infarction with nonobstructive coronary arteries (MINOCA) are difficult due to its variable presentations, different causes, and challenging diagnostic approaches. Cardiac imaging modalities including cardiac magnetic resonance (CMR) are very useful tools for diagnosing and managing MINOCA. Myocardial infarction (MI) can be caused by coronary emboli that can be contributed to atrial fibrillation (AF). Rarely, coronary embolism with resultant MINOCA can occur after direct current cardioversion (DCCV) even in fully anticoagulated patients. We present a rare case of a coronary embolism following DCCV as well as a CMR finding of microvascular obstruction (MVO), which has not previously been reported after DCCV. This case also emphasizes the value of obtaining a CMR for patients with MINOCA.
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19
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Karam M, Fahs D, Maatouk B, Safi B, Jaffa AA, Mhanna R. Polymeric nanoparticles in the diagnosis and treatment of myocardial infarction: Challenges and future prospects. Mater Today Bio 2022; 14:100249. [PMID: 35434594 PMCID: PMC9006854 DOI: 10.1016/j.mtbio.2022.100249] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
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20
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Shah DV, Kalekar DT, Gupta DA, Lamghare DP. Role of Late Gadolinium Enhancement in the Assessment of Myocardial Viability. Cureus 2022; 14:e22844. [PMID: 35382188 PMCID: PMC8977074 DOI: 10.7759/cureus.22844] [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] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Prior to any revascularization procedure for coronary artery disease, it is essential to identify viable myocardium which will likely benefit from it. In such a situation, delayed enhanced cardiac MRI is beneficial. Methods: Our study consisted of 50 patients with at least a one-month prior history of myocardial infarction (MI), abnormal findings on electrocardiography (ECG), and 2D-echocardiography (2D-ECHO), who were subjected to cardiac MRI performed on a 3T MRI machine. The MRI scans were evaluated for anatomical and especially functional characteristics of the heart, such as wall motion. On late gadolinium enhancement (LGE), the diseased segments were classified into two categories: < 50% LGE (viable) and > 50% LGE (non-viable). Results: Of the 378 diseased segments detected on LGE, 137 (36.2%) segments showed < 50% LGE and 241 (63.8%) segments showed > 50% LGE. The segments showing < 50% LGE showed normokinesia or hypokinesia, with none of the segments showing akinesia or dyskinesia, whereas the segments showing > 50% LGE showed akinesia or dyskinesia predominantly. This was found to be statistically highly significant (p-value < 0.001). Conclusion: Delayed enhanced-cardiac magnetic resonance (DE-CMR) imaging in patients with ischemic heart disease (IHD) helps evaluate the severity of the infarcted myocardium by classifying the diseased myocardium into viable and non-viable, as viable myocardium is more likely to regain functional recovery than non-viable myocardium. It also predicts the functional recovery of the myocardium after revascularization therapy.
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21
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Qi RX, Jiang JS, Shao J, Zhang Q, Zheng KL, Xiao J, Huang S, Gong SC. Measurement of myocardial extracellular volume fraction in patients with heart failure with preserved ejection fraction using dual-energy computed tomography. Eur Radiol 2022; 32:4253-4263. [DOI: 10.1007/s00330-021-08514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
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22
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Liu P, Lin L, Xu C, Han Y, Lin X, Hou Y, Lu X, Vembar M, Jin Z, Wang Y. Quantitative analysis of late iodine enhancement using dual-layer spectral detector computed tomography: comparison with magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:310-320. [PMID: 34993080 DOI: 10.21037/qims-21-344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the segmental myocardial extracellular volume (ECV) fraction and to define a threshold ECV value that can be used to distinguish positive late gadolinium enhancement (LGE) segments from negative myocardial segments using dual-layer spectral detector computed tomography (SDCT), with magnetic resonance imaging (MRI) as a reference. METHODS Fifty-six subjects with cardiac disease or suspected cardiac disease, underwent both late iodine enhancement on CT (CT-LIE) scanning and late gadolinium enhancement on MRI (MRI-LGE) scanning. Each procedure occurred within a week of the other. Global and segmental ECVs of the left ventricle were measured by CT and MRI images. According to the location and pattern of delayed enhancement on MRI image, myocardial segments were classified into 3 groups: ischemic LGE segments (group 1), nonischemic LGE segments (group 2) and negative LGE segments (group 3). The correlation and agreement between CT-ECV and MRI-ECV were compared on a per-segment basis. Receiver operating characteristic (ROC) curve analysis was performed to establish a threshold for LIE detection. RESULTS Among the 56 patients, 896 segments were analyzed, and of these, 73 segments were in group 1, 229 segments were in group 2, and 594 segments were in group 3. In segmental analysis, CT-ECV in group 3 (27.0%; 24.9-28.9%) was significantly lower than that in group 1 (33.2%; 30.7-36.3%) and group 2 (34.9%; 32.3-39.8%; all P<0.001). Good correlations were seen between CT-ECV and MRI-ECV for all groups (group 1: r=0.920; group 2: r=0.936; group 3: r=0.799; all P<0.001). Bland-Altman analysis between CT-ECV and MRI-ECV showed a small bias in all 3 groups (group 1: -2.1%, 95% limits of agreement -11.3-7.1%; group 2: -0.6%, 95% limits of agreement -13.1-11.9%; group 3: 1.0%, 95% limits of agreement -12.7-14.7%). CT-ECV could differentiate between LGE-positive and LGE-negative segments with 83.1% sensitivity and 93.3% specificity at a cutoff of 31%. CONCLUSIONS ECV values derived from CT imaging showed good correlation and agreement with MR imaging findings, and CT-ECV provided high diagnostic accuracy for discriminating between LGE-positive and LGE-negative segments. Thus, cardiac CT imaging might be a suitable noninvasive imaging technique for myocardial ECV quantification.
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Affiliation(s)
- Peijun Liu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Lin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yechen Han
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Lin
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaomei Lu
- Clinical Science, Philips Healthcare, Beijing, China
| | - Mani Vembar
- CT Clinical Science, Philips Healthcare, Cleveland, OH, USA
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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A 3D Network Based Shape Prior for Automatic Myocardial Disease Segmentation in Delayed-Enhancement MRI. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Peng F, Zheng T, Tang X, Liu Q, Sun Z, Feng Z, Zhao H, Gong L. Magnetic Resonance Texture Analysis in Myocardial Infarction. Front Cardiovasc Med 2021; 8:724271. [PMID: 34778395 PMCID: PMC8581163 DOI: 10.3389/fcvm.2021.724271] [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: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Texture analysis (TA) is a newly arisen field that can detect the invisible MRI signal changes among image pixels. Myocardial infarction (MI) is cardiomyocyte necrosis caused by myocardial ischemia and hypoxia, becoming the primary cause of death and disability worldwide. In recent years, various TA studies have been performed in patients with MI and show a good clinical application prospect. This review briefly presents the main pathogenesis and pathophysiology of MI, introduces the overview and workflow of TA, and summarizes multiple magnetic resonance TA (MRTA) clinical applications in MI. We also discuss the facing challenges currently for clinical utilization and propose the prospect.
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Affiliation(s)
- Fei Peng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tian Zheng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoping Tang
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiao Liu
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zijing Sun
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaofeng Feng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Lianggeng Gong
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
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25
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Bustin A, Sridi S, Gravinay P, Legghe B, Gosse P, Ouattara A, Rozé H, Coste P, Gerbaud E, Desclaux A, Boyer A, Prevel R, Gruson D, Bonnet F, Issa N, Montaudon M, Laurent F, Stuber M, Camou F, Cochet H. High-resolution Free-breathing late gadolinium enhancement Cardiovascular magnetic resonance to diagnose myocardial injuries following COVID-19 infection. Eur J Radiol 2021; 144:109960. [PMID: 34600236 PMCID: PMC8450147 DOI: 10.1016/j.ejrad.2021.109960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE High-resolution free-breathing late gadolinium enhancement (HR-LGE) was shown valuable for the diagnosis of acute coronary syndromes with non-obstructed coronary arteries. The method may be useful to detect COVID-related myocardial injuries but is hampered by prolonged acquisition times. We aimed to introduce an accelerated HR-LGE technique for the diagnosis of COVID-related myocardial injuries. METHOD An undersampled navigator-gated HR-LGE (acquired resolution of 1.25 mm3) sequence combined with advanced patch-based low-rank reconstruction was developed and validated in a phantom and in 23 patients with structural heart disease (test cohort; 15 men; 55 ± 16 years). Twenty patients with laboratory-confirmed COVID-19 infection associated with troponin rise (COVID cohort; 15 men; 46 ± 24 years) prospectively underwent cardiovascular magnetic resonance (CMR) with the proposed sequence in our center. Image sharpness, quality, signal intensity differences and diagnostic value of free-breathing HR-LGE were compared against conventional breath-held low-resolution LGE (LR-LGE, voxel size 1.8x1.4x6mm). RESULTS Structures sharpness in the phantom showed no differences with the fully sampled image up to an undersampling factor of x3.8 (P > 0.5). In patients (N = 43), this acceleration allowed for acquisition times of 7min21s ± 1min12s at 1.25 mm3 resolution. Compared with LR-LGE, HR-LGE showed higher image quality (P = 0.03) and comparable signal intensity differences (P > 0.5). In patients with structural heart disease, all LGE-positive segments on LR-LGE were also detected on HR-LGE (80/391) with 21 additional enhanced segments visible only on HR-LGE (101/391, P < 0.001). In 4 patients with COVID-19 history, HR-LGE was definitely positive while LR-LGE was either definitely negative (1 microinfarction and 1 myocarditis) or inconclusive (2 myocarditis). CONCLUSIONS Undersampled free-breathing isotropic HR-LGE can detect additional areas of late enhancement as compared to conventional breath-held LR-LGE. In patients with history of COVID-19 infection associated with troponin rise, the method allows for detailed characterization of myocardial injuries in acceptable scan times and without the need for repeated breath holds.
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Affiliation(s)
- Aurélien Bustin
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux - INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Soumaya Sridi
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Pierre Gravinay
- Cardiac Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Benoit Legghe
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Philippe Gosse
- Cardiac Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Alexandre Ouattara
- Department of Anaesthesia and Critical Care, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Hadrien Rozé
- Department of Anaesthesia and Critical Care, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Pierre Coste
- Cardiac Intensive Care Unit, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France
| | - Edouard Gerbaud
- Cardiac Intensive Care Unit, Groupe Hospitalier Sud, CHU de Bordeaux, Pessac, France
| | - Arnaud Desclaux
- Infectious disease Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Renaud Prevel
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Didier Gruson
- Medical Intensive Care Unit, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Fabrice Bonnet
- Infectious Disease Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Nahema Issa
- Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Michel Montaudon
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - François Laurent
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux - INSERM U1045, Avenue du Haut Lévêque, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Lausanne, Switzerland
| | - Fabrice Camou
- Intensive Care Unit, Hôpital St André, CHU Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux - INSERM U1045, Avenue du Haut Lévêque, Pessac, France
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Cardiovascular Magnetic Resonance (CMR) for the Evaluation of Myocardial Infarction in Patients with Non-obstructive Coronary Artery Disease (MINOCA). CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
Myocardial infarction in the absence of coronary artery disease is caused by a variety of clinical conditions, so it is important to detect the specific causes in order to perform a better prognostic stratification of these patients. The aim of this review is to summarize the most important findings that established the role of CMR (cardiovascular magnetic resonance) to detect the MINOCA (myocardial infarction with non-obstructive arteries) patients and the importance to differentiate them from myocardial infarction patients.
Recent Findings
The role of CMR is crucial to diagnose the principal diseases involved in MINOCA, as demonstrated. The several MR sequences used in all the MINOCA patients showed different results for all the different causes of MINOCA and, surely, high-resolution MR with gadolinium enhancement has been considered the best method to differentiate the transmural lesions.
Summary
Another fundamental aspect to be considered is the experience of CMR radiologists, which represent the most important element for the right diagnosis of MINOCA. Surely, in the future, CMR will be the most important technique of choice for MINOCA patients, playing a key role in their management.
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27
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Myocardial Infarction Quantification from Late Gadolinium Enhancement MRI Using Top-Hat Transforms and Neural Networks. ALGORITHMS 2021. [DOI: 10.3390/a14080249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Late gadolinium enhancement (LGE) MRI is the gold standard technique for myocardial viability assessment. Although the technique accurately reflects the damaged tissue, there is no clinical standard to quantify myocardial infarction (MI). Moreover, commercial software used in clinical practice are mostly semi-automatic, and hence require direct intervention of experts. In this work, a new automatic method for MI quantification from LGE-MRI is proposed. Our novel segmentation approach is devised for accurately detecting not only hyper-enhanced lesions, but also microvascular obstruction areas. Moreover, it includes a myocardial disease detection step which extends the algorithm for working under healthy scans. The method is based on a cascade approach where firstly, diseased slices are identified by a convolutional neural network (CNN). Secondly, by means of morphological operations a fast coarse scar segmentation is obtained. Thirdly, the segmentation is refined by a boundary-voxel reclassification strategy using an ensemble of very light CNNs. We tested the method on a LGE-MRI database with healthy (n = 20) and diseased (n = 80) cases following a 5-fold cross-validation scheme. Our approach segmented myocardial scars with an average Dice coefficient of 77.22 ± 14.3% and with a volumetric error of 1.0 ± 6.9 cm3. In a comparison against nine reference algorithms, the proposed method achieved the highest agreement in volumetric scar quantification with the expert delineations (p< 0.001 when compared to the other approaches). Moreover, it was able to reproduce the scar segmentation intra- and inter-rater variability. Our approach was shown to be a good first attempt towards automatic and accurate myocardial scar segmentation, although validation over larger LGE-MRI databases is needed.
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28
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Goerne H, de la Fuente D, Cabrera M, Chaturvedi A, Vargas D, Young PM, Saboo SS, Rajiah P. Imaging Features of Complications after Coronary Interventions and Surgical Procedures. Radiographics 2021; 41:699-719. [PMID: 33798007 DOI: 10.1148/rg.2021200147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Coronary artery interventions and surgical procedures are used in the treatment of coronary artery disease and some congenital heart diseases. Cardiac and noncardiac complications can occur at variable times after these procedures, with the clinical presentation ranging from asymptomatic to devastating symptoms. Invasive coronary angiography is the reference standard modality used in the evaluation of coronary arteries, with intravascular US and optical coherence tomography providing high-resolution information regarding the vessel wall. CT is the mostly commonly used noninvasive imaging modality in the evaluation of coronary artery intervention complications and allows assessment of the stent, lumen of the stent, lumen of the coronary arteries, and extracoronary structures. MRI is limited to the evaluation of the proximal coronary arteries but allows comprehensive evaluation of the myocardium, including ischemia and infarction. The authors review the clinical symptoms and pathophysiologic and imaging features of various complications of coronary artery interventions and surgical procedures. Complications of percutaneous coronary interventions are discussed, including restenosis, thrombosis, dissection of coronary arteries or the aorta, coronary wall rupture or perforation, stent deployment failure, stent fracture, stent infection, stent migration or embolism, and reperfusion injury. Complications of several surgical procedures are reviewed, including coronary artery bypass grafting, coronary artery reimplantation procedure (for anomalous origin from opposite sinuses or the pulmonary artery or as part of surgical procedures such as arterial switching surgery and the Bentall and Cabrol procedures), coronary artery unroofing, and the Takeuchi procedure. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Harold Goerne
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Diego de la Fuente
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Miguel Cabrera
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Abhishek Chaturvedi
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Daniel Vargas
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Phillip M Young
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Sachin S Saboo
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
| | - Prabhakar Rajiah
- From the Department of Cardiac Imaging, Imaging and Diagnostic Center CID, Americas Avenue 2016, Guadalajara, Jalisco, Mexico (H.G.); Department of Radiology, Western National Medical Center IMSS, Guadalajara, Jalisco, Mexico (H.G., D.d.l.F., M.C.); Department of Radiology, University of Rochester Medical Center, Rochester, NY (A.C.); Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.M.Y., P.R.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.S.)
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29
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Le TT, Ang BWY, Bryant JA, Chin CY, Yeo KK, Wong PEH, Ho KW, Tan JWC, Lee PT, Chin CWL, Cook SA. Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial. J Cardiovasc Magn Reson 2021; 23:17. [PMID: 33658056 PMCID: PMC7931509 DOI: 10.1186/s12968-021-00705-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. METHODS In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. RESULTS In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94-1.00)] in discriminating between FFR-normal and FFR-positive patients. CONCLUSION The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. TRIAL REGISTRATION ClinicalTrials.gov, NCT03217227, Registered 11 July 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart.
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Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Briana W Y Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Chee Yang Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Philip E H Wong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Kay Woon Ho
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jack W C Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Phong Teck Lee
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Calvin W L Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart A Cook
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
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30
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Jiang X, Li J, Zhang X, Chen H. Acute coronary syndrome in a young woman with a giant coronary aneurysm and mitral valve prolapse: a case report and literature review. J Int Med Res 2021; 49:300060521999525. [PMID: 33752500 PMCID: PMC7995495 DOI: 10.1177/0300060521999525] [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: 12/24/2020] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
Acute coronary syndrome in the young population is infrequently seen and has a different etiology from that in the elderly population. Giant coronary artery aneurysms are rare and usually asymptomatic, but they can cause acute clinical symptoms such as chest pain or chest tightness. We herein describe a young woman with a history of mitral valve prolapse who developed sudden-onset chest pain. She had mild elevations of her creatine kinase and cardiac troponin levels; however, no ST segment alteration was found on an electrocardiogram, and no abnormal regional wall movement was noted on echocardiography. Cardiac magnetic resonance imaging with late gadolinium enhancement revealed a "mass" at the right coronary artery and linear subendocardial enhancement at the posterior wall. Coronary angiography later confirmed a giant coronary aneurysm with a substantial thrombus. The combined presence of the coronary artery aneurysm and mitral valve prolapse in this patient was likely a sequela of Kawasaki disease.
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Affiliation(s)
- Xiaoyan Jiang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Lab of Cardiovascular Disease Diagnosis and Treatment, Zhejiang, China
- Department of Medical Examinations, First People’s Hospital of Wenling, Zhejiang, China
| | - Jiamin Li
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Lab of Cardiovascular Disease Diagnosis and Treatment, Zhejiang, China
| | - Xuehua Zhang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Lab of Cardiovascular Disease Diagnosis and Treatment, Zhejiang, China
| | - Han Chen
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Lab of Cardiovascular Disease Diagnosis and Treatment, Zhejiang, China
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31
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Blinick R, Chaya N, Zalta B, Haramati LB, Shmukler A. Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse. J Thorac Imaging 2021; 36:W16-W31. [PMID: 32102017 DOI: 10.1097/rti.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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Affiliation(s)
| | - Nathan Chaya
- Montefiore Medical Center, Bronx
- Staten Island University Hospital, Staten Island, NY
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32
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Fleming H, Clifford SM, Haughey A, MacDermott R, McVeigh N, Healy GM, Lavelle L, Abbara S, Murphy DJ, Fabre A, McKone E, McCarthy C, Butler M, Doran P, Lynch DA, Keane MP, Dodd JD. Differentiating combined pulmonary fibrosis and emphysema from pure emphysema: utility of late gadolinium-enhanced MRI. Eur Radiol Exp 2020; 4:61. [PMID: 33141269 PMCID: PMC7641295 DOI: 10.1186/s41747-020-00187-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Differentiating combined pulmonary fibrosis with emphysema (CPFE) from pure emphysema can be challenging on high-resolution computed tomography (HRCT). This has antifibrotic therapy implications. Methods Twenty patients with suspected CPFE underwent late gadolinium-enhanced (LGE) thoracic magnetic resonance imaging (LGE-MRI) and HRCT. Data from twelve healthy control subjects from a previous study who underwent thoracic LGE-MRI were included for comparison. Quantitative LGE signal intensity (SI) was retrospectively compared in regions of fibrosis and emphysema in CPFE patients to similar lung regions in controls. Qualitative comparisons for the presence/extent of reticulation, honeycombing, and traction bronchiectasis between LGE-MRI and HRCT were assessed by two readers in consensus. Results There were significant quantitative differences in fibrosis SI compared to emphysema SI in CPFE patients (25.8, IQR 18.4–31.0 versus 5.3, IQR 5.0–8.1, p < 0.001). Significant differences were found between LGE-MRI and HRCT in the extent of reticulation (12.5, IQR 5.0–20.0 versus 25.0, IQR 15.0–26.3, p = 0.038) and honeycombing (5.0, IQR 0.0–10.0 versus 20.0, IQR 10.6–20.0, p = 0.001) but not traction bronchiectasis (10.0, IQR 5–15 versus 15.0, IQR 5–15, p = 0.878). Receiver operator curve analysis of fibrosis SI compared to similarly located regions in control subjects showed an area under the curve of 0.82 (p = 0.002). A SI cutoff of 19 yielded a sensitivity of 75% and specificity of 86% in differentiating fibrosis from similarly located regions in control subjects. Conclusion LGE-MRI can differentiate CPFE from pure emphysema and may be a useful adjunct test to HRCT in patients with suspected CPFE.
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Affiliation(s)
- Hannah Fleming
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Simon M Clifford
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Aoife Haughey
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Roisin MacDermott
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Niall McVeigh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Lisa Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Hospital, Dallas, TX, USA
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Edward McKone
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Marcus Butler
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Peter Doran
- UCD Clinical Research Center, University College Dublin, Dublin, Ireland
| | - David A Lynch
- Department of Radiology, National Jewish Medical and Research Center, Denver, CO, USA
| | - Michael P Keane
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. .,School of Medicine, University College Dublin, Dublin, Ireland.
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33
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Life-saving myocarditis? A case in a young adult leading to discovery of an anomalous origin of the right coronary artery. Cardiol Young 2020; 30:1510-1511. [PMID: 32741418 DOI: 10.1017/s1047951120002279] [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] [Indexed: 11/06/2022]
Abstract
Myocarditis and coronary artery anomalies are both potentially life-threatening aetiologies of cardiac chest pain in children. We present a case of a young man presenting with non-exertional chest pain and subsequently found to have an anomalous origin of the right coronary artery from the left coronary sinus with an interarterial course in addition to a diagnosis of myocarditis. The patient subsequently was able to undergo surgical correction of his anomalous coronary to mitigate the risk of sudden cardiac death.
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34
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Buffa V, Di Renzi P. CMR in the diagnosis of ischemic heart disease. Radiol Med 2020; 125:1114-1123. [PMID: 32936388 DOI: 10.1007/s11547-020-01278-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.
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Affiliation(s)
- Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
| | - Paolo Di Renzi
- Department of Radiology, Ospedale San Giovanni Calibita FBF, Rome, Italy
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35
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Im DJ, Hong SJ, Park EA, Kim EY, Jo Y, Kim J, Park CH, Yong HS, Lee JW, Hur JH, Yang DH, Lee BY. Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging-Part 3: Perfusion, Delayed Enhancement, and T1- and T2 Mapping. Korean J Radiol 2020; 20:1562-1582. [PMID: 31854146 PMCID: PMC6923208 DOI: 10.3348/kjr.2019.0411] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022] Open
Abstract
This document is the third part of the guidelines for the protocol, the interpretation and post-processing of cardiac magnetic resonance (CMR) studies. These consensus recommendations have been developed by the Consensus Committee of the Korean Society of Cardiovascular Imaging to standardize the requirements for image interpretation and post-processing of CMR. This third part of the recommendations describes tissue characterization modules, including perfusion, late gadolinium enhancement, and T1- and T2 mapping. Additionally, this document provides guidance for visual and quantitative assessment consisting of “What-to-See,” “How-To,” and common pitfalls for the analysis of each module. The Consensus Committee hopes that this document will contribute to the standardization of image interpretation and post-processing of CMR studies.
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Affiliation(s)
- Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yeseul Jo
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Jeju, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Jae Wook Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jee Hye Hur
- Department of Radiology, Hanil General Hospital, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bae Young Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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36
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Zabihollahy F, Rajan S, Ukwatta E. Machine Learning-Based Segmentation of Left Ventricular Myocardial Fibrosis from Magnetic Resonance Imaging. Curr Cardiol Rep 2020; 22:65. [PMID: 32562100 DOI: 10.1007/s11886-020-01321-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Myocardial fibrosis (MF) arises due to myocardial infarction and numerous cardiac diseases. MF may lead to several heart disorders, such as heart failure, arrhythmias, and ischemia. Cardiac magnetic resonance (CMR) imaging techniques, such as late gadolinium enhancement (LGE) CMR, enable non-invasive assessment of MF in the left ventricle (LV). Manual assessment of MF on CMR is a tedious and time-consuming task that is subject to high observer variability. Automated segmentation and quantification of MF is important for risk stratification and treatment planning in patients with heart disorders. This article aims to review the machine learning (ML)-based methodologies developed for MF quantification in the LV using CMR images. RECENT FINDINGS With the availability of relatively large labeled datasets supervised learning methods based on both conventional ML and state-of-the-art deep learning (DL) methods have been successfully applied for automated segmentation of MF. The incorporation of ML algorithms into imaging techniques such as 3D LGE CMR permits fast characterization of MF on CMR imaging and may enhance the diagnosis and prognosis of patients with heart disorders. Concurrently, the studies using cine CMR images have revealed that accurate segmentation of MF on non-contrast CMR imaging might be possible. The application of ML/DL tools in CMR image interpretation is likely to result in accurate and efficient quantification of MF.
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Affiliation(s)
- Fatemeh Zabihollahy
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada.
| | - S Rajan
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - E Ukwatta
- School of Engineering, University of Guelph, Guelph, ON, Canada
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37
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Affiliation(s)
- Moises Vasquez
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
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38
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Nazir SA, Shetye AM, Khan JN, Singh A, Arnold JR, Squire I, McCann GP. Inter-study repeatability of circumferential strain and diastolic strain rate by CMR tagging, feature tracking and tissue tracking in ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2020; 36:1133-1146. [PMID: 32152811 PMCID: PMC7228913 DOI: 10.1007/s10554-020-01806-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Strain assessment allows accurate evaluation of myocardial function and mechanics in ST-segment elevation myocardial infarction (STEMI). Strain using cardiovascular magnetic resonance (CMR) has traditionally been assessed with tagging but limitations of this technique have led to more widespread use of alternative methods, which may be more robust. We compared the inter-study repeatability of circumferential global peak-systolic strain (Ecc) and peak-early diastolic strain rate (PEDSR) derived by tagging with values obtained using novel cine-based software: Feature Tracking (FT) (TomTec, Germany) and Tissue Tracking (TT) (Circle cvi42, Canada) in patients following STEMI. Twenty male patients (mean age 56 ± 10 years, mean infarct size 13.7 ± 7.1% of left ventricular mass) were randomised to undergo CMR 1-5 days post-STEMI at 1.5 T or 3.0 T, repeated after ten minutes at the same field strength. Ecc and PEDSR were assessed using tagging, FT and TT. Inter-study repeatability was evaluated using Bland-Altman analyses, coefficients of variation (CoV) and intra-class correlation coefficient (ICC). Ecc (%) was significantly lower with tagging than with FT or TT at 1.5 T (- 9.5 ± 3.3 vs. - 17.5 ± 3.8 vs. -15.5 ± 5.2, respectively, p < 0.001) and 3.0 T (- 13.1 ± 1.8 vs. - 19.4 ± 2.9 vs. - 17.3 ± 2.1, respectively, p = 0.001). This was similar for PEDSR (.s-1): 1.5 T (0.6 ± 0.2 vs. 1.5 ± 0.4 vs. 1.0 ± 0.4, for tagging, FT and TT respectively, p < 0.001) and 3.0 T (0.6 ± 0.2 vs. 1.5 ± 0.3 vs. 0.9 ± 0.3, respectively, p < 0.001). Inter-study repeatability for Ecc at 1.5 T was good for tagging and excellent for FT and TT: CoV 16.7%, 6.38%, and 8.65%, respectively. Repeatability for Ecc at 3.0 T was good for all three techniques: CoV 14.4%, 11.2%, and 13.0%, respectively. However, repeatability of PEDSR was generally lower than that for Ecc at 1.5 T (CoV 15.1%, 13.1%, and 34.0% for tagging, FT and TT, respectively) and 3.0 T (CoV 23.0%, 18.6%, and 26.2%, respectively). Following STEMI, Ecc and PEDSR are higher when measured with FT and TT than with tagging. Inter-study repeatability of Ecc is good for tagging, excellent for FT and TT at 1.5 T, and good for all three methods at 3.0 T. The repeatability of PEDSR is good to moderate at 1.5 T and moderate at 3.0 T. Cine-based methods to assess Ecc following STEMI may be preferable to tagging.
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Affiliation(s)
- Sheraz A. Nazir
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Abhishek M. Shetye
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Jamal N. Khan
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Jayanth R. Arnold
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QF UK
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39
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Escalon JG, Bang TJ, Broncano J, Vargas D. Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Potential Etiologies, Mimics and Imaging Findings. Curr Probl Diagn Radiol 2020; 50:85-94. [PMID: 32513516 DOI: 10.1067/j.cpradiol.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/06/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs when a patient presents with positive cardiac enzymes in the absence of obstructive atherosclerosis on coronary angiography. Several hypotheses for the pathogenesis of MINOCA have been suggested and multiple potential underlying etiologies have been reported. This review will outline the reported causes of MINOCA and associated major imaging features. In doing so, it will increase awareness of this entity and equip cardiac imagers with the knowledge to appropriately tailor imaging to make a prompt and accurate diagnosis.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY.
| | - Tami J Bang
- Department of Radiology, Division of Cardiopulmonary Imaging, University of Colorado School of Medicine, Aurora, CO
| | - Jordi Broncano
- Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA, Health Time Group, Cordoba, Spain
| | - Daniel Vargas
- Department of Radiology, Division of Cardiopulmonary Imaging, University of Colorado School of Medicine, Aurora, CO
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40
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Applications of artificial intelligence in multimodality cardiovascular imaging: A state-of-the-art review. Prog Cardiovasc Dis 2020; 63:367-376. [DOI: 10.1016/j.pcad.2020.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 02/06/2023]
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41
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High-Resolution Late Gadolinium Enhancement Magnetic Resonance for the Diagnosis of Myocardial Infarction With Nonobstructed Coronary Arteries. JACC Cardiovasc Imaging 2020; 13:1135-1148. [DOI: 10.1016/j.jcmg.2019.11.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 02/08/2023]
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42
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Zou Q, Zheng T, Zhou SL, Tang XP, Li SH, Zhou W, Gong LG. Quantitative Evaluation of Myocardial Strain After Myocardial Infarction with Cardiovascular Magnetic Resonance Tissue-Tracking Imaging. Int Heart J 2020; 61:429-436. [PMID: 32350202 DOI: 10.1536/ihj.19-384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To investigate the value of cardiovascular magnetic resonance tissue-tracking (CMR-TT) imaging in the differentiation of subendocardial and transmural myocardial infarction (MI) and determine whether strain parameters are enable to detect adverse left ventricular (LV) remodeling.Global peak circumferential, longitudinal, and radial strains (GPCS, GPLS, GPRS) and segmental peak circumferential, longitudinal, and radial strains (PCS, PLS, PRS) in accordance with the 16-segment model were all derived. All positive segments were divided into two groups according to transmural degree. All patients were dichotomized in accordance with the existence of LV remodeling, which was defined as infarct size (IS) > 24%.Patients with MI showed significant lower GPRS, GPCS, and GPLS than the control group (16.41% ± 8.92%, -8.77%± 3.51%, -7.54% ± 2.43% versus 32.41% ± 12.99%, -14.92% ± 3.32%, -11.50% ± 2.51%). Lower PRS [3.25% (-5.57, 7.835) versus 19.94% (12.50, 30.75), P < 0.001] and PCS (-3.81 ± 4.60% versus -8.97± 4.43%, P < 0.001) can be found in transmural infarcted segments compared to subendocardial infarcted segments. PLS between transmural and subendocardial infarcted segments (-4.03% ± 4.88% versus -4.34% ± 4.98%), without however statistical significance (P = 0.523). The optimal cutoff value for PRS in the discriminate diagnosis of MI was 8.97% with a sensitivity of 81.8% and specificity of 98.0%. The optimal cutoff value for PCS was -7.56% with a sensitivity of 83.6% and specificity of 72.1%. Receiver operating characteristic (ROC) analysis revealed an optimal cutoff GPRS of 15.45%, and GPCS of -6.72% yielded high diagnostic accuracy in the identification of remodeling, which was higher than left ventricular ejection fraction (LVEF).CMR-TT can differentiate between subendocardial and transmural infarction and detect LV remodeling, and the diagnostic value was superior to conventional functional parameters.
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Affiliation(s)
- Qian Zou
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University.,Medical Imaging Center, Shenzhen Hospital, Southern Medical University
| | - Tian Zheng
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University
| | - Shu-Li Zhou
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University
| | - Xue-Pei Tang
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University
| | - Shu-Hao Li
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University
| | - Wei Zhou
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University
| | - Liang-Geng Gong
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University
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43
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Image quality of late gadolinium enhancement in cardiac magnetic resonance with different doses of contrast material in patients with chronic myocardial infarction. Eur Radiol Exp 2020; 4:21. [PMID: 32242266 PMCID: PMC7118177 DOI: 10.1186/s41747-020-00149-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/21/2020] [Indexed: 01/26/2023] Open
Abstract
Background Contrast-enhanced cardiac magnetic resonance (CMR) is pivotal for evaluating chronic myocardial infarction (CMI). Concerns about safety of gadolinium-based contrast agents favour dose reduction. We assessed image quality of scar tissue in CMRs performed with different doses of gadobutrol in CMI patients. Methods Informed consent was waived for this Ethics Committee-approved single-centre retrospective study. Consecutive contrast-enhanced CMRs from CMI patients were retrospectively analysed according to the administered gadobutrol dose (group A, 0.10 mmol/kg; group B, 0.15 mmol/kg; group C, 0.20 mmol/kg). We calculated the signal-to-noise ratio for scar tissue (SNRscar) and contrast-to-noise ratio between scar and either remote myocardium (CNRscar-rem) or blood (CNRscar-blood). Results Of 79 CMRs from 79 patients, 22 belonged to group A, 26 to group B, and 31 to group C. The groups were homogeneous for age, sex, left ventricular morpho-functional parameters, and percentage of scar tissue over whole myocardium (p ≥ 0.300). SNRscar was lower in group A (46.4; 40.3–65.1) than in group B (70.1; 52.2–111.5) (p = 0.013) and group C (72.1; 59.4–100.0) (p = 0.002), CNRscar-rem was lower in group A (62.9; 52.2–87.4) than in group B (96.5; 73.1–152.8) (p = 0.008) and in group C (103.9; 83.9–132.0) (p = 0.001). No other significant differences were found (p ≥ 0.335). Conclusions Gadobutrol at 0.10 mmol/kg provides inferior scar image quality of CMI than 0.15 and 0.20 mmol/kg; the last two dosages seem to provide similar LGE. Thus, for CMR of CMI, 0.15 mmol/kg of gadobutrol can be suggested instead of 0.20 mmol/kg, with no hindrance to scar visualisation. Dose reduction would not impact on diagnostic utility of CMR examinations.
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44
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Serinsoz S, Akturk R, Bayramoglu S. Comparison of cardiac magnetic resonance and cardiac ultrasound imaging findings in congenital and acquired heart diseases. SANAMED 2020. [DOI: 10.24125/sanamed.v15i2.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Nowadays, non-invasive methods are emerging in the evaluation of cardiovascular diseases. The aim of this study was to determine the diagnostic performance of cardiac magnetic resonance (CMR) imaging and cardiac ultrasound imaging (Echo) in cardiac patients diagnosed with Echo previously. Methods: In a total of 32 various cardiac patients with Echo findings including congenital and acquired heart pathologies who applied to our clinic were included in the study. The distribution of cardiac pathologies including valve dysfunctions, right and left ventricular wall lesions and movement disorders, atrioventricular hypertrophy, septal defect, pericardial effusion-mass, additional congenital or acquired vascular pathologies and additional thoracic pathology, age and gender correlations were determined. The CMR and Echo findings were compared statistically. Results: It was found that 12 (37.5%) of the individuals were female, 20 (62.5%) were male, aged between 6 and 80 years with an average age of 29.9 years. The cardiac parameters were positive in 27 (84.4%) patients according to Echo and were positive in 22 (68.8%) patients according to CMR. There was no statistically significant correlation between CMR and Echo for cardiac pathology detection rates (p > 0.05). However, only 18 out of 22 patients who were positive on CMR were positive on Echo. CMR was superior in detecting congenital cardiac pathologies. Conclusion: Echo has a diagnostic advantage and in general, CMR and Echo findings overlap in cases with valve dysfunctions, ventricular wall motion disorders, and hypertrophy, whereas we found that Echo findings were insufficient for diagnosis of congenital heart pathologies.
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45
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Diagnostic Accuracy of Single-shot 2-Dimensional Multisegment Late Gadolinium Enhancement in Ischemic and Nonischemic Cardiomyopathy. J Thorac Imaging 2020; 35:56-63. [PMID: 30870309 DOI: 10.1097/rti.0000000000000402] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Ko SM, Kim TH, Chun EJ, Kim JY, Hwang SH. Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography. Korean J Radiol 2019; 20:333-351. [PMID: 30799565 PMCID: PMC6389818 DOI: 10.3348/kjr.2018.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
Rapid advances in cardiac computed tomography (CT) have enabled the characterization of left ventricular (LV) myocardial diseases based on LV anatomical morphology, function, density, and enhancement pattern. Global LV function and regional wall motion can be evaluated using multi-phasic cine CT images. CT myocardial perfusion imaging facilitates the identification of hemodynamically significant coronary artery disease. CT delayed-enhancement imaging is used to detect myocardial scar in myocardial infarction and to measure the extracellular volume fraction in non-ischemic cardiomyopathy. Multi-energy cardiac CT allows the mapping of iodine distribution in the myocardium. This review summarizes the current techniques of cardiac CT for LV myocardial assessment, highlights the key findings in various myocardial diseases, and presents future applications to complement echocardiography and cardiovascular magnetic resonance.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Tae Hoon Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
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47
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Gan Y, Lye TH, Marboe CC, Hendon CP. Characterization of the human myocardium by optical coherence tomography. JOURNAL OF BIOPHOTONICS 2019; 12:e201900094. [PMID: 31400074 PMCID: PMC7456394 DOI: 10.1002/jbio.201900094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/25/2019] [Accepted: 08/08/2019] [Indexed: 05/21/2023]
Abstract
Imaging of cardiac tissue structure plays a critical role in the treatment and understanding of cardiovascular disease. Optical coherence tomography (OCT) offers the potential to provide valuable, high-resolution imaging of cardiac tissue. However, there is a lack of comprehensive OCT imaging data of the human heart, which could improve identification of structural substrates underlying cardiac abnormalities. The objective of this study was to provide qualitative and quantitative analysis of OCT image features throughout the human heart. Fifty human hearts were acquired, and tissues from all chambers were imaged with OCT. Histology was obtained to verify tissue composition. Statistical differences between OCT image features corresponding to different tissue types and chambers were estimated using analysis of variance. OCT imaging provided features that were able to distinguish structures such as thickened collagen, as well as adipose tissue and fibrotic myocardium. Statistically significant differences were found between atria and ventricles in attenuation coefficient, and between adipose and all other tissue types. This study provides an overview of OCT image features throughout the human heart, which can be used for guiding future applications such as OCT-integrated catheter-based treatments or ex vivo investigation of structural substrates.
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Affiliation(s)
- Yu Gan
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Theresa H. Lye
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Charles C. Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, New York
- Correspondence: Christine P. Hendon, Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY 10032.
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48
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Albumin nanocomposites with MnO 2/Gd 2O 3 motifs for precise MR imaging of acute myocardial infarction in rabbit models. Biomaterials 2019; 230:119614. [PMID: 31753475 DOI: 10.1016/j.biomaterials.2019.119614] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/23/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
The severe mortality and morbidity of myocardial infarction requests appropriate and accurate detection. Considering pathological profile of the acidic myocardial infarction microenvironments, herein, the low pH-sensitive albumin nanocomposites with MnO2 motifs (MnO2@BSA) have been engineered for T1-weighted MR imaging of myocardial infarction, while using non-pH-responsive Gd2O3@BSA nanocomposites as control. The nanocomposites were 20-30 nm in diameter with spheroid morphology. Besides, the MnO2@BSA have exhibited pH-triggered releasing of Mn2+, demonstrating approximately 38-fold and 55-fold increased molecular relaxivity at acute myocardial infarction-mimicking pH 6.5 (13.08 mM-1s-1) and macrophage intracellular pH 5.0 (18.76 mM-1s-1) compared to the extremely low relaxivity (0.34 mM-1s-1) at normal physiological conditions (pH 7.4). However, the Gd2O3@BSA with molecular relaxivity approximately 10 mM-1s-1 were without pH-sensitive properties. Furthermore, the MnO2@BSA have demonstrated high accumulation in the acute myocardial infarction regions and fast metabolism from the body after systemic injection, accounting high contrast enhancement for accurate MR imaging of acute myocardial infarction in rabbit models, demonstrating better diagnostic performance over the controls.
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49
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Haghbayan H, Lougheed N, Deva DP, Chan KK, Lima JA, Yan AT. Peri-Infarct Quantification by Cardiac Magnetic Resonance to Predict Outcomes in Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2019; 12:e009156. [DOI: 10.1161/circimaging.119.009156] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background:
In ischemic cardiomyopathy, cardiac magnetic resonance assessment of the peri-infarct zone, a potential substrate for arrhythmogenesis, may serve as a novel prognosticator and guide the optimal use of implantable cardioverter-defibrillators. We undertook a systematic review and meta-analysis assessing the prognostic value of the peri-infarct zone on late gadolinium enhancement cardiac magnetic resonance in ischemic cardiomyopathy.
Methods:
We searched MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Medical Literature Analysis and Retrieval System Online), and CENTRAL (Medical Literature Analysis and Retrieval System Online) from inception to January 2019 for prognostic studies relating peri-infarct size with clinical outcomes in ischemic cardiomyopathy. Two authors independently performed study selection and data extraction. Pooled effect estimates were calculated with random effects models, risk of bias and strength of evidence were assessed by the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development, and Education, respectively.
Results:
Twenty studies were eligible, representing 14 cohort studies (n=1518) with mean follow-up of 3.6 years and 6 cross-sectional studies (n=189). The extent of the peri-infarct zone was significantly predictive of all-cause mortality (3 studies; n=539; hazard ratio, 1.34/10 g [95% CI, 1.13–1.59];
I
2
=0%; high-quality evidence), appropriate implantable cardioverter-defibrillator therapy (5 studies; n=361; hazard ratio, 1.31/10 g [95% CI, 1.17–1.47];
I
2
=0%; high-quality evidence), and inducibility of ventricular tachycardia on electrophysiological study (5 studies; n=167; OR, 2.63/g [95% CI, 1.39–4.96];
I
2
=14%; low-quality evidence). After adjusting for age and left ventricular ejection fraction, the peri-infarct zone, as a percentage of total infarct size, remained an independent predictor of all-cause mortality (2 studies; n=445; hazard ratio, 1.29/10% [95% CI, 1.15–1.44];
I
2
=0%; high-quality evidence).
Conclusions:
There is limited but consistent evidence that quantification of the peri-infarct zone predicts long-term mortality and appropriate implantable cardioverter-defibrillator therapy in ischemic cardiomyopathy. Future studies should confirm whether late gadolinium enhancement-cardiac magnetic resonance assessment may improve implantable cardioverter-defibrillator treatment decisions.
Clinical Trial Registration:
URL:
https://www.crd.york.ac.uk/prospero/
. Unique identifier: CRD42017077337.
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Affiliation(s)
- Hourmazd Haghbayan
- Department of Medicine (H.H), University of Toronto, ON, Canada
- Department of Social and Preventive Medicine, Université Laval, QC, Canada (H.H.)
| | - Nick Lougheed
- Royal Victoria Regional Health Centre, Barrie, Canada (N.L.)
| | - Djeven P. Deva
- Department of Medical Imaging, St. Michael’s Hospital, Toronto, ON, Canada (D.P.D.)
| | - Kelvin K.W. Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada (K.K.W.C.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada (K.K.W.C.)
| | - João A.C. Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (J.A.C.L.)
| | - Andrew T. Yan
- Terrence Donnelly Heart Centre, St. Michael’s Hospital (A.T.Y.), University of Toronto, ON, Canada
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Mukai-Yatagai N, Ohta Y, Amisaki R, Sasaki N, Akasaka T, Watanabe T, Kishimoto J, Kato M, Ogawa T, Yamamoto K. Myocardial delayed enhancement on dual-energy computed tomography: The prevalence and related factors in patients with suspicion of coronary artery disease. J Cardiol 2019; 75:302-308. [PMID: 31500962 DOI: 10.1016/j.jjcc.2019.08.004] [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: 03/01/2019] [Revised: 07/17/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We aimed to assess the prevalence of myocardial delayed enhancement (MDE) in patients with suspected obstructive coronary artery disease (CAD), and to investigate factors related to the presence or absence of MDE. METHODS We retrospectively evaluated 191 consecutive patients who underwent coronary computed tomography angiography (CCTA) with MDE imaging for clinical suspicion of CAD from December 2014 to December 2016. The presence of MDE on iodine-density images using dual-energy CT was assessed by two independent readers. Multivariable logistic regression analyses were used to determine factors associated with the presence of MDE. RESULTS MDE was detected in 58 (30%) patients. Male gender, hypertension, prior heart failure (HF) hospitalization, and CCTA-detected CAD were independent factors related to the presence of MDE. When CCTA-detected CAD was excluded to narrow down the analysis to factors obtainable before CCTA, interventricular septum thickness (IVST) ≥12 mm was added as another independent factor. The combination of the following four factors: female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm demonstrated high specificity (98.3%) and positive predictive value (96.2%) for predicting the absence of MDE. CONCLUSIONS Male gender, hypertension, prior HF hospitalization, and CAD were independently associated with the presence of MDE in patients with suspected CAD. The combination of female gender, no history of hypertension, no history of prior HF hospitalization, and IVST < 12 mm is likely to be a helpful predictor in discriminating patients without MDE before CCTA.
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Affiliation(s)
- Natsuko Mukai-Yatagai
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Yasutoshi Ohta
- Division of Radiology, Department of Pathophysiological Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryosuke Amisaki
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Naoko Sasaki
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihiko Akasaka
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tomomi Watanabe
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Junichi Kishimoto
- Department of Clinical Radiology, Tottori University Hospital, Yonago, Japan
| | - Masahiko Kato
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Toshihide Ogawa
- Division of Radiology, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan
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