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Samimisedeh P, Jafari Afshar E, Tayebi A, Rastad H. Post-acute midterm follow-up cardiac MRI findings and clinical outcomes in patients with COVID-19 vaccine-associated myocarditis: a comprehensive systematic review and meta-analysis. Infect Dis (Lond) 2024; 56:193-205. [PMID: 38000007 DOI: 10.1080/23744235.2023.2286289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Although previous investigations revealed favourable in-hospital outcomes of COVID-19 vaccine-related myocarditis, the mid-term prognosis is still unclear. Hence, we aim to summarise existing evidence on the follow-up imaging and clinical findings in patients with COVID-19 vaccine-related myocarditis. METHODS We performed a systematic search in online databases using relevant key terms covering COVID-19 vaccine, myocarditis, follow-up, and cardiac MRI. We included all observational studies that reported cardiac MRI findings of patients with myocarditis following COVID-19 vaccination in both acute and follow-up phases. Data on clinical outcomes and cardiac MRI findings were extracted and pooled using a random-effect model. RESULTS A total of 27 studies (126 patients) met our eligibility criteria. At the time of follow-up, myocarditis symptoms were resolved in all patients, but abnormal electrocardiography and elevated troponin levels were detected in 18.7% and 3.8% of them, respectively. Median imaging follow-up times varied from 3 to 6.3 months. On follow-up cardiac MRI, the persistence of LGE was observed in 76% (95%CI: 62 to 85%), but its extension declined compared to the baseline in almost all patients. Persistent LGE was accompanied by myocardial edoema in six patients, and it was consistent with myocardial fibrosis (LGE without edoema) in the remaining cases. Mean changes (95%CI) of cardiac MRI left ventricular ejection fraction (LVEF) (%) was +2.97 (+1.59 to +4.34) from baseline. CONCLUSION In conclusion, although most patients likely experience favourable clinical outcomes without serious complications, cardiac MRI abnormalities, mainly LGE, may persist in a notable proportion of them beyond the acute phase.
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Affiliation(s)
- Parham Samimisedeh
- Cardiovascular Research Center, Alborz University of Medical Sciences, Alborz, Iran
| | - Elmira Jafari Afshar
- Cardiovascular Research Center, Alborz University of Medical Sciences, Alborz, Iran
| | - Amirhossein Tayebi
- Cardiovascular Research Center, Alborz University of Medical Sciences, Alborz, Iran
| | - Hadith Rastad
- Cardiovascular Research Center, Alborz University of Medical Sciences, Alborz, Iran
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Kim SG, Lee JY, Jeong WG, Lee JE, Kim YH. Cardiac Magnetic Resonance Imaging Findings and Clinical Features of COVID-19 Vaccine-Associated Myocarditis, Compared With Those of Other Types of Myocarditis. J Korean Med Sci 2024; 39:e42. [PMID: 38288542 PMCID: PMC10825460 DOI: 10.3346/jkms.2024.39.e42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND To compare the clinical and cardiac magnetic resonance (CMR) imaging findings of coronavirus disease 2019 (COVID-19) vaccine-associated myocarditis (VAM) with those of other types of myocarditis. METHODS From January 2020 to March 2022, a total of 39 patients diagnosed with myocarditis via CMR according to the Modified Lake Louise criteria were included in the present study. The patients were classified into two groups based on their vaccination status: COVID-19 VAM and other types of myocarditis not associated with COVID-19 vaccination. Clinical outcomes, including the development of clinically significant arrhythmias, sudden cardiac arrest, and death, and CMR imaging features were compared between COVID-19 VAM and other types of myocarditis. RESULTS Of the 39 included patients (mean age, 39 years ± 16.4 [standard deviation]; 23 men), 23 (59%) had COVID-19 VAM and 16 (41%) had other types of myocarditis. The occurrence of clinical adverse events did not differ significantly between the two groups. As per the CMR imaging findings, the presence and dominant pattern of late gadolinium enhancement did not differ significantly between the two groups. The presence of high native T1 or T2 values was not significantly different between the two groups. Although the native T1 and T2 values tended to be lower in COVID-19 VAM than in other types of myocarditis, there were no statistically significant differences between the native T1 and T2 values in the two groups. CONCLUSION The present study demonstrated that the CMR imaging findings and clinical outcomes of COVID-19 VAM did not differ significantly from those of other types of myocarditis during hospitalization.
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Affiliation(s)
- Sang Gyun Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Yeop Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea.
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Shenton P, Schrader S, Smith J, Alafaci A, Cox N, Taylor A, Hare J, Jones B, Crawford NW, Buttery JP, Cheng DR. Long term follow up and outcomes of Covid-19 vaccine associated myocarditis in Victoria, Australia: A clinical surveillance study. Vaccine 2024; 42:522-528. [PMID: 38154991 DOI: 10.1016/j.vaccine.2023.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Myocarditis and myopericarditis are well described adverse events of special interest (AESI) following COVID-19 vaccinations. Although reports are reassuring regarding initial clinical outcomes, information about longer term outcomes remains limited. We aimed to further this knowledge and report outcomes to 6 months post diagnosis from a single population cohort. METHODS Reports of myocarditis following COVID-19 vaccination were followed up by SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), the state-wide vaccine safety service for Victoria, Australia. Confirmed myocarditis cases (Brighton Collaboration Criteria levels 1-3) were followed up via surveys at 1, 3 and 6 months post symptom onset. Responses received between 22 February 2021 and 30 September 2022 were analysed. RESULTS 87.5 % (N = 182) of eligible participants completed at least 1 survey report. 377 reports were analysed. 76.9 % of completed reports were from male patients. The median age of patients was 21 years [IQR: 16 to 32]. 54.8 % (n = 74) of survey reports at 6 months, reported ongoing symptoms. At all follow-up time points, females were significantly more likely to have ongoing symptoms. At 6 months, 51.9 % of male respondents reported symptom resolution compared to 22.6 % of female patients (p = 0.002). Females were also more likely to continue medication and have ongoing exercise restrictions. However, males were significantly more likely to have higher initial peak troponin results and abnormal initial cardiac imaging investigations. CONCLUSIONS There appears to be a significant proportion of patients who experience ongoing symptoms to 6 months post onset amongst patients that experience these AESI. Male patients were more likely to report earlier and more complete symptom recovery, despite significantly higher average initial peak troponin. This difference in phenotypic presentation in females compared to males warrants further investigation and there is a need for longer term follow up data.
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Affiliation(s)
- Priya Shenton
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Silja Schrader
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Julia Smith
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Annette Alafaci
- SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Nicholas Cox
- Department of Medicine, Western Health, The University of Melbourne, Australia; Cardiology Unit, Western Health, Australia
| | | | - James Hare
- Department of Cardiology, Alfred Health, Australia
| | - Bryn Jones
- The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Nigel W Crawford
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Jim P Buttery
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Centre for Health Analytics, Melbourne Children's Campus, Australia; Health Informatics, Infection and Immunity, Murdoch Children's Research Institute, Australia
| | - Daryl R Cheng
- The Royal Children's Hospital, Melbourne, Australia; SAEFVIC, Infection and Immunity, Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Centre for Health Analytics, Melbourne Children's Campus, Australia.
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4
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Fries RC. Current use of cardiac MRI in animals. J Vet Cardiol 2023; 51:13-23. [PMID: 38052149 DOI: 10.1016/j.jvc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
Cardiovascular magnetic resonance (CMR) imaging has evolved to become an indispensable tool in human cardiology. It is a non-invasive technique that enables objective assessment of myocardial function, size, and tissue composition. Recent innovations in magnetic resonance imaging scanner technology and parallel imaging techniques have facilitated the generation of parametric mapping to explore tissue characteristics, and the emergence of strain imaging has enabled cardiologists to evaluate cardiac function beyond conventional metrics. As veterinary cardiology continues to utilize CMR beyond the reference standard, clinical application of CMR will further expand our capabilities. This article describes the current use of CMR and adoption of more recent advances such as T1/T2 mapping in veterinary cardiology.
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Affiliation(s)
- R C Fries
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign College of Veterinary Medicine, Urbana, IL, USA.
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Lyu Z, Hua S, Xu J, Shen Y, Guo R, Hu P, Qi H. Free-breathing simultaneous native myocardial T1, T2 and T1ρ mapping with Cartesian acquisition and dictionary matching. J Cardiovasc Magn Reson 2023; 25:63. [PMID: 37946191 PMCID: PMC10636995 DOI: 10.1186/s12968-023-00973-6] [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: 05/29/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND T1, T2 and T1ρ are well-recognized parameters for quantitative cardiac MRI. Simultaneous estimation of these parameters allows for comprehensive myocardial tissue characterization, such as myocardial fibrosis and edema. However, conventional techniques either quantify the parameters individually with separate breath-hold acquisitions, which may result in unregistered parameter maps, or estimate multiple parameters in a prolonged breath-hold acquisition, which may be intolerable to patients. We propose a free-breathing multi-parametric mapping (FB-MultiMap) technique that provides co-registered myocardial T1, T2 and T1ρ maps in a single efficient acquisition. METHODS The proposed FB-MultiMap performs electrocardiogram-triggered single-shot Cartesian acquisition over 16 consecutive cardiac cycles, where inversion, T2 and T1ρ preparations are introduced for varying contrasts. A diaphragmatic navigator was used for prospective through-plane motion correction and the in-plane motion was corrected retrospectively with a group-wise image registration method. Quantitative mapping was conducted through dictionary matching of the motion corrected images, where the subject-specific dictionary was created using Bloch simulations for a range of T1, T2 and T1ρ values, as well as B1 factors to account for B1 inhomogeneities. The FB-MultiMap was optimized and validated in numerical simulations, phantom experiments, and in vivo imaging of 15 healthy subjects and six patients with suspected cardiac diseases. RESULTS The phantom T1, T2 and T1ρ values estimated with FB-MultiMap agreed well with reference measurements with no dependency on heart rate. In healthy subjects, FB-MultiMap T1 was higher than MOLLI T1 mapping (1218 ± 50 ms vs. 1166 ± 38 ms, p < 0.001). The myocardial T2 and T1ρ estimated with FB-MultiMap were lower compared to the mapping with T2- or T1ρ-prepared 2D balanced steady-state free precession (T2: 41.2 ± 2.8 ms vs. 42.5 ± 3.1 ms, p = 0.06; T1ρ: 45.3 ± 4.4 ms vs. 50.2 ± 4.0, p < 0.001). The pathological changes in myocardial parameters measured with FB-MultiMap were consistent with conventional techniques in all patients. CONCLUSION The proposed free-breathing multi-parametric mapping technique provides co-registered myocardial T1, T2 and T1ρ maps in 16 heartbeats, achieving similar mapping quality to conventional breath-hold mapping methods.
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Affiliation(s)
- Zhenfeng Lyu
- School of Biomedical Engineering, ShanghaiTech University, 4th Floor, BME Building, 393 Middle Huaxia Road, Pudong District, Shanghai, 201210, China
- Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Sha Hua
- Department of Cardiovascular Medicine, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Xu
- UIH America, Inc., Houston, TX, USA
| | - Yiwen Shen
- Department of Cardiovascular Medicine, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Guo
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, 4th Floor, BME Building, 393 Middle Huaxia Road, Pudong District, Shanghai, 201210, China.
- Shanghai Clinical Research and Trial Center, Shanghai, China.
| | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, 4th Floor, BME Building, 393 Middle Huaxia Road, Pudong District, Shanghai, 201210, China.
- Shanghai Clinical Research and Trial Center, Shanghai, China.
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Małek ŁA, Śpiewak M. Isolated myocardial edema in cardiac magnetic resonance - in search of a management strategy. Trends Cardiovasc Med 2023; 33:395-402. [PMID: 35405307 DOI: 10.1016/j.tcm.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 01/04/2023]
Abstract
Isolated myocardial edema not accompanied by late gadolinium enhancement (LGE) may be occasionally found on cardiac magnetic resonance (CMR). This type of picture may be encountered in patients with suspected myocarditis, post some acute cardiac events, with cardiac allograft rejection or even in athletes after an extreme exercise. Currently, there is no clear management strategy for this type of incidental finding. In this narrative review we discuss the methods and pitfalls of edema detection with means of CMR, review published data on isolated myocardial edema for each of the most probable clinical scenarios and propose a structured clinical decision-making algorithm to help clinicians navigate through this type of CMR result. Finally, we highlight the most important gaps in evidence related to isolated myocardial edema without fibrosis, where further research is particularly needed.
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Affiliation(s)
- Łukasz A Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
| | - Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, National Institute of Cardiology, Warsaw, Poland
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Sánchez Tijmes F, Marschner CA, de Matos JFRG, Urzua Fresno CM, Gutiérrez Chacoff JM, Thavendiranathan P, Fuss C, Hanneman K. Imaging Acute and Chronic Cardiac Complications of COVID-19 and after COVID-19 Vaccination. Radiographics 2023; 43:e230044. [PMID: 37616171 DOI: 10.1148/rg.230044] [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: 08/25/2023]
Abstract
COVID-19 is associated with acute and longer-term cardiovascular manifestations including myocardial injury, myopericarditis, stress-induced cardiomyopathy, myocardial infarction, and thromboembolic disease. Although the morbidity and mortality related to acute COVID-19 have decreased substantially, there is growing concern about the longer-term cardiovascular effects of the disease and postacute sequelae. Myocarditis has also been reported after messenger ribonucleic acid (mRNA)-based COVID-19 vaccination, with the highest risk among adolescent boys and young adult men. Noninvasive imaging including cardiac MRI has a key role in identifying the presence of cardiovascular disease, evaluating for potential mechanisms of injury, stratifying risk of future adverse cardiovascular events, and potentially guiding treatment in patients with suspected cardiovascular injury after COVID-19 and vaccination. Patterns of injury identified at cardiac MRI after COVID-19 include myocarditis and pericarditis, myocardial ischemia, and infarction. Myocardial edema and late gadolinium enhancement have been described months after the initial infection in a minority of patients with persistent cardiac symptoms after COVID-19. In patients with myocarditis after receiving a COVID-19 vaccination, the most common pattern of late gadolinium enhancement is subepicardial at the basal inferolateral wall, and patients tend to have milder imaging abnormalities compared with those from other causes of myocarditis. This article describes the role of multimodality cardiac imaging and imaging findings in patients with acute and longer-term cardiovascular manifestations of COVID-19 and in patients with myocarditis after receiving an mRNA-based COVID-19 vaccination. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Felipe Sánchez Tijmes
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Constantin A Marschner
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Joao Francisco Ribeiro Gavina de Matos
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Camila M Urzua Fresno
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Jose Miguel Gutiérrez Chacoff
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Cristina Fuss
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
| | - Kate Hanneman
- From the Department of Medical Imaging (F.S.T., C.A.M., J.F.R.G.d.M., C.M.U.F., P.T., K.H.) and the Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile (F.S.T.); Department of Medical Imaging, Hospital Barros Luco, Universidad Mayor, Santiago, Chile (J.M.G.C.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (C.F.)
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Salehi M, Khalili H, Khoshavi M, Mollazadeh R, Jahanshahi B, Hosseini MS. Brucella myocarditis with unusual clinical features & abnormal cardiac MRI: A case report. IDCases 2023; 33:e01868. [PMID: 37583787 PMCID: PMC10424257 DOI: 10.1016/j.idcr.2023.e01868] [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: 07/08/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
Brucellosis is a zoonotic disease that remains an important public health problem in developing countries. It can affect almost all organs, including the heart. While cardiac complications of brucellosis are not common, they usually manifest as endocarditis. Brucella myocarditis, on the other hand, is a highly rare complication of brucellosis. In this case report, we present the case of a 35-year-old woman who was admitted to the hospital with severe palpitations, fever, and fatigue. Due to the patient's long history of brucellosis and clinical symptoms, she underwent cardiac evaluation, including cardiac magnetic resonance imaging, which was a promising method to diagnose Brucella myocarditis. Hopefully our patient responded well to Rifampin and Doxycycline with gentamicin. It is important to raise awareness of this rare but potentially serious complication of brucellosis and to emphasize the value of early diagnosis and treatment.
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Affiliation(s)
- Mohammadreza Salehi
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Infectious Diseases, Tehran University of Medical Sciences (TUMS), Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Meysam Khoshavi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mollazadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahare Jahanshahi
- Tehran University of Medical Sciences, Cardiovascular Department, Tehran, Iran
| | - Mahnaz Sadat Hosseini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Aldajani A, Chetrit M. Editorial commentary: Myocardial involvement in systemic lupus erythematosus - More than the MR-eye can see. Trends Cardiovasc Med 2023; 33:355-356. [PMID: 35314322 DOI: 10.1016/j.tcm.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Ahmed Aldajani
- Department of Cardiovascular Medicine and Cardiovascular Imaging, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
| | - Michael Chetrit
- Department of Cardiovascular Medicine and Cardiovascular Imaging, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
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Mastrodicasa D, Aquino GJ, Ordovas KG, Vargas D, Fleischmann D, Abbara S, Hanneman K. Radiology: Cardiothoracic Imaging Highlights 2022. Radiol Cardiothorac Imaging 2023; 5:e230042. [PMID: 37404783 PMCID: PMC10316293 DOI: 10.1148/ryct.230042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/07/2023] [Accepted: 05/08/2023] [Indexed: 07/06/2023]
Abstract
Since its inaugural issue in 2019, Radiology: Cardiothoracic Imaging has disseminated the latest scientific advances and technical developments in cardiac, vascular, and thoracic imaging. In this review, we highlight select articles published in this journal between October 2021 and October 2022. The scope of the review encompasses various aspects of coronary artery and congenital heart diseases, vascular diseases, thoracic imaging, and health services research. Key highlights include changes in the revised Coronary Artery Disease Reporting and Data System 2.0, the value of coronary CT angiography in informing prognosis and guiding treatment decisions, cardiac MRI findings after COVID-19 vaccination or infection, high-risk features at CT angiography to identify patients with aortic dissection at risk for late adverse events, and CT-guided fiducial marker placement for preoperative planning for pulmonary nodules. Ongoing research and future directions include photon-counting CT and artificial intelligence applications in cardiovascular imaging. Keywords: Pediatrics, CT Angiography, CT-Perfusion, CT-Spectral Imaging, MR Angiography, PET/CT, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Pulmonary, Vascular, Aorta, Coronary Arteries © RSNA, 2023.
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Shalmon T, Thavendiranathan P, Seidman MA, Wald RM, Karur GR, Harvey PJ, Akhtari S, Osuntokun T, Tselios K, Gladman DD, Hanneman K. Cardiac Magnetic Resonance Imaging T1 and T2 Mapping in Systemic Lupus Erythematosus in Relation to Antimalarial Treatment. J Thorac Imaging 2023; 38:W33-W42. [PMID: 36917505 DOI: 10.1097/rti.0000000000000703] [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: 03/15/2023]
Abstract
PURPOSE Patients with systemic lupus erythematosus (SLE) are at risk of cardiac disease including antimalarial-induced cardiomyopathy (AMIC). The purpose of this study is to evaluate cardiac magnetic resonance imaging parametric mapping findings in SLE patients with AMIC and investigate the relationship of T1/T2 mapping to antimalarial (AM) treatment duration. MATERIALS AND METHODS All patients with SLE who had undergone cardiac magnetic resonance imaging with T1/T2 mapping for evaluation of suspected cardiac disease between 2018 and 2021 were evaluated and compared with healthy controls. To facilitate comparison between scanners, T1/T2 values were converted to a z -score using scanner-specific local reference values. Patients were classified into 3 groups: AMIC, myocarditis, and other (no AMIC or myocarditis). RESULTS Forty-five SLE patients (47±17 y, 80% female; 8 [18%] with AMIC and 7 [16%] with myocarditis) and 30 healthy controls (39±15 y, 60% female) were included. Patients with AMIC had higher T1 and T2 compared with controls ( z -score 1.1±1.3 vs. 0±0.6, P =0.01 and 1.7±1.1 vs. 0±1.0, P <0.01, respectively) and lower values compared with those with myocarditis (3.7±1.6, P <0.01 and 4.0±2.0, P <0.01, respectively). T1 correlated negatively with AM treatment duration in patients without AMIC or myocarditis ( r =-0.36, P =0.048) and positively in patients with AMIC ( r =0.92, P =0.001). AM treatment duration did not correlate significantly with T1 in patients with myocarditis or with T2 in any group. CONCLUSIONS The relationship between T1 and AM treatment duration differed between groups. Native T1 decreases with longer treatment in patients without AMIC or myocarditis, possibility due to glycosphingolipid accumulation. In patients with AMIC, increasing T1 with longer treatment could reflect fibrosis.
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Affiliation(s)
- Tamar Shalmon
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Paaladinesh Thavendiranathan
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
| | | | - Rachel M Wald
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
| | - Gauri Rani Karur
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
| | - Paula J Harvey
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto
| | - Shadi Akhtari
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto
| | - Tosin Osuntokun
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto
| | - Kostantinos Tselios
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kate Hanneman
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
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12
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Marschner CA, Thavendiranathan P, Gustafson D, Howe KL, Fish JE, Iwanochko RM, Wald RM, Abdel-Qadir H, Epelman S, Cheung AM, Hong R, Hanneman K. Myocardial Inflammation on FDG PET/MRI and Clinical Outcomes in Symptomatic and Asymptomatic Participants after COVID-19 Vaccination. Radiol Cardiothorac Imaging 2023; 5:e220247. [PMID: 36987440 PMCID: PMC10037313 DOI: 10.1148/ryct.220247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Purpose To evaluate potential cardiac sequelae of COVID-19 vaccination at 2-month follow-up and relate cardiac symptoms to myocardial tissue changes on fluorodeoxyglucose (FDG) PET/MRI, blood biomarkers, health-related quality of life, and adverse outcomes. Materials and Methods In this prospective study (ClinicalTrials.gov: NCT04967807), a convenience sample of individuals aged ≥17 years were enrolled after COVID-19 vaccination and were categorized as symptomatic myocarditis (new cardiac symptoms within 14 days of vaccination and met diagnostic criteria for acute myocarditis), symptomatic no myocarditis (new cardiac symptoms but did not meet criteria for myocarditis), and asymptomatic (no new cardiac symptoms). Standardized evaluation was performed 2 months after vaccination, including cardiac fluorine 18 FDG PET/MRI, blood biomarkers, and health-related quality of life. Statistical analysis included Kruskal-Wallis and Fisher exact tests. Results Fifty-four participants were evaluated a median of 72 days (IQR: 42, 91) after COVID-19 vaccination, 17 symptomatic with myocarditis (36±[SD]15 years, 13 males), 17 symptomatic without myocarditis (42±12 years, 7 males), and 20 asymptomatic (45±14 years, 9 males). No participants in the symptomatic without myocarditis or asymptomatic groups had focal FDG-uptake, myocardial edema or impaired ventricular function. Two participants with symptomatic myocarditis had focal FDG-uptake, and three had high T2 on MRI. Health-related quality of life was lower in the symptomatic myocarditis group than the asymptomatic group. There were no adverse cardiac events beyond myocarditis in any participant. Conclusions At two-month follow-up, FDG PET/MRI showed evidence of myocardial inflammation in 2/17 participants diagnosed with acute myocarditis early after COVID-19 vaccination, but not in symptomatic and asymptomatic participants without acute myocarditis.Keywords: Myocarditis, Vaccination, COVID-19, PET/MRI, Cardiac MRI, FDG-PET.
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Affiliation(s)
- Constantin Arndt Marschner
- Department of Medical Imaging, Toronto General Hospital, Peter Munk
Cardiac Center, University Health Network (UHN), University of Toronto,
Toronto
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk
Cardiac Center, University Health Network (UHN), University of Toronto,
Toronto
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General
Hospital, University Health Network (UHN), University of Toronto, Toronto
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
| | - Dakota Gustafson
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University
Health Network (UHN), University of Toronto, Toronto
| | - Kathryn L. Howe
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University
Health Network (UHN), University of Toronto, Toronto
- Department of Vascular Surgery, University Health Network (UHN),
University of Toronto, Toronto
| | - Jason E. Fish
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University
Health Network (UHN), University of Toronto, Toronto
| | - Robert M. Iwanochko
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General
Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Rachel M. Wald
- Department of Medical Imaging, Toronto General Hospital, Peter Munk
Cardiac Center, University Health Network (UHN), University of Toronto,
Toronto
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General
Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Husam Abdel-Qadir
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General
Hospital, University Health Network (UHN), University of Toronto, Toronto
- Cardiovascular Division, Women's College Hospital, University
of Toronto, Toronto
| | - Slava Epelman
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General
Hospital, University Health Network (UHN), University of Toronto, Toronto
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, University
Health Network (UHN), University of Toronto, Toronto
- Department of Immunology, University of Toronto, Toronto,
Canada
| | - Angela M. Cheung
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
- Department of Medicine, University Health Network (UHN) and Sinai
Health System (SHS), University of Toronto, Toronto, Canada
| | - Rachel Hong
- Department of Medical Imaging, Toronto General Hospital, Peter Munk
Cardiac Center, University Health Network (UHN), University of Toronto,
Toronto
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk
Cardiac Center, University Health Network (UHN), University of Toronto,
Toronto
- Toronto General Hospital Research Institute, University Health
Network (UHN), Toronto, Canada
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13
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Hanneman K, Thavendiranathan P. Editorial for "Cardiac Magnetic Resonance Imaging Findings in COVID-19 Vaccine-Related Myocarditis: A Pooled Analysis of 468 Patients". J Magn Reson Imaging 2023; 57:1289-1290. [PMID: 35614544 PMCID: PMC9348152 DOI: 10.1002/jmri.28271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023] Open
Affiliation(s)
- Kate Hanneman
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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14
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Marschner CA, Shaw KE, Tijmes FS, Fronza M, Khullar S, Seidman MA, Thavendiranathan P, Udell JA, Wald RM, Hanneman K. Myocarditis Following COVID-19 Vaccination. Heart Fail Clin 2023; 19:251-264. [PMID: 36863817 PMCID: PMC9973554 DOI: 10.1016/j.hfc.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Myocarditis is an established but rare adverse event following administration of messenger RNA-based coronavirus disease 2019 (COVID-19) vaccines and is most common in male adolescents and young adults. Symptoms typically develop within a few days of vaccine administration. Most patients have mild abnormalities on cardiac imaging with rapid clinical improvement with standard treatment. However, longer term follow-up is needed to determine whether imaging abnormalities persist, to evaluate for adverse outcomes, and to understand the risk associated with subsequent vaccination. The purpose of the review is to evaluate the current literature related to myocarditis following COVID-19 vaccination, including the incidence, risk factors, clinical course, imaging findings, and proposed pathophysiologic mechanisms.
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Affiliation(s)
- Constantin A Marschner
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Department of Radiology, University Hospital, LMU Munich, Munich 81377, Germany
| | - Kirsten E Shaw
- Department of Graduate Medical Education, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA
| | - Felipe Sanchez Tijmes
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santa Maria 500, Santiago, Chile 7520378
| | - Matteo Fronza
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | - Sharmila Khullar
- Department of Laboratory Medicine & Pathobiology, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada; Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11E-444, Toronto, Ontario M5G 2C4, Canada
| | - Michael A Seidman
- Department of Laboratory Medicine & Pathobiology, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada; Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11E-444, Toronto, Ontario M5G 2C4, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
| | - Jacob A Udell
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G2N2, Canada; Cardiovascular Division, Women's College Hospital, University of Toronto, 76 Grenville Street, Room 6324, Toronto, Ontario M5G2N2, Canada
| | - Rachel M Wald
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada; Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 5N-517, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
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15
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Ferreira VM, Plein S, Wong TC, Tao Q, Raisi-Estabragh Z, Jain SS, Han Y, Ojha V, Bluemke DA, Hanneman K, Weinsaft J, Vidula MK, Ntusi NAB, Schulz-Menger J, Kim J. Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2023; 25:21. [PMID: 36973744 PMCID: PMC10041524 DOI: 10.1186/s12968-023-00933-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has affected nearly 600 million people to date across the world. While COVID-19 is primarily a respiratory illness, cardiac injury is also known to occur. Cardiovascular magnetic resonance (CMR) imaging is uniquely capable of characterizing myocardial tissue properties in-vivo, enabling insights into the pattern and degree of cardiac injury. The reported prevalence of myocardial involvement identified by CMR in the context of COVID-19 infection among previously hospitalized patients ranges from 26 to 60%. Variations in the reported prevalence of myocardial involvement may result from differing patient populations (e.g. differences in severity of illness) and the varying intervals between acute infection and CMR evaluation. Standardized methodologies in image acquisition, analysis, interpretation, and reporting of CMR abnormalities across would likely improve concordance between studies. This consensus document by the Society for Cardiovascular Magnetic Resonance (SCMR) provides recommendations on CMR imaging and reporting metrics towards the goal of improved standardization and uniform data acquisition and analytic approaches when performing CMR in patients with COVID-19 infection.
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Affiliation(s)
- Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford British Heart Foundation Centre of Research Excellence, The National Institute for Health Research Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, University of Leeds, Leeds, UK
| | - Timothy C Wong
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Supriya S Jain
- Division of Pediatric Cardiology, Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, New York, USA
| | - Yuchi Han
- Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, USA
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Jonathan Weinsaft
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine/New York Presbyterian Hospital, Weill Cornell Medical College, New York, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital; Cape Heart Institute, University of Cape Town, South African Medical Research Council Extramural Unit On Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité and MDC, Charité University Medicine, Berlin, Germany
- Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine/New York Presbyterian Hospital, Weill Cornell Medical College, New York, USA.
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16
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Aitken M, Davidson M, Chan MV, Urzua Fresno C, Vasquez LI, Huo YR, McAllister BJ, Broncano J, Thavendiranathan P, McInnes MDF, Iwanochko MR, Balter M, Moayedi Y, Farrell A, Hanneman K. Prognostic Value of Cardiac MRI and FDG PET in Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e222483. [PMID: 36809215 DOI: 10.1148/radiol.222483] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background There is no consensus regarding the relative prognostic value of cardiac MRI and fluorodeoxyglucose (FDG) PET in cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis of the prognostic value of cardiac MRI and FDG PET for major adverse cardiac events (MACE) in cardiac sarcoidosis. Materials and Methods In this systematic review, MEDLINE, Ovid Epub, CENTRAL, Embase, Emcare, and Scopus were searched from inception until January 2022. Studies that evaluated the prognostic value of cardiac MRI or FDG PET in adults with cardiac sarcoidosis were included. The primary outcome of MACE was assessed as a composite including death, ventricular arrhythmia, and heart failure hospitalization. Summary metrics were obtained using random-effects meta-analysis. Meta-regression was used to assess covariates. Risk of bias was assessed using the Quality in Prognostic Studies, or QUIPS, tool. Results Thirty-seven studies were included (3489 patients with mean follow-up of 3.1 years ± 1.5 [SD]); 29 studies evaluated MRI (2931 patients) and 17 evaluated FDG PET (1243 patients). Five studies directly compared MRI and PET in the same patients (276 patients). Left ventricular late gadolinium enhancement (LGE) at MRI and FDG uptake at PET were both predictive of MACE (odds ratio [OR], 8.0 [95% CI: 4.3, 15.0] [P < .001] and 2.1 [95% CI: 1.4, 3.2] [P < .001], respectively). At meta-regression, results varied by modality (P = .006). LGE (OR, 10.4 [95% CI: 3.5, 30.5]; P < .001) was also predictive of MACE when restricted to studies with direct comparison, whereas FDG uptake (OR, 1.9 [95% CI: 0.82, 4.4]; P = .13) was not. Right ventricular LGE and FDG uptake were also associated with MACE (OR, 13.1 [95% CI: 5.2, 33] [P < .001] and 4.1 [95% CI: 1.9, 8.9] [P < .001], respectively). Thirty-two studies were at risk for bias. Conclusion Left and right ventricular late gadolinium enhancement at cardiac MRI and fluorodeoxyglucose uptake at PET were predictive of major adverse cardiac events in cardiac sarcoidosis. Limitations include few studies with direct comparison and risk of bias. Systematic review registration no. CRD42021214776 (PROSPERO) © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Malcolm Davidson
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Michael V Chan
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Leon I Vasquez
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Ya R Huo
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Brylie J McAllister
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Jordi Broncano
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Mark R Iwanochko
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Meyer Balter
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Ashley Farrell
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Kate Hanneman
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
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17
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Urzua Fresno C, Sanchez Tijmes F, Shaw KE, Huang F, Thavendiranathan P, Khullar S, Seidman MA, Hanneman K. Cardiac Imaging in Myocarditis: Current Evidence and Future Directions. Can Assoc Radiol J 2023; 74:147-159. [PMID: 36062360 DOI: 10.1177/08465371221119713] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Myocarditis is defined as a non-ischemic inflammatory disease of the myocardium. It remains a challenge to diagnose given non-specific symptoms and lack of specific blood biomarkers. Cardiac imaging plays an important role in the evaluation of myocarditis with unique strengths and limitations of different imaging modalities, including cardiac magnetic resonance imaging, echocardiography, cardiac computed tomography, and positron emission tomography. The purpose of this review is to discuss the strengths and limitations of various cardiac imaging techniques in the evaluation of myocarditis, review imaging findings in specific causes of myocarditis including COVID-19 and after vaccination, evaluate the role of imaging in differentiating myocarditis from potential mimics and differential considerations, identify current gaps in knowledge, and propose future directions.
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Affiliation(s)
- Camila Urzua Fresno
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada
| | - Felipe Sanchez Tijmes
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, Clinica Santa Maria, 33179Universidad de los Andes, Santiago, Chile
| | - Kirsten E Shaw
- Department of Cardiology, 123769Hennepin Healthcare/Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Flora Huang
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada
| | - Sharmila Khullar
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, Toronto, ON, Canada
| | - Michael A Seidman
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, Toronto, ON, Canada.,Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada
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18
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Varga I, Michalka P, Mištinová JP. Complications after administration of mRNA vaccine against COVID-19 - case report and short review. VNITRNI LEKARSTVI 2023; 69:20-27. [PMID: 37468319 DOI: 10.36290/vnl.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The pandemic of the disease COVID-19 (COronaVIrus Disease 2019) caused by the SARS-CoV-2 coronavirus (severe acute respiratory syndrome coronavirus 2) resulted in millions of deaths and many patients have chronic consequences after overcoming the acute condition. Several vaccines have been developed in an effort to stop the spread of the virus, but they have potentially serious adverse effects. We present a case report of a patient with acute (myocarditis, exacerbation of bronchial asthma) and long-term (postural orthostatic tachycardia syndrome - POTS) complications after vaccination with the second dose of mRNA vaccine BNT162b2 (Comirnaty®). Treatment consists of regimen measures, numerous pharmacotherapy (metoprolol, ivabradine, corticosteroids, antihistamines, antiphlogistics, bronchodilators) and several nutraceuticals (maritime pine bark extract, quercetin, vitamins, magnesium, phosphatidylcholine). In the discussion, we analyze post-vaccination injury and present a short review of the current literature.
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19
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Cardiac MRI in patients with COVID-19 infection. Eur Radiol 2022; 33:3867-3877. [PMID: 36512043 PMCID: PMC9745285 DOI: 10.1007/s00330-022-09325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
Objective COVID-19 infection is a systemic disease with various cardiovascular symptoms and complications. Cardiac MRI with late gadolinium enhancement is the modality of choice for the assessment of myocardial involvement. T1 and T2 mapping can increase diagnostic accuracy and improve further management. Our study aimed to evaluate the different aspects of myocardial damage in cases of COVID-19 infection using cardiac MRI. Methods This descriptive retrospective study included 86 cases, with a history of COVID-19 infection confirmed by positive RT-PCR, who met the inclusion criteria. Patients had progressive chest pain or dyspnoea with a suspected underlying cardiac cause, either by an abnormal electrocardiogram or elevated troponin levels. Cardiac MRI was performed with late contrast-enhanced (LGE) imaging, followed by T1 and T2 mapping. Results Twenty-four patients have elevated hsTnT with a median hsTnT value of 133 ng/L (IQR: 102 to 159 ng/L); normal value < 14 ng/L. Other sixty-two patients showed elevated hsTnI with a median hsTnI value of 1637 ng/L (IQR: 1340 to 2540 ng/L); normal value < 40 ng/L. CMR showed 52 patients with acute myocarditis, 23 with Takotsubo cardiomyopathy, and 11 with myocardial infarction. Invasive coronary angiography was performed only in selected patients. Conclusion Different COVID-19-related cardiac injuries may cause similar clinical symptoms. Cardiac MRI is the modality of choice to differentiate between the different types of myocardial injury such as Takotsubo cardiomyopathy and infection-related cardiomyopathy or even acute coronary syndrome secondary to vasculitis or oxygen-demand mismatch. Key Points • It is essential to detect early COVID-related cardiac injury using different cardiac biomarkers and cardiac imaging, as it has a significant impact on patient management and outcome. • Cardiac MRI is the modality of choice to differentiate between the different aspects of COVID-related myocardial injury.
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20
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Blann AD, Heitmar R. SARS-CoV-2 and COVID-19: A Narrative Review. Br J Biomed Sci 2022; 79:10426. [PMID: 36148046 PMCID: PMC9486701 DOI: 10.3389/bjbs.2022.10426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
The World Health Organisation has reported that the viral disease known as COVID-19, caused by SARS-CoV-2, is the leading cause of death by a single infectious agent. This narrative review examines certain components of the pandemic: its origins, early clinical data, global and UK-focussed epidemiology, vaccination, variants, and long COVID.
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21
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Evertz R, Schulz A, Lange T, Backhaus SJ, Vollmann D, Kowallick JT, von Haehling S, Hasenfuß G, Schuster A. Cardiovascular magnetic resonance imaging patterns of acute COVID-19 mRNA vaccine-associated myocarditis in young male patients: A first single-center experience. Front Cardiovasc Med 2022; 9:965512. [PMID: 36082124 PMCID: PMC9445185 DOI: 10.3389/fcvm.2022.965512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/14/2023] Open
Abstract
Background The risk of myocarditis after mRNA vaccination against COVID-19 has emerged recently. Current evidence suggests that young male patients are predominantly affected. In the majority of the cases, only mild symptoms were observed. However, little is known about cardiac magnetic resonance (CMR) imaging patterns in mRNA-related myocarditis and their differences when compared to classical viral myocarditis in the acute phase of inflammation. Methods and results In total, 10 mRNA vaccination-associated patients with myocarditis were retrospectively enrolled in this study and compared to 10 patients suffering from viral myocarditis, who were matched for age, sex, comorbidities, and laboratory markers. All patients (n = 20) were hospitalized and underwent a standardized clinical examination, as well as an echocardiography and a CMR. Both, clinical and imaging findings and, in particular, functional and volumetric CMR assessments, as well as detailed tissue characterization using late gadolinium enhancement and T1 + T2-weighted sequences, were compared between both groups. The median age of the overall cohort was 26 years (group 1: 25.5; group 2: 27.5; p = 0.57). All patients described chest pain as the leading reason for their initial presentation. CMR volumetric and functional parameters did not differ significantly between both groups. In all cases, the lateral left ventricular wall showed late gadolinium enhancement without significant differences in terms of the localization or in-depth tissue characterization (late gadolinium enhancement [LGE] enlargement: group 1: 5.4%; group 2: 6.5%; p = 0.14; T2 global/maximum value: group 1: 38.9/52 ms; group 2: 37.8/54.5 ms; p = 0.79 and p = 0.80). Conclusion This study yielded the first evidence that COVID-19 mRNA vaccine-associated myocarditis does not show specific CMR patterns during the very acute stage in the most affected patient group of young male patients. The observed imaging markers were closely related to regular viral myocarditis in our cohort. Additionally, we could not find any markers implying adverse outcomes in this relatively little number of patients; however, this has to be confirmed by future studies that will include larger sample sizes.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Dirk Vollmann
- Herz- and Gefäßzentrum Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
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22
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Henning RJ. Cardiovascular complications of COVID-19 severe acute respiratory syndrome. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:170-191. [PMID: 36147783 PMCID: PMC9490160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
603,711,760 confirmed cases of COVID-19 have been reported throughout the world and 6,484,136 individuals have died from complications of COVID-19 as of September 7, 2022. Significantly, the Omicron variant has produced the largest number of COVID-19 associated hospitalizations since the beginning of the pandemic. Cardiac injury occurs in ≥20% of the hospitalized patients with COVID-19 and is associated with cardiac dysrhythmias in 17 to 44%, cardiac injury with increases in blood troponin in 22 to 40%, myocarditis in 2 to 7%, heart failure in 4 to 21%, and thromboembolic events in 15 to 39%. Risk factors for cardiac complications include age >70 years, male sex, BMI ≥30 kg/m2, diabetes, pre-existing cardiovascular disease, and moderate to severe pneumonia at hospital presentation. Patients with prior cardiovascular disease who contract COVID-19 and experience a significant increase in their blood troponin concentration are at risk for mortality rates as high as 69%. This review focuses on the prevalence, the pathophysiologic mechanisms of CoV-2 injury to the cardiovascular system and the current recommended treatments in hospitalized patients with COVID-19 in order that medical personnel can decrease the morbidity and mortality of patients with COVID-19 and effectively treat patients with Covid and post Covid syndrome.
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Affiliation(s)
- Robert J Henning
- University of South Florida 13201 Bruce B. Downs Blvd, Tampa, Florida 33612-3805, USA
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23
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Cadegiani FA. Catecholamines Are the Key Trigger of COVID-19 mRNA Vaccine-Induced Myocarditis: A Compelling Hypothesis Supported by Epidemiological, Anatomopathological, Molecular, and Physiological Findings. Cureus 2022; 14:e27883. [PMID: 35971401 PMCID: PMC9372380 DOI: 10.7759/cureus.27883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine-induced myocarditis is a rare but well-documented complication in young males. The increased incidence of sudden death among athletes following vaccination has been reported and requires further investigation. Whether the risk of myocarditis, a known major cause of sudden death in young male athletes, also increases after coronavirus disease 2019 (COVID-19) infection is unknown. The severity and implications of these critical adverse effects require a thorough analysis to elucidate their key triggering mechanisms. The present review aimed to evaluate whether there is a justification to hypothesize that catecholamines in a “hypercatecholaminergic” state are the key trigger of SARS-CoV-2 mRNA vaccine-induced myocarditis and related outcomes and whether similar risks are also present following COVID-19 infection. A thorough, structured scoping review of the literature was performed to build the hypothesis through three pillars: detection of myocarditis risk, potential alterations and abnormalities identified after SARS-CoV-2 mRNA vaccination or COVID-19 infection and consequent events, and physiological characteristics of the most affected population. The following terms were searched in indexed and non-indexed peer review articles and recent preprints (<12 months): agent, “SARS-CoV-2” or “COVID-19”; event, “myocarditis” or “sudden death(s)” or “myocarditis+sudden death(s)” or “cardiac event(s)”; underlying cause, “mRNA” or “spike protein” or “infection” or “vaccine”; proposed trigger, “catecholamine(s)” or “adrenaline” or “epinephrine” or “noradrenaline” or “norepinephrine” or “testosterone”; and affected population, “young male(s)” or “athlete(s).” The rationale and data that supported the hypothesis were as follows: SARS-CoV-2 mRNA vaccine-induced myocarditis primarily affected young males, while the risk was not observed following COVID-19 infection; independent autopsies or biopsies of patients who presented post-SARS-CoV-2 mRNA vaccine myocarditis in different geographical regions enabled the conclusion that a primary hypercatecholaminergic state was the key trigger of these events; SARS-CoV-2 mRNA was densely present, and SARS-CoV-2 spike protein was progressively produced in adrenal medulla chromaffin cells, which are responsible for catecholamine production; the dihydroxyphenylalanine decarboxylase enzyme that converts dopamine into noradrenaline was overexpressed in the presence of SARS-CoV-2 mRNA, leading to enhanced noradrenaline activity; catecholamine responses were physiologically higher in young adults and males than in other populations; catecholamine responses and resting catecholamine production were higher in male athletes than in non-athletes; catecholamine responses to stress and its sensitivity were enhanced in the presence of androgens; and catecholamine expressions in young male athletes were already high at baseline, were higher following vaccination, and were higher than those in non-vaccinated athletes. The epidemiological, autopsy, molecular, and physiological findings unanimously and strongly suggest that a hypercatecholaminergic state is the critical trigger of the rare cases of myocarditis due to components from SARS-CoV-2, potentially increasing sudden deaths among elite male athletes.
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24
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Warnica W, Al-Arnawoot A, Stanimirovic A, Thavendiranathan P, Wald RM, Pakkal M, Karur GR, Wintersperger BJ, Rac V, Hanneman K. Clinical Impact of Cardiac MRI T1 and T2 Parametric Mapping in Patients with Suspected Cardiomyopathy. Radiology 2022; 305:319-326. [PMID: 35787201 DOI: 10.1148/radiol.220067] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There are limited data on the incremental value of parametric mapping compared with core cardiac MRI protocols for suspected cardiomyopathy in routine clinical practice. Purpose To evaluate the impact of cardiac MRI T1 and T2 mapping in routine clinical practice with respect to diagnostic accuracy, reader diagnostic confidence, and downstream cardiac imaging utilization. Materials and Methods In this retrospective single-center study, consecutive clinical cardiac MRI scans obtained with and without T1 and T2 mapping for evaluation of suspected cardiomyopathy between January 2017 and October 2019 were evaluated. Diagnostic accuracy and reader diagnostic confidence were evaluated in a random subset. Downstream cardiac imaging utilization was analyzed in patients with a minimum of 1 year of clinical follow-up ending before January 2020. Results A total of 1876 patients (mean age, 51 years ± 17 [SD]; 1113 men) were evaluated. Of these, 751 (40%) underwent cardiac MRI with the core protocol and 1125 (60%) with the core protocol plus T1 and T2 mapping. In the mapping group, T1 and T2 were high in 280 (25%) and 47 patients (4%), respectively. In the subset evaluated for diagnostic utility (n = 450), the addition of T1 and T2 maps to the core protocol resulted in an improvement in reader diagnostic confidence in 174 patients (39%). Diagnostic sensitivity was higher with the core protocol plus mapping compared with the core protocol alone for myocarditis (89% [31 of 35 patients] vs 69% [24 of 35]; P = .008), Fabry disease (93% [13 of 14 patients] vs 50% [seven of 14]; P = .01), and amyloidosis (100% [16 of 16 patients] vs 63% [10 of 16]; P = .01). In the subset evaluated for downstream imaging utilization (n = 903), 47% of patients with mapping had at least one subsequent cardiac imaging test compared with 55% of patients without mapping (P = .01). Conclusion In patients with suspected cardiomyopathy, cardiac MRI with T1 and T2 mapping had high diagnostic utility and was associated with lower downstream cardiac imaging utilization. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Jerosch-Herold and Coelho-Filho in this issue.
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Affiliation(s)
- William Warnica
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Amna Al-Arnawoot
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Aleksandra Stanimirovic
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Rachel M Wald
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Mini Pakkal
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Gauri Rani Karur
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Bernd J Wintersperger
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Valeria Rac
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Kate Hanneman
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
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Schmutzler L, Mirna M, Hoppe UC, Lichtenauer M. From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9060170. [PMID: 35735799 PMCID: PMC9224538 DOI: 10.3390/jcdd9060170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature review was performed in concordance with the current PRISMA guidelines, including the databases PubMed/MEDLINE, Web of Science, CDSR, CENTRAL, CCAs, EBM Reviews, and LILACS. Articles were included if they covered myocarditis after streptococcal pharyngitis/tonsillitis in humans. Exclusion criteria were rheumatic, autoimmune, or toxic myocarditis. (3) Results: Patients that developed myocarditis after group A streptococcal throat infection frequently presented with chest pain, elevated cardiac markers, and ST-segment elevations, making it a condition that shows more similarities to acute coronary syndrome than viral myocarditis. (4) Conclusions: Myocarditis after streptococcal pharyngitis and/or tonsillitis is a rather infrequently described disease; however, it is necessary to consider this condition when investigating streptococcal sore throat because it can be associated with severe adverse events for the individual patient.
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Affiliation(s)
| | - Moritz Mirna
- Correspondence: (L.S.); (M.M.); Tel.: +43-(0)57255-58340 (M.M.)
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26
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Liguori C, Tamburrini S, Ferrandino G, Leboffe S, Rosano N, Marano I. Role of CT and MRI in Cardiac Emergencies. Tomography 2022; 8:1386-1400. [PMID: 35645398 PMCID: PMC9149871 DOI: 10.3390/tomography8030112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT provides consistent diagnostic support, mainly in suspected coronary disease in patients with a low or intermediate pre-test risk. Moreover, it can gain information in the case of cardiac involvement in pulmonary vascular obstructive disease. MRI, on the other hand, has a leading role in the condition of myocardial damage irrespective of the underlying inflammatory or stress related etiology. This article discusses how radiology techniques (CT and MRI) can impact the diagnostic workflow of the most common cardiac and vascular pathologies that are responsible for non-traumatic chest pain admissions to the Emergency Department.
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27
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Aitken M, Chan MV, Urzua Fresno C, Farrell A, Islam N, McInnes MDF, Iwanochko M, Balter M, Moayedi Y, Thavendiranathan P, Metser U, Veit-Haibach P, Hanneman K. Diagnostic Accuracy of Cardiac MRI versus FDG PET for Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2022; 304:566-579. [PMID: 35579526 DOI: 10.1148/radiol.213170] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is limited consensus regarding the relative diagnostic performance of cardiac MRI and fluorodeoxyglucose (FDG) PET for cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis to compare the diagnostic accuracy of cardiac MRI and FDG PET for cardiac sarcoidosis. Materials and Methods Medline, Ovid Epub, Cochrane Central Register of Controlled Trials, Embase, Emcare, and Scopus were searched from inception until January 2022. Inclusion criteria included studies that evaluated the diagnostic accuracy of cardiac MRI or FDG PET for cardiac sarcoidosis in adults. Data were independently extracted by two investigators. Summary accuracy metrics were obtained by using bivariate random-effects meta-analysis. Meta-regression was used to assess the effect of different covariates. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The study protocol was registered a priori in the International Prospective Register of Systematic Reviews (Prospero protocol CRD42021214776). Results Thirty-three studies were included (1997 patients, 687 with cardiac sarcoidosis); 17 studies evaluated cardiac MRI (1031 patients) and 26 evaluated FDG PET (1363 patients). Six studies directly compared cardiac MRI and PET in the same patients (303 patients). Cardiac MRI had higher sensitivity than FDG PET (95% vs 84%; P = .002), with no difference in specificity (85% vs 82%; P = .85). In a sensitivity analysis restricted to studies with direct comparison, point estimates were similar to those from the overall analysis: cardiac MRI and FDG PET had sensitivities of 92% and 81% and specificities of 72% and 82%, respectively. Covariate analysis demonstrated that sensitivity for FDG PET was highest with quantitative versus qualitative evaluation (93% vs 76%; P = .01), whereas sensitivity for MRI was highest with inclusion of T2 imaging (99% vs 88%; P = .001). Thirty studies were at risk of bias. Conclusion Cardiac MRI had higher sensitivity than fluorodeoxyglucose PET for diagnosis of cardiac sarcoidosis but similar specificity. Limitations, including risk of bias and few studies with direct comparison, necessitate additional study. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Michael Vinchill Chan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ashley Farrell
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Nayaar Islam
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Mark Iwanochko
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Meyer Balter
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ur Metser
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Patrick Veit-Haibach
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Kate Hanneman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
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28
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Fronza M, Thavendiranathan P, Karur GR, Abdel-Qadir H, Udell JA, Wald RM, Hanneman K. Cardiac MRI and Clinical Follow-up in COVID-19 Vaccine-associated Myocarditis. Radiology 2022; 304:E48-E49. [PMID: 35503017 PMCID: PMC9096714 DOI: 10.1148/radiol.220802] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Matteo Fronza
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Gauri Rani Karur
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Husam Abdel-Qadir
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto.,Cardiovascular Division, Women's College Hospital, University of Toronto, Toronto
| | - Jacob A Udell
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto.,Cardiovascular Division, Women's College Hospital, University of Toronto, Toronto
| | - Rachel M Wald
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
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29
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Marschner CA, Shaw KE, Tijmes FS, Fronza M, Khullar S, Seidman MA, Thavendiranathan P, Udell JA, Wald RM, Hanneman K. Myocarditis Following COVID-19 Vaccination. Cardiol Clin 2022; 40:375-388. [PMID: 35851461 PMCID: PMC9072816 DOI: 10.1016/j.ccl.2022.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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30
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Sanchez Tijmes F, Zamorano A, Thavendiranathan P, Hanneman K. Imaging of Myocarditis Following mRNA COVID-19 Booster Vaccination. Radiol Cardiothorac Imaging 2022; 4:e220019. [PMID: 35506135 PMCID: PMC9059082 DOI: 10.1148/ryct.220019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/31/2022]
Abstract
Keywords: Echocardiography, MR-Functional Imaging, MRI, Cardiac
Supplemental material is available for this article.
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Affiliation(s)
- Felipe Sanchez Tijmes
- Department of Medical Imaging (F.S.T., K.H.) and Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Departments of Medical Imaging (F.S.T.) and Cardiology (A.Z., P.T.), Clínica Santa María, Santiago, Chile
| | - Anibal Zamorano
- Department of Medical Imaging (F.S.T., K.H.) and Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Departments of Medical Imaging (F.S.T.) and Cardiology (A.Z., P.T.), Clínica Santa María, Santiago, Chile
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging (F.S.T., K.H.) and Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Departments of Medical Imaging (F.S.T.) and Cardiology (A.Z., P.T.), Clínica Santa María, Santiago, Chile
| | - Kate Hanneman
- Department of Medical Imaging (F.S.T., K.H.) and Division of Cardiology (P.T.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; and Departments of Medical Imaging (F.S.T.) and Cardiology (A.Z., P.T.), Clínica Santa María, Santiago, Chile
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31
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Maitz T, Parfianowicz D, Vojtek A, Rajeswaran Y, Vyas AV, Gupta R. COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities. Curr Probl Cardiol 2022:101186. [PMID: 35351486 PMCID: PMC8957382 DOI: 10.1016/j.cpcardiol.2022.101186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 01/08/2023]
Abstract
The coronavirus pandemic has crippled healthcare system since its outbreak in 2020, and has led to over 2.6 million deaths worldwide. Clinical manifestations of COVID-19 range from asymptomatic carrier to severe pneumonia, to life-threatening acute respiratory distress syndrome (ARDS). The early efforts of the pandemic surrounded treating the pulmonary component of COVID-19, however, there has been robust data surrounding the cardiac complications associated with the virus. This is suspected to be from a marked inflammatory response as well as direct viral injury. Arrhythmias, acute myocardial injury, myocarditis, cardiomyopathy, thrombosis, and myocardial fibrosis are some of the observed cardiac complications. There have been high morbidity and mortality rates in those affected by cardiac conditions associated with COVID-19. Additionally, there have been documented cases of patients presenting with typical cardiac symptoms who are subsequently discovered to have COVID-19 infection. In those who test positive for COVID-19, clinical awareness of the significant cardiac components of the virus is pertinent to prevent morbidity and mortality. Unfortunately, treatment and preventative measures developed for COVID-19 have been shown to be also be associated with cardiac complications. This is a comprehensive review of the cardiac complications and manifestations of COVID-19 infection in addition to those associated with both treatment and vaccination.
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Affiliation(s)
- Theresa Maitz
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | - Ashley Vojtek
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA.
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Fronza M, Thavendiranathan P, Chan V, Karur GR, Udell JA, Wald RM, Hong R, Hanneman K. Myocardial Injury Pattern at MRI in COVID-19 Vaccine-associated Myocarditis. Radiology 2022; 304:553-562. [PMID: 35166587 PMCID: PMC8856022 DOI: 10.1148/radiol.212559] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background There are limited data on the pattern and severity of myocardial injury
in patients with COVID-19 vaccination–associated myocarditis. Purpose To describe myocardial injury following COVID-19 vaccination and to
compare these findings to other causes of myocarditis. Materials and Methods In this retrospective cohort study, consecutive adult patients with
myocarditis with at least one T1-based and at least one T2-based
abnormality at cardiac MRI performed at a tertiary referral hospital
from December 2019 to November 2021 were included. Patients were
classified into one of three groups: myocarditis following COVID-19
vaccination, myocarditis following COVID-19 illness, and other
myocarditis not associated with COVID-19 vaccination or illness. Results Of the 92 included patients, 21 (23%) had myocarditis following COVID-19
vaccination (mean age, 31 years ± 14 [SD]; 17 men; messenger
RNA–1273 in 12 [57%] and BNT162b2 in nine [43%]). Ten of 92 (11%)
patients had myocarditis following COVID-19 illness (mean age, 51 years
± 14; three men) and 61 of 92 (66%) patients had other
myocarditis (mean age, 44 years ± 18; 36 men). MRI findings in
the 21 patients with vaccine-associated myocarditis included late
gadolinium enhancement (LGE) in 17 patients (81%) and left ventricular
dysfunction in six (29%). Compared with other causes of myocarditis,
patients with vaccine-associated myocarditis had a higher left
ventricular ejection fraction and less extensive LGE, even after
controlling for age, sex, and time from symptom onset to MRI. The most
frequent location of LGE in all groups was subepicardial at the basal
inferolateral wall, although septal involvement was less common in
vaccine-associated myocarditis. At short-term follow-up (median, 22 days
[IQR, 7–48 days]), all patients with vaccine-associated
myocarditis were asymptomatic with no adverse events. Conclusion Cardiac MRI demonstrated a similar pattern of myocardial injury in
vaccine-associated myocarditis compared with other causes, although
abnormalities were less severe, with less frequent septal involvement
and no adverse events over the short-term follow-up. © RSNA, 2022 Online supplemental material is available for this
article. See also the editorial by Raman and Neubauer in this issue.
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Affiliation(s)
- Matteo Fronza
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Victor Chan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Gauri Rani Karur
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
| | - Jacob A Udell
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto.,Cardiovascular Division, Women's College Hospital, University of Toronto, Toronto
| | - Rachel M Wald
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto
| | - Rachel Hong
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto.,Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto
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33
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Cheung E, Ahmad S, Aitken M, Chan R, Iwanochko RM, Balter M, Metser U, Veit-Haibach P, Billia F, Moayedi Y, Ross HJ, Hanneman K. Combined simultaneous FDG-PET/MRI with T1 and T2 mapping as an imaging biomarker for the diagnosis and prognosis of suspected cardiac sarcoidosis. Eur J Hybrid Imaging 2021; 5:24. [PMID: 34913098 PMCID: PMC8674394 DOI: 10.1186/s41824-021-00119-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate the diagnostic and prognostic significance of combined cardiac 18F-fluorodeoxyglucose (FDG) PET/MRI with T1/T2 mapping in the evaluation of suspected cardiac sarcoidosis. METHODS Patients with suspected cardiac sarcoidosis were prospectively enrolled for cardiac 18F-FDG PET/MRI, including late gadolinium enhancement (LGE) and T1/T2 mapping with calculation of extracellular volume (ECV). The final diagnosis of cardiac sarcoidosis was established using modified JMHW guidelines. Major adverse cardiac events (MACE) were assessed as a composite of cardiovascular death, ventricular tachyarrhythmia, bradyarrhythmia, cardiac transplantation or heart failure. Statistical analysis included Cox proportional hazard models. RESULTS Forty-two patients (53 ± 13 years, 67% male) were evaluated, 13 (31%) with a final diagnosis of cardiac sarcoidosis. Among patients with cardiac sarcoidosis, 100% of patients had at least one abnormality on PET/MRI: FDG uptake in 69%, LGE in 100%, elevated T1 and ECV in 100%, and elevated T2 in 46%. FDG uptake co-localized with LGE in 69% of patients with cardiac sarcoidosis compared to 24% of those without, p = 0.014. Diagnostic specificity for cardiac sarcoidosis was highest for FDG uptake (69%), elevated T2 (79%), and FDG uptake co-localizing with LGE (76%). Diagnostic sensitivity was highest for LGE, elevated T1 and ECV (100%). After median follow-up duration of 634 days, 13 patients experienced MACE. All patients who experienced MACE had LGE, elevated T1 and elevated ECV. FDG uptake (HR 14.7, p = 0.002), elevated T2 (HR 9.0, p = 0.002) and native T1 (HR 1.1 per 10 ms increase, p = 0.044) were significant predictors of MACE even after adjusting for left ventricular ejection fraction and immune suppression treatment. The presence of FDG uptake co-localizing with LGE had the highest diagnostic performance overall (AUC 0.73) and was the best predictor of MACE based on model goodness of fit (HR 14.9, p = 0.001). CONCLUSIONS Combined cardiac FDG-PET/MRI with T1/T2 mapping provides complementary diagnostic information and predicts MACE in patients with suspected cardiac sarcoidosis.
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Affiliation(s)
- Edward Cheung
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Avenue, 1 PMB-298, Toronto, ON, M5G 2N2, Canada
| | - Sarah Ahmad
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Matthew Aitken
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Avenue, 1 PMB-298, Toronto, ON, M5G 2N2, Canada
| | - Rosanna Chan
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Avenue, 1 PMB-298, Toronto, ON, M5G 2N2, Canada
| | - Robert M Iwanochko
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Meyer Balter
- Division of Respiratory Medicine, Sinai Health System, University of Toronto, 600 University Ave, Toronto, ON, M5G 1X5, Canada
| | - Ur Metser
- Division of Molecular Imaging, Department of Medical Imaging, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Patrick Veit-Haibach
- Division of Molecular Imaging, Department of Medical Imaging, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Filio Billia
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Yasbanoo Moayedi
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Heather J Ross
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Avenue, 1 PMB-298, Toronto, ON, M5G 2N2, Canada.
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