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Peverill RE, Lin KY, Fogel MA, Cheung MMH, Moir WS, Corben LA, Cahoon G, Delatycki MB. Insights into the effects of Friedreich ataxia on the left ventricle using T1 mapping and late gadolinium enhancement. PLoS One 2024; 19:e0303969. [PMID: 38814901 PMCID: PMC11139319 DOI: 10.1371/journal.pone.0303969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/04/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The left ventricular (LV) changes which occur in Friedreich ataxia (FRDA) are incompletely understood. METHODS Cardiac magnetic resonance (CMR) imaging was performed using a 1.5T scanner in subjects with FRDA who are homozygous for an expansion of an intron 1 GAA repeat in the FXN gene. Standard measurements were performed of LV mass (LVM), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). Native T1 relaxation time and the extracellular volume fraction (ECV) were utilised as markers of left ventricular (LV) diffuse myocardial fibrosis and late gadolinium enhancement (LGE) was utilised as a marker of LV replacement fibrosis. FRDA genetic severity was assessed using the shorter FXN GAA repeat length (GAA1). RESULTS There were 93 subjects with FRDA (63 adults, 30 children, 54% males), 9 of whom had a reduced LVEF (<55%). A LVEDV below the normal range was present in 39%, a LVM above the normal range in 22%, and an increased LVM/LVEDV ratio in 89% subjects. In adults with a normal LVEF, there was an independent positive correlation of LVM with GAA1, and a negative correlation with age, but no similar relationships were seen in children. GAA1 was positively correlated with native T1 time in both adults and children, and with ECV in adults, all these associations independent of LVM and LVEDV. LGE was present in 21% of subjects, including both adults and children, and subjects with and without a reduced LVEF. None of GAA1, LVM or LVEDV were predictors of LGE. CONCLUSION An association between diffuse interstitial LV myocardial fibrosis and genetic severity in FRDA was present independently of FRDA-related LV structural changes. Localised replacement fibrosis was found in a minority of subjects with FRDA and was not associated with LV structural change or FRDA genetic severity in subjects with a normal LVEF.
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Affiliation(s)
- Roger E. Peverill
- Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine (School of Clinical Sciences at Monash Health), Monash University and Monash Health, Clayton, Victoria, Australia
| | - Kimberly Y. Lin
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Mark A. Fogel
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Michael M. H. Cheung
- Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Heart Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - W. Stuart Moir
- Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine (School of Clinical Sciences at Monash Health), Monash University and Monash Health, Clayton, Victoria, Australia
| | - Louise A. Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Glenn Cahoon
- Department of Cardiology, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Martin B. Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia
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Katznelson E, Jerosch-Herold M, Cuddy SAM, Clerc OF, Benz DC, Taylor A, Rao S, Kijewski MF, Liao R, Landau H, Yee AJ, Ruberg FL, Di Carli MF, Falk RH, Kwong RY, Dorbala S. Mechanisms of left ventricular systolic dysfunction in light chain amyloidosis: a multiparametric cardiac MRI study. Front Cardiovasc Med 2024; 11:1371810. [PMID: 38873265 PMCID: PMC11169788 DOI: 10.3389/fcvm.2024.1371810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Background Cardiac systolic dysfunction is a poor prognostic marker in light-chain (AL) cardiomyopathy, a primary interstitial disorder; however, its pathogenesis is poorly understood. Purpose This study aims to analyze the effects of extracellular volume (ECV) expansion, a surrogate marker of amyloid burden on myocardial blood flow (MBF), myocardial work efficiency (MWE), and left ventricular (LV) systolic dysfunction in AL amyloidosis. Methods Subjects with biopsy-proven AL amyloidosis were prospectively enrolled (April 2016-June 2021; Clinicaltrials.gov ID NCT02641145) and underwent cardiac magnetic resonance imaging (MRI) to quantify rest MBF by perfusion imaging, LV ejection fraction (LVEF) by cine MRI, and ECV by pre- and post-contrast T1 mapping. The MWE was estimated as external cardiac work from the stroke volume and mean arterial pressure normalized to the LV myocardial mass. Results Rest MBF in 92 subjects (62 ± 8 years, 52 men) with AL amyloidosis averaged 0.87 ± 0.21 ml/min/g and correlated with MWE (r = 0.42; p < 0.001). Rest MBF was similarly low in subjects with sustained hematologic remission after successful AL amyloidosis therapy (n = 21), as in those with recently diagnosed AL amyloidosis. Both MBF and MWE decreased by ECV tertile (p < 0.01 for linear trends). The association of ECV with MWE comprised a direct effect (84% of the total effect; p < 0.001) on MWE from adverse interstitial remodeling assessed by ECV and an indirect effect (16% of the total effect; p < 0.001) mediated by MBF. There was a significant base-to-apex gradient of rest MBF in subjects with higher amyloid burden. Conclusions In AL amyloidosis, both MBF and MWE decrease as cardiac amyloid burden and ECV expansion increase. Both structural and vascular changes from ECV expansion and myocardial amyloid burden appear to contribute to lower MWE.
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Affiliation(s)
- Ethan Katznelson
- Department of Cardiology, Weill Cornell Medical Center, New York, NY, United States
| | - Michael Jerosch-Herold
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Sarah A. M. Cuddy
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Olivier F. Clerc
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Dominik C. Benz
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Alexandra Taylor
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Shivani Rao
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Marie Foley Kijewski
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Ronglih Liao
- Amyloidosis Program, Stanford University, Stanford, CA, United States
| | - Heather Landau
- Division of Medical Oncology, Memorial Sloan Kettering Medical Center, New York, NY, United States
| | - Andrew J. Yee
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Marcelo F. Di Carli
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Rodney H. Falk
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Raymond Y. Kwong
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Sharmila Dorbala
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
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3
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Sharrack N, Biglands JD, Broadbent DA, Kellman P, Chow K, Greenwood JP, Levelt E, Plein S, Buckley DL. The impact of water exchange on estimates of myocardial extracellular volume calculated using contrast enhanced T 1 measurements: A preliminary analysis in patients with severe aortic stenosis. Magn Reson Med 2024; 91:1637-1644. [PMID: 38041477 PMCID: PMC10872615 DOI: 10.1002/mrm.29956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/06/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Guidelines recommend measuring myocardial extracellular volume (ECV) using T1 -mapping before and 10-30 min after contrast agent administration. Data are then analyzed using a linear model (LM), which assumes fast water exchange (WX) between the ECV and cardiomyocytes. We investigated whether limited WX influences ECV measurements in patients with severe aortic stenosis (AS). METHODS Twenty-five patients with severe AS and 5 healthy controls were recruited. T1 measurements were made on a 3 T Siemens system using a multiparametric saturation-recovery single-shot acquisition (a) before contrast; (b) 4 min post 0.05 mmol/kg gadobutrol; and (c) 4 min, (d) 10 min, and (e) 30 min after an additional gadobutrol dose (0.1 mmol/kg). Three LM-based ECV estimates, made using paired T1 measurements (a and b), (a and d), and (a and e), were compared to ECV estimates made using all 5 T1 measurements and a two-site exchange model (2SXM) accounting for WX. RESULTS Median (range) ECV estimated using the 2SXM model was 25% (21%-39%) for patients and 26% (22%-29%) for controls. ECV estimated in patients using the LM at 10 min following a cumulative contrast dose of 0.15 mmol/kg was 21% (17%-32%) and increased significantly to 22% (19%-35%) at 30 min (p = 0.0001). ECV estimated using the LM was highest following low dose gadobutrol, 25% (19%-38%). CONCLUSION Current guidelines on contrast agent dose for ECV measurements may lead to underestimated ECV in patients with severe AS because of limited WX. Use of a lower contrast agent dose may mitigate this effect.
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Affiliation(s)
- Noor Sharrack
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John D Biglands
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David A Broadbent
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - John P Greenwood
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - David L Buckley
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Oyama-Manabe N, Oda S, Ohta Y, Takagi H, Kitagawa K, Jinzaki M. Myocardial late enhancement and extracellular volume with single-energy, dual-energy, and photon-counting computed tomography. J Cardiovasc Comput Tomogr 2024; 18:3-10. [PMID: 38218665 DOI: 10.1016/j.jcct.2023.12.006] [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: 09/27/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024]
Abstract
Computed tomography late enhancement (CT-LE) is emerging as a non-invasive technique for cardiac diagnosis with wider accessibility compared to MRI, despite its typically lower contrast-to-noise ratio. Optimizing CT-LE image quality necessitates a thorough methodology addressing contrast administration, timing, and radiation dose, alongside a robust understanding of extracellular volume (ECV) quantification methods. This review summarizes CT-LE protocols, clinical utility, and advances in ECV measurement through both single-energy and dual-energy CT. It also highlights photon-counting detector CT technology as an innovative means to potentially improve image quality and reduce radiation exposure.
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Affiliation(s)
- Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hidenobu Takagi
- Department of Advanced Radiological Imaging Collaborative Research, Tohoku University, Sendai, Japan; Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan.
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5
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Cadour F, Quemeneur M, Biere L, Donal E, Bentatou Z, Eicher JC, Roubille F, Lalande A, Giorgi R, Rapacchi S, Cortaredona S, Tradi F, Bartoli A, Willoteaux S, Delahaye F, Biene SM, Mangin L, Ferrier N, Dacher JN, Bauer F, Leurent G, Lentz PA, Kovacsik H, Croisille P, Thuny F, Bernard M, Guye M, Furber A, Habib G, Jacquier A. Prognostic value of cardiovascular magnetic resonance T1 mapping and extracellular volume fraction in nonischemic dilated cardiomyopathy. J Cardiovasc Magn Reson 2023; 25:7. [PMID: 36747201 PMCID: PMC9900939 DOI: 10.1186/s12968-023-00919-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Heart failure- (HF) and arrhythmia-related complications are the main causes of morbidity and mortality in patients with nonischemic dilated cardiomyopathy (NIDCM). Cardiovascular magnetic resonance (CMR) imaging is a noninvasive tool for risk stratification based on fibrosis assessment. Diffuse interstitial fibrosis in NIDCM may be a limitation for fibrosis assessment through late gadolinium enhancement (LGE), which might be overcome through quantitative T1 and extracellular volume (ECV) assessment. T1 and ECV prognostic value for arrhythmia-related events remain poorly investigated. We asked whether T1 and ECV have a prognostic value in NIDCM patients. METHODS This prospective multicenter study analyzed 225 patients with NIDCM confirmed by CMR who were followed up for 2 years. CMR evaluation included LGE, native T1 mapping and ECV values. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE) which was divided in two groups: HF-related events and arrhythmia-related events. Optimal cutoffs for prediction of MACE occurrence were calculated for all CMR quantitative values. RESULTS Fifty-eight patients (26%) developed a MACE during follow-up, 42 patients (19%) with HF-related events and 16 patients (7%) arrhythmia-related events. T1 Z-score (p = 0.008) and global ECV (p = 0.001) were associated with HF-related events occurrence, in addition to left ventricular ejection fraction (p < 0.001). ECV > 32.1% (optimal cutoff) remained the only CMR independent predictor of HF-related events occurrence (HR 2.15 [1.14-4.07], p = 0.018). In the arrhythmia-related events group, patients had increased native T1 Z-score and ECV values, with both T1 Z-score > 4.2 and ECV > 30.5% (optimal cutoffs) being independent predictors of arrhythmia-related events occurrence (respectively, HR 2.86 [1.06-7.68], p = 0.037 and HR 2.72 [1.01-7.36], p = 0.049). CONCLUSIONS ECV was the sole independent predictive factor for both HF- and arrhythmia-related events in NIDCM patients. Native T1 was also an independent predictor in arrhythmia-related events occurrence. The addition of ECV and more importantly native T1 in the decision-making algorithm may improve arrhythmia risk stratification in NIDCM patients. Trial registration NCT02352129. Registered 2nd February 2015-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02352129.
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Affiliation(s)
- Farah Cadour
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Morgane Quemeneur
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Loic Biere
- Department of Cardiology, University Hospital of Angers, 49000 Angers, France
- UMR CNRS 6015-INSERMU1083, Institut Mitovasc, University of Angers, 49000 Angers, France
| | - Erwan Donal
- Department of Cardiology, Inserm, LTSI–UMR 1099, CHU Rennes, Univ Rennes, 35000 Rennes, France
| | - Zakarya Bentatou
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | | | - François Roubille
- PhyMedExp, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Alain Lalande
- ImViA Laboratory, University of Burgundy, 7 Bld Jeanne d’arc, 21000 Dijon, France
- Medical Imaging Department, University Hospital of Dijon, 21000 Dijon, France
| | - Roch Giorgi
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Hop Timone, BioSTICBiostatistique et Technologies de l’Information et de la Communication, Aix Marseille Univ, Marseille, France
| | - Stanislas Rapacchi
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Sébastien Cortaredona
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Farouk Tradi
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Axel Bartoli
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Serge Willoteaux
- UMR CNRS 6015-INSERMU1083, Institut Mitovasc, University of Angers, 49000 Angers, France
| | - François Delahaye
- Department of Cardiology, Hospices civils de Lyon, 69002 Lyon, France
| | | | - Lionel Mangin
- Department of Cardiology, CH d’Annecy, 74370 Annecy, France
| | - Nadine Ferrier
- Department of Cardiology, CH de Vichy, 03207 Vichy, France
| | - Jean-Nicolas Dacher
- Department of Radiology, UNIROUEN, Inserm U1096, CHU de Rouen, 76000 Rouen, France
| | - Fabrice Bauer
- INSERM U 1096, Cardiovascular Surgery Department, Pulmonary Hypertension and Advanced Heart Failure Clinic, Rouen University Hospital, Rouen, France
| | - Guillaume Leurent
- Department of Cardiology, Inserm, LTSI–UMR 1099, CHU Rennes, Univ Rennes, 35000 Rennes, France
| | - Pierre-Axel Lentz
- Department of Radiology, University Hospital Pontchaillou, Rennes, France
| | - Hélène Kovacsik
- Departement of Cardiovascular Imaging, Chu Montpellier, Montpellier, France
| | - Pierre Croisille
- Department of Radiology, University Hospital Saint-Etienne, Saint-Étienne, France
- CNRS UMR 5520, INSERM U1294, CREATIS, INSA-Lyon, Univ Lyon, UJM-Saint-Etienne, 42023 Saint-Étienne, France
| | - Franck Thuny
- Unit of Heart Failure and Valvular Heart Diseases, Inserm 1263, Inrae 1260, Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), University Mediterranean Center of Cardio-Oncology, Aix-Marseille University, Marseille, France
| | - Monique Bernard
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
- Faculté de Médecine, CNRS, Aix-Marseille Université, 27 Bd Jean Moulin, 13385 Marseille cedex 5, France
| | - Maxime Guye
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
| | - Alain Furber
- Department of Cardiology, University Hospital of Angers, 49000 Angers, France
- UMR CNRS 6015-INSERMU1083, Institut Mitovasc, University of Angers, 49000 Angers, France
| | - Gilbert Habib
- Cardiology Department, IRD, APHM, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Aix Marseille Univ, Marseille, France
| | - Alexis Jacquier
- CNRS, CRMBM, Aix-Marseille University, Marseille, France
- CEMEREM, APHM, CHU Timone, Marseille, France
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Brown LAE, Wahab A, Ikongo E, Saunderson CED, Jex N, Thirunavukarasu S, Chowdhary A, Das A, Craven TP, Levelt E, Dall’Armellina E, Knott KD, Greenwood JP, Moon JC, Xue H, Kellman P, Plein S, Swoboda PP. Cardiovascular magnetic resonance phenotyping of heart failure with mildly reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2022; 24:38-45. [PMID: 36285884 PMCID: PMC9762938 DOI: 10.1093/ehjci/jeac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/14/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS The 2016 European Society of Cardiology Heart Failure Guidelines defined a new category: heart failure with mid-range ejection fraction (HFmrEF) of 40-49%. This new category was highlighted as having limited evidence and research was advocated into underlying characteristics, pathophysiology, and diagnosis. We used multi-parametric cardiovascular magnetic resonance (CMR) to define the cardiac phenotype of presumed non-ischaemic HFmrEF. METHODS AND RESULTS Patients (N = 300, 62.7 ± 13 years, 63% males) with a clinical diagnosis of heart failure with no angina symptoms, history of myocardial infarction, or coronary intervention were prospectively recruited. Patients underwent clinical assessment and CMR including T1 mapping, extracellular volume (ECV) mapping, late gadolinium enhancement, and measurement of myocardial blood flow at rest and maximal hyperaemia. Of 273 patients in the final analysis, 93 (34%) patients were categorized as HFmrEF, 46 (17%) as heart failure with preserved ejection fraction (HFpEF), and 134 (49%) as heart failure with reduced ejection fraction (HFrEF). Nineteen (20%) patients with HFmrEF had evidence of occult ischaemic heart disease. Diffuse fibrosis and hyperaemic myocardial blood flow were similar in HFmrEF and HFpEF, but HFmrEF showed significantly lower native T1 (1311 ± 32 vs. 1340 ± 45 ms, P < 0.001), ECV (24.6 ± 3.2 vs. 26.3 ± 3.1%, P < 0.001), and higher myocardial perfusion reserve (2.75 ± 0.84 vs. 2.28 ± 0.84, P < 0.001) compared with HFrEF. CONCLUSION Patients with HFmrEF share most phenotypic characteristics with HFpEF, including the degree of microvascular impairment and fibrosis, but have a high prevalence of occult ischaemic heart disease similar to HFrEF. Further work is needed to confirm how the phenotype of HFmrEF responds to medical therapy.
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Affiliation(s)
- Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Ali Wahab
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Eunice Ikongo
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Chirstopher E D Saunderson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Arka Das
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Thomas P Craven
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Erica Dall’Armellina
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - Kristopher D Knott
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
| | - James C Moon
- The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK
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7
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Lin YH, Hsueh HW, Su MY, Cheng MF, Chiang MC, Juang JMJ, Kao YH, Chang KC, Feng FP, Hsieh ST, Chao CC. Cardiomyopathy correlates to nerve damage in p.A117S late-onset transthyretin amyloid polyneuropathy. Ann Clin Transl Neurol 2022; 9:1359-1369. [PMID: 35945697 PMCID: PMC9463956 DOI: 10.1002/acn3.51635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Late‐onset hereditary transthyretin amyloidosis with polyneuropathy (ATTRv‐PN) is often associated with heart involvement. Recent advances in cardiac imaging allow the detection of cardiac amyloidosis. This study aimed to explore cardiomyopathy by cardiac imaging and its clinical correlates with polyneuropathy in late‐onset ATTRv‐PN. Methods Polyneuropathy was assessed by intraepidermal nerve fiber (IENF) density, nerve conduction study (NCS), autonomic function tests, quantitative sensory testing, and clinical questionnaires. Cardiomyopathy was evaluated by echocardiography, 99mTc‐pyrophosphate (PYP) single‐photon emission computed tomography (SPECT) imaging, cardiac magnetic resonance imaging (CMR), and serum Pro‐B‐type natriuretic peptide. Healthy controls and patients with Brugada syndrome were enrolled for comparison of CMR. Results Fifty late‐onset ATTRv‐PN patients (38 men, 46 with p. A117S mutation), aged 63.7 ± 5.5 years, of polyneuropathy disability stage 1–4 were enrolled. All patients presented polyneuropathy in NCS, and 74.5% of patients had reduced IENF density in distal legs. All patients showed significant radiotracer uptake in the heart on 99mTc‐PYP SPECT imaging, and 87.8% of patients had abnormally increased left ventricular (LV) septum thickness on echocardiography. CMR showed longer myocardial native T1, larger extracellular volume, greater LV mass index, and higher LV mass to end‐diastolic volume ratio in ATTRv‐PN patients than healthy controls and patients with Brugada syndrome. These CMR parameters were associated with skin denervation, absent sympathetic skin responses, elevated thermal thresholds, worsened NCS profiles, and functional deficits of polyneuropathy. Interpretation Late‐onset ATTRv‐PN coexisted with cardiomyopathy regardless of the clinical severity of polyneuropathy. The cardiac amyloid burden revealed by CMR was correlated with pathophysiology and clinical disability of nerve degeneration.
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Affiliation(s)
- Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsueh-Wen Hsueh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chang Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jyh-Ming Jimmy Juang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hui Kao
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Kai-Chieh Chang
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Fang-Ping Feng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Center of Precision Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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8
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Zhang SJ, Chang D, Jin JY, Wang YL, Wang L, Wang YC, Wang Z, Ju S. Myocardial Extracellular Volume Fraction Measured by Cardiac Magnetic Resonance Imaging Negatively Correlates With Cardiomyocyte Breadth in a Healthy Porcine Model. Front Cardiovasc Med 2022; 9:791963. [PMID: 35369328 PMCID: PMC8968101 DOI: 10.3389/fcvm.2022.791963] [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: 10/09/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe extracellular volume fraction (ECV) derived from cardiac magnetic resonance imaging (MRI) is extensively used to evaluate myocardial fibrosis. However, due to the limited histological verification in healthy individuals, it remains unclear whether the size of cardiomyocytes may play a potential role in the physiological changes of ECV. The aim of this study was to examine the association between cardiomyocyte size and myocardial ECV by using a healthy porcine model.MethodsSixteen domestic healthy pigs were anesthetized and underwent cardiac MRI with mechanical controlled breathing. Intravenous contrast medium was introduced at a dose of 0.2–0.25 mmol/kg. The interventricular septum ECV was calculated using an established MRI procedure, which was based on the pre- and post-contrast T1 values of the heart and individual blood hematocrit. The cardiomyocyte breadth (CmyB) in cross section was measured by hematoxylin and eosin staining to reflect the cardiomyocyte size.ResultsData were successfully acquired from 14 pigs. The CmyB was obtained from the myocardial tissues corresponding to the region of interest on cardiac MRI. The mean ± SD of the ECV was 0.253 ± 0.043, and the mean ± SD of the CmyB was 10.02 ± 0.84 μm. The ECV exhibited a negative correlation with the CmyB (r = −0.729, p = 0.003).ConclusionThe myocardial ECV detected by cardiac MRI is negatively correlated with the CmyB in healthy pigs, demonstrating that the size of cardiomyocytes is potentially associated with the ECV under physiological conditions.
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Affiliation(s)
- Shi-Jun Zhang
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Di Chang
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Ji-Yang Jin
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Ya-Ling Wang
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Lin Wang
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Yuan-Cheng Wang
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Zhen Wang
- Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
- *Correspondence: Shenghong Ju,
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9
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Heusch G. Coronary blood flow in heart failure: cause, consequence and bystander. Basic Res Cardiol 2022; 117:1. [PMID: 35024969 PMCID: PMC8758654 DOI: 10.1007/s00395-022-00909-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/31/2023]
Abstract
Heart failure is a clinical syndrome where cardiac output is not sufficient to sustain adequate perfusion and normal bodily functions, initially during exercise and in more severe forms also at rest. The two most frequent forms are heart failure of ischemic origin and of non-ischemic origin. In heart failure of ischemic origin, reduced coronary blood flow is causal to cardiac contractile dysfunction, and this is true for stunned and hibernating myocardium, coronary microembolization, myocardial infarction and post-infarct remodeling, possibly also for the takotsubo syndrome. The most frequent form of non-ischemic heart failure is dilated cardiomyopathy, caused by genetic mutations, myocarditis, toxic agents or sustained tachyarrhythmias, where alterations in coronary blood flow result from and contribute to cardiac contractile dysfunction. Hypertrophic cardiomyopathy is caused by genetic mutations but can also result from increased pressure and volume overload (hypertension, valve disease). Heart failure with preserved ejection fraction is characterized by pronounced coronary microvascular dysfunction, the causal contribution of which is however not clear. The present review characterizes the alterations of coronary blood flow which are causes or consequences of heart failure in its different manifestations. Apart from any potentially accompanying coronary atherosclerosis, all heart failure entities share common features of impaired coronary blood flow, but to a different extent: enhanced extravascular compression, impaired nitric oxide-mediated, endothelium-dependent vasodilation and enhanced vasoconstriction to mediators of neurohumoral activation. Impaired coronary blood flow contributes to the progression of heart failure and is thus a valid target for established and novel treatment regimens.
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Affiliation(s)
- Gerd Heusch
- grid.5718.b0000 0001 2187 5445Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
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10
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Nordmeyer S, Lee CB, Goubergrits L, Knosalla C, Berger F, Falk V, Ghorbani N, Hireche-Chikaoui H, Zhu M, Kelle S, Kuehne T, Kelm M. Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement. J Cardiovasc Magn Reson 2021; 23:15. [PMID: 33641670 PMCID: PMC7919094 DOI: 10.1186/s12968-020-00686-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Circulatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR. METHODS Circulatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n = 41) before and 4 months after AVR and in age and sex-matched healthy subjects (n = 10). RESULTS In patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9 ± 3% vs 12 ± 2%; p = 0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r = - 0.591, p < 0.001), myocardial fibrosis volume (r = - 0.427, p = 0.015), end systolic volume (r = - 0.609, p < 0.001) and NT-proBNP (r = - 0.444, p = 0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r = 0.704, p < 0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9 ± 3 vs 13 ± 5%; p < 0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR. CONCLUSION In our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered.
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Affiliation(s)
- S Nordmeyer
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany.
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - C B Lee
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - L Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Knosalla
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - F Berger
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - V Falk
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - N Ghorbani
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - H Hireche-Chikaoui
- Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - M Zhu
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Kuehne
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - M Kelm
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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11
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Dusenbery SM, Newburger JW, Colan SD, Gauvreau K, Baker A, Powell AJ. Myocardial fibrosis in patients with a history of Kawasaki disease. IJC HEART & VASCULATURE 2021; 32:100713. [PMID: 33521237 PMCID: PMC7820031 DOI: 10.1016/j.ijcha.2021.100713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
Objectives Cardiac magnetic resonance (CMR) measurements of myocardial extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) in patients with a history of Kawasaki disease (KD) were analyzed to determine whether fibrosis was increased compared to controls. Methods In this single center retrospective study, patients with KD who had a CMR with ECV measurement and LGE assessment were included. The ECV was calculated in the mid-left ventricle by measuring T1 values for blood pool and myocardium before and after gadolinium administration with a Look-Locker technique. CMR findings were compared to 20 control subjects. Results KD patients (n = 13) had a median age at CMR of 14.9 years (range, 7.5-36.0). Control subjects (n = 20) had a median age at CMR of 16 years (range, 11.0-36.0). Twelve KD patients had coronary aneurysms. The KD patients had a significantly lower indexed LV mass (p = 0.03) and LV mass/volume ratio (p = 0.01). ECV was not significantly different in KD patients and controls (0.26 (range, 0.20-0.30) vs. 0.25 (range, 0.18-0.28), p = 0.28). One KD patient (8%) had an increased (>0.28) ECV. LGE indicating focal fibrosis was found in 5 of 13 (38%) of KD patients. Patients with LGE tended to have a higher maximum coronary dimension z-score (p = 0.09). Conclusions In this study of KD patients, most of whom had aneurysms, ECV did not differ significantly from that in normal controls. Focal fibrosis based on LGE was common. Future larger studies should compare ECV in KD patients with and without aneurysms to define the risk of myocardial fibrosis after KD.
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Affiliation(s)
- Susan M Dusenbery
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Annette Baker
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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12
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Su MY, Huang YS, Niisato E, Chow K, Juang JMJ, Wu CK, Yu HY, Lin LY, Yang SC, Chang YC. Is a timely assessment of the hematocrit necessary for cardiovascular magnetic resonance-derived extracellular volume measurements? J Cardiovasc Magn Reson 2020; 22:77. [PMID: 33250055 PMCID: PMC7702722 DOI: 10.1186/s12968-020-00689-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/17/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR)-derived extracellular volume (ECV) requires a hematocrit (Hct) to correct contrast volume distributions in blood. However, the timely assessment of Hct can be challenging and has limited the routine clinical application of ECV. The goal of the present study was to evaluate whether ECV measurements lead to significant error if a venous Hct was unavailable on the day of CMR. METHODS 109 patients with CMR T1 mapping and two venous Hcts (Hct0: a Hct from the day of CMR, and Hct1: a Hct from a different day) were retrospectively identified. A synthetic Hct (Hctsyn) derived from native blood T1 was also assessed. The study used two different ECV methods, (1) a conventional method in which ECV was estimated from native and postcontrast T1 maps using a region-based method, and (2) an inline method in which ECV was directly measured from inline ECV mapping. ECVs measured with Hct0, Hct1, and Hctsyn were compared for each method, and the reference ECV (ECV0) was defined using the Hct0. The error between synthetic (ECVsyn) and ECV0was analyzed for the two ECV methods. RESULTS ECV measured using Hct1 and Hctsyn were significantly correlated with ECV0 for each method. No significant differences were observed between ECV0 and ECV measured with Hct1 (ECV1; 28.4 ± 6.6% vs. 28.3 ± 6.1%, p = 0.789) and between ECV0 and ECV calculated with Hctsyn (ECVsyn; 28.4 ± 6.6% vs. 28.2 ± 6.2%, p = 0.45) using the conventional method. Similarly, ECV0 was not significantly different from ECV1 (28.5 ± 6.7% vs. 28.5 ± 6.2, p = 0.801) and ECVsyn (28.5 ± 6.7% vs. 28.4 ± 6.0, p = 0.974) using inline method. ECVsyn values revealed relatively large discrepancies in patients with lower Hcts compared with those with higher Hcts. CONCLUSIONS Venous Hcts measured on a different day from that of the CMR examination can still be used to measure ECV. ECVsyn can provide an alternative method to quantify ECV without needing a blood sample, but significant ECV errors occur in patients with severe anemia.
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Affiliation(s)
- Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100 Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100 Taiwan
| | | | - Kelvin Chow
- Siemens Medical Solutions USA Inc., Chicago, IL USA
| | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cho-Kai Wu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shun-Chung Yang
- Department of Medical Imaging, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100 Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100 Taiwan
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13
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Yamada A, Kitagawa K, Nakamura S, Takafuji M, Goto Y, Okamoto R, Dohi K, Sakuma H. Quantification of extracellular volume fraction by cardiac computed tomography for noninvasive assessment of myocardial fibrosis in hemodialysis patients. Sci Rep 2020; 10:15367. [PMID: 32958834 PMCID: PMC7506012 DOI: 10.1038/s41598-020-72417-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/31/2020] [Indexed: 12/04/2022] Open
Abstract
Extent of myocardial fibrosis in hemodialysis patients has been associated with poor prognosis. Myocardial extracellular volume (ECV) quantification using contrast enhanced cardiac computed tomography (CT) is a novel method to determine extent of myocardial fibrosis. Cardiac CT-based myocardial ECV in hemodialysis patients with those of propensity-matched non-hemodialysis control subjects were compared. Twenty hemodialysis patients (mean age, 67.4 ± 9.6 years; 80% male) and 20 propensity-matched non-hemodialysis controls (mean age, 66.3 ± 9.1 years; 85% male) who underwent comprehensive cardiac CT consisted of calcium scoring, coronary CT angiography, stress perfusion CT and delayed enhancement CT were evaluated. Myocardial ECV was significantly greater in the hemodialysis group than in the control group (33.8 ± 4.7% versus 26.6 ± 2.9%; P < 0.0001). In the hemodialysis group, modest correlation was evident between myocardial ECV and left atrial volume index (r = 0.54; P = 0.01), while there was no correlation between myocardial ECV and other cardiac parameters including left ventricular mass index and severity of myocardial ischemia. Cardiac CT-based myocardial ECV may offer a potential imaging biomarker for myocardial fibrosis in HD patients.
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Affiliation(s)
- Akimasa Yamada
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | | | | | - Yoshitaka Goto
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Ryuji Okamoto
- Department of Cardiology, Mie University Hospital, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology, Mie University Hospital, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
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14
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Bush MA, Pan Y, Jin N, Liu Y, Varghese J, Ahmad R, Simonetti OP. Prospective correction of patient-specific respiratory motion in myocardial T 1 and T 2 mapping. Magn Reson Med 2020; 85:855-867. [PMID: 32851676 DOI: 10.1002/mrm.28475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/29/2020] [Accepted: 07/22/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Respiratory motion in cardiovascular MRI presents a challenging problem with many potential solutions. Current approaches require breath-holds, apply retrospective image registration, or significantly increase scan time by respiratory gating. Myocardial T1 and T2 mapping techniques are particularly sensitive to motion as they require multiple source images to be accurately aligned prior to the estimation of tissue relaxation. We propose a patient-specific prospective motion correction (PROCO) strategy that corrects respiratory motion on the fly with the goal of reducing the spatial variation of myocardial parametric mapping techniques. METHODS A rapid, patient-specific training scan was performed to characterize respiration-induced motion of the heart relative to a diaphragmatic navigator, and a parametric mapping pulse sequence utilized the resulting motion model to prospectively update the scan plane in real-time. Midventricular short-axis T1 and T2 maps were acquired under breath-hold or free-breathing conditions with and without PROCO in 7 healthy volunteers and 3 patients. T1 and T2 were measured in 6 segments and compared to reference standard breath-hold measurements using Bland-Altman analysis. RESULTS PROCO significantly reduced the spatial variation of parametric maps acquired during free-breathing, producing limits of agreement of -47.16 to 30.98 ms (T1 ) and -1.35 to 4.02 ms (T2 ), compared to -67.77 to 74.34 ms (T1 ) and -2.21 to 5.62 ms (T2 ) for free-breathing acquisition without PROCO. CONCLUSION Patient-specific respiratory PROCO method significantly reduced the spatial variation of myocardial T1 and T2 mapping, while allowing for 100% efficient free-breathing acquisitions.
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Affiliation(s)
- Michael A Bush
- Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Yue Pan
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA Inc, Columbus, Ohio, USA
| | - Yingmin Liu
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Rizwan Ahmad
- Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.,Electrical and Computer Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA.,Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.,Internal Medicine, The Ohio State University, Columbus, Ohio, USA.,Radiology, The Ohio State University, Columbus, Ohio, USA
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15
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Diffusely Increased Myocardial Extracellular Volume With or Without Focal Late Gadolinium Enhancement. J Thorac Imaging 2020; 37:17-25. [DOI: 10.1097/rti.0000000000000515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Insulin Resistance Modifies the Effects of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction (from the OMEGA-REMODEL Randomized Clinical Trial). Am J Cardiol 2020; 125:678-684. [PMID: 31948661 DOI: 10.1016/j.amjcard.2019.11.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/31/2022]
Abstract
Insulin resistance early after acute myocardial infarction is associated with increased heart failure and mortality. OMEGA-REMODEL was a prospective double-blind 1:1 randomized control trial of patients with AMI. We reported that 6-month treatment with omega-3 fatty acid (O-3FA) 4 g/day attenuated cardiac remodeling accompanied by reduction in inflammation. We hypothesized that insulin resistance modifies the therapeutic effect of O-3FA on post-MI cardiac remodeling. The OMEGA-REMODEL study group was dichotomized according to cohort- and gender-specific median cutoff value of leptin-to-adiponectin ratio (LAR) at baseline (LAR-Hi vs LAR-Lo). Mixed model regression analyses were used to evaluate effect modification of O-3FA on reduction of left ventricular end-systolic volume index (LVESVI) by LAR status. Baseline LAR was evaluated on 325 patients (59 ± 11 years, 81% male). A total of 168 patients were categorized in LAR-Lo, and 157 in LAR-Hi. O-3FA treatment resulted in significant LVESVI reduction in patients with LAR-Lo but not with LAR-Hi (p = 0.0002 vs 0.66, respectively). Mixed model regression analysis showed significant modification of LAR on O-3FA's treatment effect in attenuating LVESVI (p = 0.021). In conclusion, this post-hoc efficacy analysis suggests that LAR status significantly modified O-3FA's treatment effect in attenuating cardiac remodeling. During the convalescent phase of acute infarct healing, patients with lower insulin resistance estimated by LAR appear to derive more therapeutic response from O-3FA toward improvement of LVESVI.
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Yang EY, Khan MA, Graviss EA, Nguyen DT, Bhimaraj A, Nambi V, Hoogeveen RC, Ballantyne CM, Zoghbi WA, Shah DJ. Relationship of extracellular volume assessed on cardiac magnetic resonance and serum cardiac troponins and natriuretic peptides with heart failure outcomes. Sci Rep 2019; 9:20168. [PMID: 31882822 PMCID: PMC6934524 DOI: 10.1038/s41598-019-56213-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022] Open
Abstract
Measures of serum cardiac troponins and natriuretic peptides have become established as prognostic heart failure risk markers. In addition to detecting myocardial fibrosis through late gadolinium enhancement (LGE), extracellular volume fraction (ECV) measures by cardiac magnetic resonance (CMR) have emerged as a phenotypic imaging risk marker for incident heart failure outcomes. We sought to examine the relationship between cardiac troponins, natriuretic peptides, ECV and their associations with incident heart failure events in a CMR referral base. Mid short axis T1 maps were divided into 6 cardiac segments, each classified as LGE absent or present. Global ECV was derived from T1 maps using the area-weighted average of only LGE-absent segments. ECV was considered elevated if measured >30%, the upper 95% bounds of a reference healthy group without known cardiac disease (n = 28). Patients were dichotomized by presence of elevated ECV. High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal B-type natriuretic peptide (NT-proBNP) were measured using serum samples acquired and stored at time of CMR scan, and patients were categorized into 3 groups for each blood marker based on recommended cutoff values. Subsequent heart failure admission and any death were ascertained. Relationships with ECV, hs-cTnT, and NT-proBNP were examined separately and as a composite with Cox proportional hazard models. Of 1,604 serial patients referred for a clinical CMR with myocardial T1 maps, 331 were eligible after exclusions and had blood available and were followed over a median 25.0 [interquartile range 21.8, 31.7] months. After adjustments for age (mean 57.3 [standard deviation (SD) 15.1 years), gender (61% male), and ethnicity (12.7% black), elevated ECV remained a predictor of a first composite heart failure outcome for patients with high levels of hs-cTnT (≥14 ng/L; hazard ratio [HR] 2.42 [95% confidence interval (CI) 1.17, 5.03]; p = 0.02) and NT-proBNP (≥300 pg/mL; HR 2.28 [95% CI 1.24, 4.29]; p = 0.01). Similar trends were seen for lower category levels of blood markers, but did not persist with minimal covariate adjustments. Elevated measures of ECV by CMR are associated with incident heart failure outcomes in patients with high hs-cTnT and NT-proBNP levels. This imaging marker may have a role for additional heart failure risk stratification.
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Affiliation(s)
- Eric Y Yang
- Houston Methodist Hospital, Houston, TX, USA
| | | | | | | | | | - Vijay Nambi
- Houston Methodist Hospital, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christie M Ballantyne
- Houston Methodist Hospital, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Yang EY, Ghosn MG, Khan MA, Gramze NL, Brunner G, Nabi F, Nambi V, Nagueh SF, Nguyen DT, Graviss EA, Schelbert EB, Ballantyne CM, Zoghbi WA, Shah DJ. Myocardial Extracellular Volume Fraction Adds Prognostic Information Beyond Myocardial Replacement Fibrosis. Circ Cardiovasc Imaging 2019; 12:e009535. [PMID: 31838882 DOI: 10.1161/circimaging.119.009535] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiac magnetic resonance techniques permit quantification of the myocardial extracellular volume fraction (ECV), representing a surrogate marker of reactive interstitial fibrosis, and late gadolinium enhancement (LGE), representing replacement fibrosis or scar. ECV and LGE have been independently linked with heart failure (HF) events. In deriving ECV, coronary artery disease type LGE, but not non-coronary artery disease type LGE, has been consistently excluded. We examined the associations between LGE, global ECV derived from myocardial tissue segments free of any detectable scar, and subsequent HF events. METHODS Mid short-axis T1 maps were divided into 6 cardiac segments, each classified as LGE absent or present. Global ECV was derived from only segments without LGE. ECV was considered elevated if >30%, the upper 95% bounds of a reference group without known cardiac disease (n=28). Patients were divided into 4 groups by presence of elevated ECV and of any LGE. Subsequent HF hospitalization and any death were ascertained. Their relationship with ECV was examined separately and as a composite with Cox proportional hazard models. RESULTS Of 1604 serial patients with T1 maps, 1255 were eligible after exclusions and followed over a median 26.3 (interquartile range, 15.9-37.5) months. Patients with elevated ECV had increased risk for death (hazard ratio [HR] 2.45 [95% CI, 1.76-3.41]), HF hospitalization (HR, 2.45 [95% CI, 1.77-3.40]), and a combined end point of both outcomes (HR, 2.46 [95% CI, 1.94-3.14]). After adjustments for covariates including LGE, the relationship persisted for death (HR, 1.82 [95% CI, 1.28-2.59]), hospitalization (HR, 1.60 [95% CI, 1.12-2.27]), and combined end points (HR, 1.73 [95% CI, 1.34-2.24]). CONCLUSIONS ECV measures of diffuse myocardial fibrosis were associated with HF outcomes, despite exclusion of replacement fibrosis segments from their derivation and even among patients without any scar. ECV may have a synergistic role with LGE in HF risk assessment.
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Affiliation(s)
- Eric Y Yang
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Mohamad G Ghosn
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Mohammad A Khan
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Nickalaus L Gramze
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Gerd Brunner
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.).,Department of Medicine, Baylor College of Medicine, Houston, TX (G.B., V.N., C.M.B.)
| | - Faisal Nabi
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Vijay Nambi
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.).,Department of Medicine, Baylor College of Medicine, Houston, TX (G.B., V.N., C.M.B.).,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (V.N.)
| | - Sherif F Nagueh
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Duc T Nguyen
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Edward A Graviss
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.)
| | - Christie M Ballantyne
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.).,Department of Medicine, Baylor College of Medicine, Houston, TX (G.B., V.N., C.M.B.)
| | - William A Zoghbi
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
| | - Dipan J Shah
- Houston Methodist Hospital, Houston, TX (E.Y.Y., M.G.G., M.A.K., N.L.G., G.B., F.N., V.N., S.F.N., D.T.N., E.A.G., C.M.B., W.A.Z., D.J.S.)
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Robinson AA, Chow K, Salerno M. Myocardial T1 and ECV Measurement: Underlying Concepts and Technical Considerations. JACC Cardiovasc Imaging 2019; 12:2332-2344. [PMID: 31542529 PMCID: PMC7008718 DOI: 10.1016/j.jcmg.2019.06.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/31/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022]
Abstract
Myocardial native T1 and extracellular volume fraction (ECV) mapping have emerged as cardiac magnetic resonance biomarkers providing unique insight into cardiac pathophysiology. Single breath-hold acquisition techniques, available on clinical scanners across multiple vendor platforms, have made clinical T1 and ECV mapping a reality. Although the relationship between changes in native T1 and alterations in cardiac microstructure is complex, an understanding of how edema, blood volume, myocyte and interstitial expansion, lipids, and paramagnetic substances affect T1 and ECV can provide insight into how and why these parameters change in various cardiac pathologies. The goals of this state-of-the-art review will be to review factors influencing native T1 and ECV, to describe how native T1 and ECV are measured, to discuss potential challenges and pitfalls in clinical practice, and to describe new T1 mapping techniques on the horizon.
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Affiliation(s)
- Austin A Robinson
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Michael Salerno
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.
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21
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Kwong RY, Heydari B, Ge Y, Abdullah S, Fujikura K, Kaneko K, Harris WS, Jerosch-Herold M, Antman EM, Seidman JG, Pfeffer MA. Genetic profiling of fatty acid desaturase polymorphisms identifies patients who may benefit from high-dose omega-3 fatty acids in cardiac remodeling after acute myocardial infarction-Post-hoc analysis from the OMEGA-REMODEL randomized controlled trial. PLoS One 2019; 14:e0222061. [PMID: 31532795 PMCID: PMC6750606 DOI: 10.1371/journal.pone.0222061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background The double-blind OMEGA-REMODEL placebo-controlled randomized trial of high-dose omega-3 fatty acids (O-3FA) post-acute myocardial infarction (AMI) reported improved cardiac remodeling and attenuation of non-infarct myocardial fibrosis. Fatty acid desaturase 2 (FADS2) gene cluster encodes key enzymes in the conversion of essential omega-3 and omega-6 fatty acids into active arachidonic (ArA) and eicosapentaenoic acids (EPA), which influence cardiovascular outcomes. Methods and results We tested the hypothesis that the genotypic status of FADS2 (rs1535) modifies therapeutic response of O-3FA in post-AMI cardiac remodeling in 312 patients. Consistent with known genetic polymorphism of FADS2, patients in our cohort with the guanine-guanine (GG) genotype had the lowest FADS2 activity assessed by arachidonic acid/linoleic acid (ArA/LA) ratio, compared with patients with the adenine-adenine (AA) and adenine-guanine (AG) genotypes (GG:1.62±0.35 vs. AA: 2.01±0.36, p<0.0001; vs. AG: 1.76±0.35, p = 0.03). When randomized to 6-months of O-3FA treatment, GG patients demonstrated significant lowering of LV end-systolic volume index (LVESVi), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and galectin-3 levels compared to placebo (-4.4 vs. 1.2 ml/m2, -733 vs. -181 pg/mL, and -2.0 vs. 0.5 ng/mL; p = 0.006, 0.006, and 0.03, respectively). In contrast, patients with either AA or AG genotype did not demonstrate significant lowering of LVESVi, NT-proBNP, or galectin-3 levels from O-3FA treatment, compared to placebo. The odds ratios for improving LVESVi by 10% with O-3FA treatment was 7.2, 1.6, and 1.2 in patients with GG, AG, and AA genotypes, respectively. Conclusion Genetic profiling using FADS2 genotype can predict the therapeutic benefits of O-3FA treatment against adverse cardiac remodeling during the convalescent phase of AMI. Clinical trial registration information clinicaltrials.gov Identifier: NCT00729430.
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Affiliation(s)
- Raymond Y. Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Bobak Heydari
- Cardiovascular Division, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Shuaib Abdullah
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Kana Fujikura
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Kyoichi Kaneko
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - William S. Harris
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall, South Dakota, United States of America
- OmegaQuant Analytics, LLC, Sioux Falls, South Dakota, United States of America
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Elliott M. Antman
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Jonathan G. Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marc A. Pfeffer
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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22
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Andrade AC, Jerosch‐Herold M, Wegner P, Gabbert DD, Voges I, Pham M, Shah R, Hedderich J, Kramer H, Rickers C. Determinants of Left Ventricular Dysfunction and Remodeling in Patients With Corrected Tetralogy of Fallot. J Am Heart Assoc 2019; 8:e009618. [PMID: 31474177 PMCID: PMC6755839 DOI: 10.1161/jaha.118.009618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The aim of this study was to identify in asymptomatic patients with repaired tetralogy of Fallot the prevalence and determinants of impaired left‐sided cardiac function and adverse ventricular remodeling and the relation of left ventricular (LV) dysfunction and remodeling with cardiopulmonary exercise capacity. Methods and Results In a cross‐sectional study, 103 patients with tetralogy of Fallot (median age, 16.3 years) in New York Heart Association class 1, with surgical repair at a median age of 1.1 years, and 63 age‐matched controls were studied. LV, right ventricular function and geometry, LV myocardial extracellular volume (n=57), and left atrial function were quantified with cardiac magnetic resonance. Peak oxygen consumption was measured by a standardized cardiopulmonary exercise test (n=70). Patients with tetralogy of Fallot had lower LV ejection fraction (P=0.001; 49% below age‐adjusted fifth percentile for controls), lower LV mass index (P=0.003), lower LV mass/volume ratio (P<0.01), and impaired left atrial function. Right ventricular mass/volume ratio was the best predictor for LV systolic dysfunction and for a lower LV mass/volume ratio. Compared with controls, LV extracellular volume was higher (P<0.001), particularly in female patients, and associated with subnormal peak oxygen consumption (P=0.037). A peak oxygen consumption below the third percentile reference level was more likely with decreasing LV ejection fraction (P=0.008), and lower LV mass index (P=0.024), but independent of right ventricular ejection fraction. Conclusions In New York Heart Association class 1 patients with tetralogy of Fallot, frequent impaired systolic and diastolic LV function, LV adverse remodeling with LV atrophy, a decreased mass/volume ratio, and extracellular matrix expansion suggest cardiomyopathic changes. The best predictor for LV systolic dysfunction was the right ventricular mass/volume ratio. The subnormal peak oxygen consumption indicates that monitoring of LV status may be important for long‐term prognosis.
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Affiliation(s)
- Ana Cristina Andrade
- Heart InstituteMedical School of São Paulo UniversitySão PauloBrazil
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | | | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Minh Pham
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Ravi Shah
- Department of RadiologyBrigham & Women's Hospital and Harvard Medical SchoolBostonMA
| | - Jürgen Hedderich
- Department for Medical Informatics and StatisticsUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Hans‐Heiner Kramer
- Department of Congenital Heart Disease and Pediatric CardiologyUniversity Hospital of Schleswig‐HolsteinKielGermany
| | - Carsten Rickers
- University Heart CenterAdult with Congenital Heart Disease UnitUniversity Hospital Hamburg‐EppendorfHamburgGermany
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23
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Analysis of physiological noise in quantitative cardiac magnetic resonance. PLoS One 2019; 14:e0214566. [PMID: 31454354 PMCID: PMC6711532 DOI: 10.1371/journal.pone.0214566] [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: 03/14/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose To determine the impact of imaging parameters on the temporal signal-to-noise ratio (TSNR) of quantitative cardiac magnetic resonance (MR) in humans, and to determine applicability of the physiological noise covariance (PNC) model for physiological noise (PN). Methods We conducted MRI experiments in four healthy volunteers, and obtained series of short-axis cardiac images acquired with snapshot balanced steady-state free precession (bSSFP) and snapshot gradient echo (GRE) using a broad range of spatial resolutions and parallel imaging acceleration factors commonly used in quantitative cardiac MR. We measured regional SNR and TSNR in these datasets and fit the measurements to the PNC model for PN, which assumes that PN scales with signal strength. Results The relationship between SNR and TSNR in human cardiac MR without contrast preparation was well modeled by the PNC model. SNR consistently decreased as the spatial resolution (matrix size) and acceleration factor (R) increased for both GRE and bSSFP imaging. TSNR varied linearly with SNR using GRE imaging, when SNR was low (SNR < 20), and approached an asymptotic limit using bSSFP imaging, when SNR was high (SNR > 40). Conclusions The PNC model can be used to guide the choice of matrix size and acceleration factor to optimize TSNR in stable contrast cardiac MR, such as T2-prepared Blood-Oxygen-Level-Dependent (BOLD) and several variants of Arterial Spin Labeled (ASL) cardiac MR.
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24
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Gulati A, Ismail TF, Ali A, Hsu LY, Gonçalves C, Ismail NA, Krishnathasan K, Davendralingam N, Ferreira P, Halliday BP, Jones DA, Wage R, Newsome S, Gatehouse P, Firmin D, Jabbour A, Assomull RG, Mathur A, Pennell DJ, Arai AE, Prasad SK. Microvascular Dysfunction in Dilated Cardiomyopathy: A Quantitative Stress Perfusion Cardiovascular Magnetic Resonance Study. JACC Cardiovasc Imaging 2019; 12:1699-1708. [PMID: 30660522 PMCID: PMC8616858 DOI: 10.1016/j.jcmg.2018.10.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study sought to quantify myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) in dilated cardiomyopathy (DCM) and examine the relationship between myocardial perfusion and adverse left ventricular (LV) remodeling. BACKGROUND Although regarded as a nonischemic condition, DCM has been associated with microvascular dysfunction, which is postulated to play a role in its pathogenesis. However, the relationship of the resulting perfusion abnormalities to myocardial fibrosis and the degree of LV remodeling is unclear. METHODS A total of 65 patients and 35 healthy control subjects underwent adenosine (140 μg/kg/min) stress perfusion cardiovascular magnetic resonance with late gadolinium enhancement imaging. Stress and rest MBF and MPR were derived using a modified Fermi-constrained deconvolution algorithm. RESULTS Patients had significantly higher global rest MBF compared with control subjects (1.73 ± 0.42 ml/g/min vs. 1.14 ± 0.42 ml/g/min; p < 0.001). In contrast, global stress MBF was significantly lower versus control subjects (3.07 ± 1.02 ml/g/min vs. 3.53 ± 0.79 ml/g/min; p = 0.02), resulting in impaired MPR in the DCM group (1.83 ± 0.58 vs. 3.50 ± 1.45; p < 0.001). Global stress MBF (2.70 ± 0.89 ml/g/min vs. 3.44 ± 1.03 ml/g/min; p = 0.017) and global MPR (1.67 ± 0.61 vs. 1.99 ± 0.50; p = 0.047) were significantly reduced in patients with DCM with LV ejection fraction ≤35% compared with those with LV ejection fraction >35%. Segments with fibrosis had lower rest MBF (mean difference: -0.12 ml/g/min; 95% confidence interval: -0.23 to -0.01 ml/g/min; p = 0.035) and lower stress MBF (mean difference: -0.15 ml/g/min; 95% confidence interval: -0.28 to -0.03 ml/g/min; p = 0.013). CONCLUSIONS Patients with DCM exhibit microvascular dysfunction, the severity of which is associated with the degree of LV impairment. However, rest MBF is elevated rather than reduced in DCM. If microvascular dysfunction contributes to the pathogenesis of DCM, then the underlying mechanism is more likely to involve stress-induced repetitive stunning rather than chronic myocardial hypoperfusion.
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Affiliation(s)
| | | | - Aamir Ali
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Li-Yueh Hsu
- National Institutes of Health, Bethesda, Maryland
| | | | - Nizar A Ismail
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Kaushiga Krishnathasan
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Natasha Davendralingam
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Pedro Ferreira
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Brian P Halliday
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Bart's Health NHS Trust, London, United Kingdom
| | | | - Simon Newsome
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Gatehouse
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - David Firmin
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | | | | | - Anthony Mathur
- Department of Cardiology, Bart's Health NHS Trust, London, United Kingdom
| | - Dudley J Pennell
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom.
| | | | - Sanjay K Prasad
- Royal Brompton Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
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Native T1 Mapping in the Diagnosis of Cardiac Allograft Rejection. JACC Cardiovasc Imaging 2019; 12:1618-1628. [DOI: 10.1016/j.jcmg.2018.10.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 09/17/2018] [Accepted: 10/26/2018] [Indexed: 01/02/2023]
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Ferreira de Souza T, Quinaglia T, Neilan TG, Coelho-Filho OR. Assessment of Cardiotoxicity of Cancer Chemotherapy: The Value of Cardiac MR Imaging. Magn Reson Imaging Clin N Am 2019; 27:533-544. [PMID: 31279455 PMCID: PMC6624085 DOI: 10.1016/j.mric.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chemotherapy is associated with cardiovascular injury, including the development of a cardiomyopathy and vascular remodeling. Cardiac magnetic resonance (CMR) is sensitive to detect not only established morphologic and functional abnormalities but also early, potentially reversible, signs of myocardial injury. It robustly detects and quantifies myocardial edema, inflammation, and focal fibrosis, as well as interstitial fibrosis and vascular remodeling. These capabilities support the role of CMR as an excellent tool for evaluating cardiotoxicity. Novel CMR markers may even enhance patient management by facilitating the early detection of reversible myocardial tissue remodeling before classic morphologic and functional changes appear.
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Affiliation(s)
- Thiago Ferreira de Souza
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil
| | - Thiago Quinaglia
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil
| | - Tomas G Neilan
- Cardio-Oncology Program and Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Otávio R Coelho-Filho
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil; Division of Cardiology, Department of Medicine, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil.
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Sussman MS, Wintersperger BJ. Modified look-locker inversion recovery (MOLLI) T 1 mapping with inversion group (IG) fitting - A method for improved precision. Magn Reson Imaging 2019; 62:38-45. [PMID: 31170429 DOI: 10.1016/j.mri.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 11/17/2022]
Abstract
MOLLI-based T1 mapping has been applied to a variety of cardiac pathologies. However, conventional MOLLI's requirement for rest periods between inversion groups increases scan time, and limits the choice of inversion groups. The recently developed inversion group (IG) fitting technique eliminates the rest period requirement, and permits complete flexibility of inversion groups. However, a limitation is that its T1 maps have low precision - up to 30% poorer than conventional 3-parameter methods. In the original IG method, T1 maps were derived from the first inversion group only. In the present study, a technique is presented which utilize data from all inversion groups to generate T1 maps. It is hypothesized this "composite-IG" fitting method will provided improved prevision over conventional-IG T1 mapping methods. Simulations, phantom, and in vivo experiments on nine clinical cardiac patients (congenital heart disease, ischemic- and non-ischemic cardiomyopathy) were performed. Imaging was performed on a 1.5 T Siemens scanner. Myocardial T1 mapping precision and reproducibility were calculated for conventional-IG, composite-IG, and 3-parameter techniques. Precision and reproducibility between the techniques was compared using the Wilcoxon Signed Rank test. Statistical significance was set at the 95% confidence level, with the Bonferroni correction for multiple comparisons employed. Composite-IG improves precision by 16-38% over conventional-IG (p < 0.01). Composite-IG T1 maps provided up to 5% better precision than 3-parameter fits (p < 0.01). Composite-IG had better reproducibility than conventional-IG (p < 0.01). However, there was no significant difference between composite-IG and conventional 5(3)3 3-parameter reproducibility.
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Affiliation(s)
- Marshall S Sussman
- Joint Department of Medical Imaging, University Health Network, University, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Bernd J Wintersperger
- Joint Department of Medical Imaging, University Health Network, University, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Sardanelli F, Schiaffino S, Zanardo M, Secchi F, Cannaò PM, Ambrogi F, Di Leo G. Point estimate and reference normality interval of MRI-derived myocardial extracellular volume in healthy subjects: a systematic review and meta-analysis. Eur Radiol 2019; 29:6620-6633. [DOI: 10.1007/s00330-019-06185-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022]
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Huber AT, Lamy J, Bravetti M, Bouazizi K, Bacoyannis T, Roux C, De Cesare A, Rigolet A, Benveniste O, Allenbach Y, Kerneis M, Cluzel P, Redheuil A, Kachenoura N. Comparison of MR T1 and T2 mapping parameters to characterize myocardial and skeletal muscle involvement in systemic idiopathic inflammatory myopathy (IIM). Eur Radiol 2019; 29:5139-5147. [DOI: 10.1007/s00330-019-06054-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/19/2018] [Accepted: 01/30/2019] [Indexed: 12/30/2022]
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Teixeira T, Hafyane T, Jerosch-Herold M, Marcotte F, Mongeon FP. Myocardial Partition Coefficient of Gadolinium: A Pilot Study in Patients With Acute Myocarditis, Chronic Myocardial Infarction, and in Healthy Volunteers. Can J Cardiol 2019; 35:51-60. [PMID: 30595183 DOI: 10.1016/j.cjca.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The tissue-blood partition coefficient (PC) of gadolinium, derived from T1 measurements, reflects myocardial connective tissue fraction and tissue injury, increasing in proportion with edema or fibrosis. We determined the myocardial PC of gadolinium in patients with acute myocarditis, chronic myocardial infarction (MI), and healthy volunteers. We hypothesized that the characteristics of the injured myocardium in patients with MI and myocarditis may differ and that the PC will be higher in chronically injured myocardium (MI) compared with acutely injured myocardium (myocarditis). METHODS We performed late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging and T1 mapping before and after administration of gadolinium (0.1 mmol/kg Gd-BOPTA) at 3 Tesla in 10 healthy volunteers (47.1 ± 12.4 years), 18 patients with chronic MI (62.5 ± 8.1 years), and 16 patients with acute myocarditis (42.5 ± 13.9 years). RESULTS In patients with chronic MI and focal scar by LGE, the whole left ventricular myocardial PC (0.45 ± 0.05) was higher compared with patients with MI without focal scar (0.39 ± 0.03, P = 0.02) but not significantly different from whole myocardial PC in volunteers (0.40 ± 0.05) or patients with myocarditis (0.41 ± 0.05). The PC in myocarditis scars was lower than in chronic MI scars (0.60 ± 0.12 vs 0.77 ± 0.16, P = 0.016). The relationships of PC and scar burden, expressed as % LGE, were similar and significant for the 2 groups (P = 0.042). CONCLUSION The tissue-blood partition coefficient of Gd-BOPTA is elevated in areas of acute and chronic myocardial injury and may serve as a marker for disease activity and density of scars, which was found to be higher in chronic MI than in acute myocarditis.
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Affiliation(s)
- Tiago Teixeira
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada; Centro Hospitalar entre Douro e Vouga, Sta Maria da Feira, Portugal
| | - Tarik Hafyane
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - François Marcotte
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - François-Pierre Mongeon
- Philippa & Marvin Carsley CMR Center, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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Comparison of the different imaging time points in delayed phase cardiac CT for myocardial scar assessment and extracellular volume fraction estimation in patients with old myocardial infarction. Int J Cardiovasc Imaging 2018; 35:917-926. [DOI: 10.1007/s10554-018-1513-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/11/2018] [Indexed: 01/02/2023]
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Magrath P, Maforo N, Renella P, Nelson SF, Halnon N, Ennis DB. Cardiac MRI biomarkers for Duchenne muscular dystrophy. Biomark Med 2018; 12:1271-1289. [PMID: 30499689 PMCID: PMC6462870 DOI: 10.2217/bmm-2018-0125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a fatal inherited genetic disorder that results in progressive muscle weakness and ultimately loss of ambulation, respiratory failure and heart failure. Cardiac MRI (MRI) plays an increasingly important role in the diagnosis and clinical care of boys with DMD and associated cardiomyopathies. Conventional cardiac MRI biomarkers permit measurements of global cardiac function and presence of fibrosis, but changes in these measures are late manifestations. Emerging MRI biomarkers of myocardial function and structure include the estimation of rotational mechanics and regional strain using MRI tagging; T1-mapping; and T2-mapping, a marker of inflammation, edema and fat. These emerging biomarkers provide earlier insights into cardiac involvement in DMD, improving patient care and aiding the evaluation of emerging therapies.
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Affiliation(s)
- Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Nyasha Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Stanley F Nelson
- Center for Duchenne Muscular Dystrophy, Department of Human Genetics, University of California, Los Angeles, CA 90095, USA
| | - Nancy Halnon
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, University of California, Los Angeles, CA 90024, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
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Dekkers IA, Lamb HJ. Clinical application and technical considerations of T 1 & T 2(*) mapping in cardiac, liver, and renal imaging. Br J Radiol 2018; 91:20170825. [PMID: 29975154 DOI: 10.1259/bjr.20170825] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pathological tissue alterations due to disease processes such as fibrosis, edema and infiltrative disease can be non-invasively visualized and quantified by MRI using T1 and T2 relaxation properties. Pixel-wise mapping of T1 and T2 image sequences enable direct quantification of T1, T2(*), and extracellular volume values of the target organ of interest. Tissue characterization based on T1 and T2(*) mapping is currently making the transition from a research tool to a clinical modality, as clinical usefulness has been established for several diseases such as myocarditis, amyloidosis, Anderson-Fabry and iron deposition. Other potential clinical applications besides the heart include, quantification of steatosis, cirrhosis, hepatic siderosis and renal fibrosis. Here, we provide an overview of potential clinical applications of T1 andT2(*) mapping for imaging of cardiac, liver and renal disease. Furthermore, we give an overview of important technical considerations necessary for clinical implementation of quantitative parametric imaging, involving data acquisition, data analysis, quality assessment, and interpretation. In order to achieve clinical implementation of these techniques, standardization of T1 and T2(*) mapping methodology and validation of impact on clinical decision making is needed.
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Affiliation(s)
- Ilona A Dekkers
- 1 Department of Radiology, Leiden University Medical Center , Leiden , The Netherlands
| | - Hildo J Lamb
- 1 Department of Radiology, Leiden University Medical Center , Leiden , The Netherlands
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36
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Nensa F, Kloth J, Tezgah E, Poeppel TD, Heusch P, Goebel J, Nassenstein K, Schlosser T. Feasibility of FDG-PET in myocarditis: Comparison to CMR using integrated PET/MRI. J Nucl Cardiol 2018; 25:785-794. [PMID: 27638745 DOI: 10.1007/s12350-016-0616-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Besides cardiac sarcoidosis, FDG-PET is rarely used in the diagnosis of myocardial inflammation, while cardiac MRI (CMR) is the actual imaging reference for the workup of myocarditis. Using integrated PET/MRI in patients with suspected myocarditis, we prospectively compared FDG-PET to CMR and the feasibility of integrated FDG-PET/MRI in myocarditis. METHODS A total of 65 consecutive patients with suspected myocarditis were prospectively assessed using integrated cardiac FDG-PET/MRI. Studies comprised T2-weighted imaging, late gadolinium enhancement (LGE), and simultaneous PET acquisition. Physiological glucose uptake in the myocardium was suppressed using dietary preparation. RESULTS FDG-PET/MRI was successful in 55 of 65 enrolled patients: two patients were excluded due to claustrophobia and eight patients due to failed inhibition of myocardial glucose uptake. Compared with CMR (LGE and/or T2), sensitivity and specificity of PET was 74% and 97%. Overall spatial agreement between PET and CMR was κ = 0.73. Spatial agreement between PET and T2 (κ = 0.75) was higher than agreement between PET and LGE (κ = 0.64) as well as between LGE and T2 (κ = 0.56). CONCLUSION In patients with suspected myocarditis, FDG-PET is in good agreement with CMR findings.
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Affiliation(s)
- Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Julia Kloth
- Clinic for Cardiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Ercan Tezgah
- Clinic for Cardiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Thorsten D Poeppel
- Clinic for Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, 45147, Dusseldorf, Germany
| | - Juliane Goebel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Evaluation of Modified Look-Locker Inversion Recovery and Arrhythmia-Insensitive Rapid Cardiac T1 Mapping Pulse Sequences in Cardiomyopathy Patients. J Comput Assist Tomogr 2018; 42:732-738. [PMID: 29613994 DOI: 10.1097/rct.0000000000000746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to compare the performance of arrhythmia-insensitive rapid (AIR) and modified Look-Locker inversion recovery (MOLLI) T1 mapping in patients with cardiomyopathies. METHODS In 58 patients referred for clinical cardiac magnetic resonance imaging at 1.5 T, we compared MOLLI and AIR native and postcontrast T1 measurements. Two readers independently analyzed myocardial and blood T1 values. Agreement between techniques, interreader agreement per technique, and intrascan agreement per technique were evaluated. RESULTS The MOLLI and AIR T1 values were strongly correlated (r = 0.98); however, statistically significantly different T1 values were derived (bias 80 milliseconds, pooled data, P < 0.01). Both techniques demonstrated high repeatability (MOLLI, r = 1.00 and coefficient of repeatability [CR] = 72 milliseconds; AIR, r = 0.99 and CR = 184.2 milliseconds) and produced high interreader agreement (MOLLI, r = 1.00 and CR = 51.7 milliseconds; AIR, r = 0.99 and CR = 183.5 milliseconds). CONCLUSIONS Arrhythmia-insensitive rapid and MOLLI sequences produced significantly different T1 values in a diverse patient cohort.
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Nacif MS, Raman FS, Gai N, Jones J, van der Geest RJ, T Sibley C, Liu S, David AB. Myocardial T1 mapping and determination of partition coefficients at 3 tesla: comparison between gadobenate dimeglumine and gadofosveset trisodium. Radiol Bras 2018; 51:13-19. [PMID: 29559761 PMCID: PMC5846320 DOI: 10.1590/0100-3984.2016.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To compare an albumin-bound gadolinium chelate (gadofosveset trisodium) and
an extracellular contrast agent (gadobenate dimeglumine), in terms of their
effects on myocardial longitudinal (T1) relaxation time and partition
coefficient. Materials and Methods Study subjects underwent two imaging sessions for T1 mapping at 3 tesla with
a modified look-locker inversion recovery (MOLLI) pulse sequence to obtain
one pre-contrast T1 map and two post-contrast T1 maps (mean 15 and 21 min,
respectively). The partition coefficient was calculated as
ΔR1myocardium
/ΔR1blood , where
R1 is 1/T1. Results A total of 252 myocardial and blood pool T1 values were obtained in 21
healthy subjects. After gadolinium administration, the myocardial T1 was
longer for gadofosveset than for gadobenate, the mean difference between the
two contrast agents being −7.6 ± 60 ms (p = 0.41).
The inverse was true for the blood pool T1, which was longer for gadobenate
than for gadofosveset, the mean difference being 56.5 ± 67 ms
(p < 0.001). The partition coefficient (λ)
was higher for gadobenate than gadofosveset (0.41 vs. 0.33), indicating
slower blood pool washout for gadofosveset than for gadobenate. Conclusion Myocardial T1 times did not differ significantly between gadobenate and
gadofosveset. At typical clinical doses of the contrast agents, partition
coefficients were significantly lower for the intravascular contrast agent
than for the extravascular agent.
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Affiliation(s)
- Marcelo Souto Nacif
- MD, PhD, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Fabio S Raman
- Biomedical Engineer, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Neville Gai
- MD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Jacquin Jones
- PhD, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Christopher T Sibley
- MD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Songtao Liu
- MD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - A Bluemke David
- MD, PhD, National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
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Abdula G, Nickander J, Sörensson P, Lundin M, Kellman P, Sigfridsson A, Ugander M. Synthetic late gadolinium enhancement cardiac magnetic resonance for diagnosing myocardial scar. SCAND CARDIOVASC J 2018; 52:127-132. [PMID: 29544374 DOI: 10.1080/14017431.2018.1449960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Late gadolinium enhancement (LGE) is the in vivo reference standard for assessing focal myocardial fibrosis. Post-contrast T1-mapping by Modified Look-Locker Inversion recovery (MOLLI) can be used to generate synthetic late gadolinium enhancement (SynLGE) images with an image contrast similar to conventional LGE images. We hypothesized that SynLGE has an accuracy that approaches conventional LGE for diagnosing focal myocardial fibrosis. METHODS Consecutive patients (n = 109, mean ± SD age 50 ± 16 years, 63% male) referred for clinical cardiac magnetic resonance imaging underwent LGE and post-contrast MOLLI starting 10-15 and 20-25 minutes post contrast, respectively. A cardiac short-axis stack and three long-axis views were acquired for SynLGE and LGE. SynLGE were generated from post-contrast T1-maps. Only LGE and SynLGE images were analyzed by two blinded observers for agreement regarding localization and origin of focal myocardial fibrosis on a per-patient basis. RESULTS Consensus identified focal fibrosis by LGE in 44/109 (40%) patients. Compared to LGE, SynLGE yielded a diagnostic sensitivity of 34/44 (77%), specificity of 64/65 (98%), positive predictive value of 34/35 (97%), negative predictive value of 64/74 (86%), and an overall accuracy of 98/109 (90%). In cases where SynLGE missed focal fibrosis (n = 10), these were either small non-ischemic focal fibrosis (n = 8) or infarction in a thin myocardial wall (n = 2). In one case, SynLGE identified midmural non-ischemic focal fibrosis not identified by LGE. DISCUSSION Overall, SynLGE showed good agreement with LGE. SynLGE derived from post-contrast T1-maps may provide the complementary ability to increase confidence in assessment of LGE images for focal myocardial fibrosis.
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Affiliation(s)
- Goran Abdula
- a Department of Clinical Physiology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
| | - Jannike Nickander
- a Department of Clinical Physiology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
| | - Peder Sörensson
- b Department of Medicine, Unit of Cardiology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
| | - Magnus Lundin
- a Department of Clinical Physiology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
| | - Peter Kellman
- c National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Andreas Sigfridsson
- a Department of Clinical Physiology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
| | - Martin Ugander
- a Department of Clinical Physiology , Karolinska Institutet, and Karolinska University Hospital , Stockholm , Sweden
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Peretto G, Sala S, Benedetti S, Di Resta C, Gigli L, Ferrari M, Della Bella P. Updated clinical overview on cardiac laminopathies: an electrical and mechanical disease. Nucleus 2018; 9:380-391. [PMID: 29929425 PMCID: PMC7000139 DOI: 10.1080/19491034.2018.1489195] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cardiac laminopathies, associated with mutations in the LMNA gene, encompass a wide spectrum of clinical manifestations, involving electrical and mechanical alterations of cardiomyocytes. Thus, dilated cardiomyopathy, bradyarrhythmias and atrial or ventricular tachyarrhythmias may occur in a number of combined phenotypes. Nowadays, some attempt has been made to identify clinical predictors for the most life-threatening complications of LMNA-associated heart disease, i.e. sudden cardiac death and end-stage heart failure. The goal of this manuscript is to combine the most recent evidences in an updated review to show the state-of-the-art of such a complex disease group. This is supposed to be the starting point to collect more data and design new ad hoc studies to identify clinically useful predictors to stratify risk in mutation carriers, including probands and their asymptomatic relatives.
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Affiliation(s)
- G. Peretto
- Department of Cardiac Electrophysyology and Arrhythmology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - S. Sala
- Department of Cardiac Electrophysyology and Arrhythmology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - S. Benedetti
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - C. Di Resta
- Genomic Unit for the diagnosis of human pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - L. Gigli
- Department of Cardiac Electrophysyology and Arrhythmology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - M. Ferrari
- Laboratory of Clinical Molecular Biology and Cytogenetics, IRCCS San Raffaele Hospital and University, Milan, Italy
- Genomic Unit for the diagnosis of human pathologies, Division of Genetics and Cellular Biology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - P. Della Bella
- Department of Cardiac Electrophysyology and Arrhythmology, IRCCS San Raffaele Hospital and University, Milan, Italy
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Sato T, Kamikawa S, Nakayama S, Ichinose N, Kuhara S, Kanaya S, Minato K, Nomura C. Motion Correction for Extracellular Volume Fraction Mapping in Cardiac MRI. ADVANCED BIOMEDICAL ENGINEERING 2018. [DOI: 10.14326/abe.7.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tetsuo Sato
- Gunma Prefectural College of Health Science
- Nara Institute of Science and Technology
| | | | | | | | | | | | | | - Cesar Nomura
- Instituto do Coração
- University of Sao Paulo Medical School
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Haggerty CM, Suever JD, Pulenthiran A, Mejia-Spiegeler A, Wehner GJ, Jing L, Charnigo RJ, Fornwalt BK, Fogel MA. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson 2017; 19:100. [PMID: 29228952 PMCID: PMC5724335 DOI: 10.1186/s12968-017-0410-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. METHODS Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). RESULTS Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). CONCLUSIONS We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.
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Affiliation(s)
- Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | | | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
| | - Mark A. Fogel
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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Likhite D, Suksaranjit P, Adluru G, Wilson B, DiBella E. Estimating extraction fraction and blood flow by combining first-pass myocardial perfusion and T1 mapping results. Quant Imaging Med Surg 2017; 7:480-495. [PMID: 29184761 DOI: 10.21037/qims.2017.08.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Quantifying myocardial perfusion is complicated by the complexity of pharmacokinetic model being used and the reliability of perfusion parameter estimates. More complex modeling provides more information about the underlying physiology, but too many parameters in complex models introduce a new problem of reliable estimation. To overcome the problem of multiple parameters, we have developed a technique that combines knowledge from two different cardiac magnetic resonance (MR) imaging techniques: dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and T1 mapping. Using extracellular volume (ECV) estimates from T1 mapping may allow more robust model parameter estimates. Methods Simulations and human scans were performed. The myocardial perfusion scans used an ungated saturation recovery prepared TurboFLASH pulse sequence. Four short-axis (SA) slices were acquired after a single saturation pulse with a saturation recovery time of ~25 ms before the first slice. Gadoteridol was injected and ~240 frames were acquired over a minute with shallow breathing and no electrocardiograph (ECG) gating. This was followed 20±5 minutes later by an injection of regadenoson to induce hyperemia. The data were acquired using an under-sampled golden angle radial acquisition. Modified look-locker inversion recovery (MOLLI) T1 mapping was performed in 3 slices pre- and post-contrast. The pre- and post-contrast T1 maps were used for ECV estimation. Quantification of perfusion was done using a 4-parameter model with additional information about ECV supplied during model fitting. Phase contrast scans of the coronary sinus (CS) were acquired at rest and immediately after the stress perfusion acquisition to estimate global flow. Results Without ECV information, the 5-parameter model fails to converge to a unique solution and often gives incorrect estimates for the perfusion parameters. The myocardial blood flow (MBF) estimates during rest and stress were 0.9±0.1 and 2.3±0.6 mL/min/g, respectively. The extraction fraction estimates were 0.49±0.04 and 0.34±0.05 during rest and stress, respectively. Conclusions These results show that it is possible to successfully fit a dynamic perfusion model with an extraction fraction parameter by using information from T1 mapping scans. This hybrid approach is especially important when the 5-parameter model alone fails to converge on a unique solution. This work is a good example of exploiting information overlaps between various cardiac MR imaging techniques.
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Affiliation(s)
- Devavrat Likhite
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | | | - Ganesh Adluru
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | - Brent Wilson
- Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Edward DiBella
- Department of Radiology and Imaging Sciences, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA.,Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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Hu C, Sinusas AJ, Huber S, Thorn S, Stacy MR, Mojibian H, Peters DC. T1-refBlochi: high resolution 3D post-contrast T1 myocardial mapping based on a single 3D late gadolinium enhancement volume, Bloch equations, and a reference T1. J Cardiovasc Magn Reson 2017; 19:63. [PMID: 28821300 PMCID: PMC5563030 DOI: 10.1186/s12968-017-0375-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High resolution 3D T1 mapping is important for assessment of diffuse myocardial fibrosis in left atrium or other thin-walled structures. In this work, we investigated a fast single-TI 3D high resolution T1 mapping method that directly transforms a 3D late gadolinium enhancement (LGE) volume to a 3D T1 map. METHODS The proposed method, T1-refBlochi, is based on Bloch equation modeling of the LGE signal, a single-point calibration, and assumptions that proton density and T2* are relatively uniform in the heart. Several sources of error of this method were analyzed mathematically and with simulations. Imaging was performed in phantoms, eight swine and five patients, comparing T1-refBlochi to a standard spin-echo T1 mapping, 3D multi-TI T1 mapping, and 2D ShMOLLI, respectively. RESULTS The method has a good accuracy and adequate precision, even considering various sources of error. In phantoms, over a range of protocols, heart-rates and T1 s, the bias ±1SD was -3 ms ± 9 ms. The porcine studies showed excellent agreement between T1-refBlochi and the multi-TI method (bias ±1SD = -6 ± 22 ms). The proton density and T2* weightings yielded ratios for scar/blood of 0.94 ± 0.01 and for myocardium/blood of 1.03 ± 0.02 in the eight swine, confirming that sufficient uniformity of proton density and T2* weightings exists among heterogeneous tissues of the heart. In the patients, the mean T1 bias ±1SD in myocardium and blood between T1-refBlochi and ShMOLLI was -9 ms ± 21 ms. CONCLUSION T1-refBlochi provides a fast single-TI high resolution 3D T1 map of the heart with good accuracy and adequate precision.
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Affiliation(s)
- Chenxi Hu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
| | - Albert J. Sinusas
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT 06520 USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
| | - Stephanie Thorn
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT 06520 USA
| | - Mitchel R. Stacy
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT 06520 USA
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
| | - Dana C. Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
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Kampf T, Bauer WR, Reiter T. Improved post-processing strategy for MOLLI based tissue characterization allows application in patients with dyspnoe and impaired left ventricular function. Z Med Phys 2017; 28:25-35. [PMID: 28801204 DOI: 10.1016/j.zemedi.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
Contrast and non-contrast MRI based characterization of myocardium by T1-mapping will be of paramount importance to obtain biomarkers, e.g. fibrosis, which determines the risk of heart failure patients. T1-mapping by the standard post-processing of the modified look-locker inversion recovery (MOLLI) lacks of accuracy when trying to reduce its duration, which on the other hand, is highly desirable in patients with heart failure. The recently suggested inversion group fitting (IGF) technique, which considers more parameters for fitting, has a superior accuracy for long T1 times despite a shorter duration. However, for short T1 values, the standard method has a superior precision. A conditional fitting routine is proposed which ideally takes advantage of both algorithms. MATERIALS AND METHODS All measurements were performed on a 1.5T clinical scanner (ACHIEVA, Philips Healthcare, The Netherlands) using a MOLLI 5(n)3(n)3 prototype with n(heart beats) being a variable waiting time between inversion experiments. Phantom experiments covered a broad range of T1 times, waiting times and heart rates. A saturation recovery experiment served as a gold standard for T1 measurement. All data were analyzed with the standard MOLLI, the IGF fit and the conditional fitting routine and the obtained T1 values were compared with the gold standard. In vivo measurements were performed in a healthy volunteer and a total of 34 patients with normal findings, dilative cardiomyopathy and amyloidosis. RESULTS Theoretical analysis and phantom experiments provided a threshold value for an apparent IGF T1* determining processing with IGF post processing for values above, or switching to the standard technique for values below. This was validated in phantoms and patients measurements. A reduction of the waiting time to 1 instead of 3 heart beats between the inversion experiments showed reliable results. The acquisition time was reduced from 17 to 13 heart beats. The in vivo measurements showed ECV values between 25% (18-33%; SD 0.03) in the healthy, 30% (22-40%; SD 0.04) in patients with DCM and 45% (30-60%; SD 0.9) in patients with amyloidosis. CONCLUSION The adopted post-processing algorithm determines long T1 values with high accuracy and short T1 values while maintaining a high precision. Based on reduction of waiting time, and independence of heart rate, it shortens breath hold duration and allows fast T1-mapping, which is frequently a prerequisite in patients with cardiac diseases.
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Affiliation(s)
- Thomas Kampf
- University of Wuerzburg, Department for Experimental Physics V, Am Hubland, 97074 Wuerzburg, Germany; Comprehensive Heart Failure Centre Wuerzburg, Germany.
| | - Wolfgang Rudolf Bauer
- University Hospital Wuerzburg, Department of Internal Medicine I, Oberduerrbacher Straße 6a, 97080 Wuerzburg, Germany; Comprehensive Heart Failure Centre Wuerzburg, Germany.
| | - Theresa Reiter
- University Hospital Wuerzburg, Department of Internal Medicine I, Oberduerrbacher Straße 6a, 97080 Wuerzburg, Germany; Comprehensive Heart Failure Centre Wuerzburg, Germany.
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46
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Schelbert EB, Sabbah HN, Butler J, Gheorghiade M. Employing Extracellular Volume Cardiovascular Magnetic Resonance Measures of Myocardial Fibrosis to Foster Novel Therapeutics. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005619. [PMID: 28512159 DOI: 10.1161/circimaging.116.005619] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Quantifying myocardial fibrosis (MF) with myocardial extracellular volume measures acquired during cardiovascular magnetic resonance promises to transform clinical care by advancing pathophysiologic understanding and fostering novel therapeutics. Extracellular volume quantifies MF by measuring the extracellular compartment depicted by the myocardial uptake of contrast relative to plasma. MF is a key domain of dysfunctional but viable myocardium among others (eg, microvascular dysfunction and cardiomyocyte/mitochondrial dysfunction). Although anatomically distinct, these domains may functionally interact. MF represents pathological remodeling in the heart associated with cardiac dysfunction and adverse outcomes likely mediated by interactions with the microvasculature and the cardiomyocyte. Reversal of MF improves key measures of cardiac dysfunction, so reversal of MF represents a likely mechanism for improved outcomes. Instead of characterizing the myocardium as homogenous tissue and using important yet still generic descriptors, such as thickness (hypertrophy) and function (diastolic or systolic), which lack mechanistic specificity, paradigms of cardiac disease have evolved to conceptualize myocardial disease and patient vulnerability based on the extent of disease involving its various compartments. Specifying myocardial compartmental involvement may then implicate cellular/molecular disease pathways for treatment and targeted pharmaceutical development and above all highlight the role of the cardiac-specific pathology in heart failure among myriad other changes in the heart and beyond. The cardiology community now requires phase 2 and 3 clinical trials to examine strategies for the regression/prevention of MF and eventually biomarkers to identify MF without reliance on cardiovascular magnetic resonance. It seems likely that efficacious antifibrotic therapy will improve outcomes, but definitive data are needed.
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Affiliation(s)
- Erik B Schelbert
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.).
| | - Hani N Sabbah
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Javed Butler
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Mihai Gheorghiade
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)
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Al-Wakeel-Marquard N, Rastin S, Muench F, O H-Ici D, Yilmaz S, Berger F, Kuehne T, Messroghli DR. Cardiac T1 mapping in congenital heart disease: bolus vs. infusion protocols for measurements of myocardial extracellular volume fraction. Int J Cardiovasc Imaging 2017; 33:1961-1968. [PMID: 28620681 DOI: 10.1007/s10554-017-1191-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
Abstract
Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.
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Affiliation(s)
- Nadya Al-Wakeel-Marquard
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
| | - Sanaz Rastin
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Frédéric Muench
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Darach O H-Ici
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sevim Yilmaz
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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48
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Towards accurate and precise T 1 and extracellular volume mapping in the myocardium: a guide to current pitfalls and their solutions. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:143-163. [PMID: 28608328 PMCID: PMC5813078 DOI: 10.1007/s10334-017-0631-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/05/2017] [Accepted: 05/24/2017] [Indexed: 01/27/2023]
Abstract
Mapping of the longitudinal relaxation time (T1) and extracellular volume (ECV) offers a means of identifying pathological changes in myocardial tissue, including diffuse changes that may be invisible to existing T1-weighted methods. This technique has recently shown strong clinical utility for pathologies such as Anderson-Fabry disease and amyloidosis and has generated clinical interest as a possible means of detecting small changes in diffuse fibrosis; however, scatter in T1 and ECV estimates offers challenges for detecting these changes, and bias limits comparisons between sites and vendors. There are several technical and physiological pitfalls that influence the accuracy (bias) and precision (repeatability) of T1 and ECV mapping methods. The goal of this review is to describe the most significant of these, and detail current solutions, in order to aid scientists and clinicians to maximise the utility of T1 mapping in their clinical or research setting. A detailed summary of technical and physiological factors, issues relating to contrast agents, and specific disease-related issues is provided, along with some considerations on the future directions of the field.
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Ghonim S, Voges I, Gatehouse PD, Keegan J, Gatzoulis MA, Kilner PJ, Babu-Narayan SV. Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease. Front Cardiovasc Med 2017; 4:30. [PMID: 28589126 PMCID: PMC5440586 DOI: 10.3389/fcvm.2017.00030] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/28/2017] [Indexed: 01/15/2023] Open
Abstract
Congenital heart disease (CHD) is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR) has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV) and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes) and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.
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Affiliation(s)
- Sarah Ghonim
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Peter D. Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Jennifer Keegan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Michael A. Gatzoulis
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Philip J. Kilner
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Sonya V. Babu-Narayan
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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50
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Vasanji Z, Sigal RJ, Eves ND, Isaac DL, Friedrich MG, Chow K, Thompson RB. Increased left ventricular extracellular volume and enhanced twist function in type 1 diabetic individuals. J Appl Physiol (1985) 2017; 123:394-401. [PMID: 28522755 DOI: 10.1152/japplphysiol.00012.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
Individuals with type 1 diabetes (T1D) characteristically have high glycemic levels that over time can result in reactive fibrosis and abnormalities in myocardial function. T1 mapping with magnetic resonance imaging (MRI) can estimate the extent of reactive fibrosis by measurement of the extracellular volume fraction (ECV). The extent of alterations in the ECV and associated changes in left ventricular (LV) function and morphology in individuals with T1D is unknown. Fourteen individuals with long-term T1D and 14 sex-, age-, and body mass index-matched controls without diabetes underwent MRI measurement of myocardial T1 and ECV values as well as LV function and morphology. Ventricular mass, volumes, and global function (LVEF and circumferential/longitudinal/radial strain) were similar in those with T1D and controls. However, those with T1D had larger myocardial ECV (22.1 ± 1.8 vs. 20.1 ± 2.1, P = 0.008) and increased native (noncontrast) myocardial T1 values (1,211 ± 44 vs. 1,172 ± 43 ms, P < 0.001) as compared with controls. Both the ECV and native T1 values significantly correlated with several components of torsion and circumferential-longitudinal shear strain (Ecl, the shear strain component associated with twist). Individuals with T1D had increased systolic torsion (P = 0.035), systolic torsion rate (P = 0.032), peak Ecl (P = 0.001), and rates of change of systolic (P = 0.007) and diastolic (P = 0.007) Ecl Individuals with T1D, with normal structure, LVEF, and strain, have increased extracellular volume and increased native T1 values with associated augmented torsion and Ecl These measures may be useful in detecting the early stages of diabetic cardiomyopathy and warrant larger prospective studies.NEW & NOTEWORTHY Individuals with type 1 diabetes, with normal left ventricular structure and function (ejection fraction and strain), have signs of interstitial fibrosis, measured with MRI as increased extracellular volume fraction and increased native myocardial T1, which significantly correlated with a number of measures of augmented left ventricular twist function. These measures may be useful in detecting the early stages of diabetic cardiomyopathy.
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Affiliation(s)
- Zainisha Vasanji
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil D Eves
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.,Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | - Debra L Isaac
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthias G Friedrich
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.,Stephenson Cardiac MRI Centre, University of Calgary, Calgary Alberta, Canada.,McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Heidelberg University, Heidelberg, Germany; and
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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