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da Silva LM, Coy‐Canguçu A, Paim LR, Bau AA, Nicolela Geraldo Martins C, Pinheiro S, Citeli Ribeiro V, Magalhães Rocha WE, Mattos‐Souza JR, Schreiber R, Antunes‐Correa L, Sposito A, Nadruz W, Ramos CD, Neilan T, Jerosch‐Herold M, Coelho‐Filho OR. Impaired Cardiac Sympathetic Activity Is Associated With Myocardial Remodeling and Established Biomarkers of Heart Failure. J Am Heart Assoc 2024; 13:e035264. [PMID: 38958130 PMCID: PMC11292752 DOI: 10.1161/jaha.124.035264] [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: 02/29/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND 123Iodine-meta-iodobenzylguanidine scintigraphy is useful for assessing cardiac autonomic dysfunction and predict outcomes in heart failure (HF). The relationship of cardiac sympathetic function with myocardial remodeling and diffuse fibrosis remains largely unknown. We aimed to evaluate the cardiac sympathetic function of patients with HF and its relation with myocardial remodeling and exercise capacity. METHODS AND RESULTS Prospectively enrolled patients with HF (New York Heart Association class II-III) were stratified into HF with preserved left ventricular ejection fraction [LVEF] ≥45%) and reduced LVEF. Ventricular morphology/function and myocardial extracellular volume (ECV) fraction were quantified by cardiovascular magnetic resonance, global longitudinal strain by echocardiography, cardiac sympathetic function by heart-to-mediastinum ratio from 123iodine-meta-iodobenzylguanidine scintigraphy. All participants underwent cardiopulmonary exercise testing. The cohort included 33 patients with HF with preserved LVEF (LVEF, 60±10%; NT-proBNP [N-terminal pro-B-type natriuretic peptide], 248 [interquartile range, 79-574] pg/dL), 28 with HF with reduced LVEF (LVEF, 30±9%; NT-proBNP, 743 [interquartile range, 250-2054] pg/dL) and 20 controls (LVEF, 65±5%; NT-proBNP, 40 [interquartile range, 19-50] pg/dL). Delayed (4 hours) 123iodine-meta-iodobenzylguanidine heart-to-mediastinum ratio was lower in HF with preserved LVEF (1.59±0.25) and HF with reduced LVEF (1.45±0.16) versus controls (1.92±0.24; P<0.001), and correlated negatively with diffuse fibrosis assessed by ECV (R=-0.34, P<0.01). ECV in segments without LGE was increased in HF with preserved ejection fraction (0.32±0.05%) and HF with reduced left ventricular ejection fraction (0.31±0.04%) versus controls (0.28±0.04, P<0.05) and was associated with the age- and sex-adjusted maximum oxygen consumption (peak oxygen consumption); (R=-0.41, P<0.01). Preliminary analysis indicates that cardiac sympathetic function might potentially act as a mediator in the association between ECV and NT-proBNP levels. CONCLUSIONS Abnormally low cardiac sympathetic function in patients with HF with reduced and preserved LVEF is associated with extracellular volume expansion and decreased cardiopulmonary functional capacity.
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Affiliation(s)
- Luis M. da Silva
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | - Andréa Coy‐Canguçu
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | - Layde R. Paim
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | - Adriana A. Bau
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | | | - Stephan Pinheiro
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | | | | | | | - Roberto Schreiber
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | | | - Andrei Sposito
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | - Wilson Nadruz
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | - Celso D. Ramos
- Faculdade de Ciências MédicasUniversidade Estadual de CampinasSão PauloBrazil
| | - Tomas Neilan
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Michael Jerosch‐Herold
- Non‐Invasive Cardiovascular Imaging Program, Department of RadiologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonMAUSA
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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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Paim LR, da Silva LM, Antunes-Correa LM, Ribeiro VC, Schreiber R, Minin EO, Bueno LC, Lopes EC, Yamaguti R, Coy-Canguçu A, Dertkigil SSJ, Sposito A, Matos-Souza JR, Quinaglia T, Neilan TG, Velloso LA, Nadruz W, Jerosch-Herold M, Coelho-Filho OR. Profile of serum microRNAs in heart failure with reduced and preserved ejection fraction: Correlation with myocardial remodeling. Heliyon 2024; 10:e27206. [PMID: 38515724 PMCID: PMC10955197 DOI: 10.1016/j.heliyon.2024.e27206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Background and aims Cardiomyocyte hypertrophy and interstitial fibrosis are key components of myocardial remodeling in Heart Failure (HF) with preserved (HFpEF) or reduced ejection fraction (HFrEF). MicroRNAs (miRNAs) are non-coding, evolutionarily conserved RNA molecules that may offer novel insights into myocardial remodeling. This study aimed to characterize miRNA expression in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%) and its association with myocardial remodeling. Methods Prospectively enrolled symptomatic HF patients (HFpEF:n = 36; HFrEF:n = 31) and controls (n = 23) underwent cardiac magnetic resonance imaging with T1-mapping and circulating miRNA expression (OpenArray system). Results 13 of 188 miRNAs were differentially expressed between HF groups (11 downregulated in HFpEF). Myocardial extracellular volume (ECV) was increased in both HF groups (HFpEF 30 ± 5%; HFrEF 30 ± 3%; controls 26 ± 2%, p < 0.001). miR-128a-3p, linked to cardiac hypertrophy, fibrosis, and dysfunction, correlated positively with ECV in HFpEF (r = 0.60, p = 0.01) and negatively in HFrEF (r = - 0.51, p = 0.04). miR-423-5p overexpression, previously associated HF mortality, was inversely associated with LVEF (r = - 0.29, p = 0.04) and intracellular water lifetime (τ ic) (r = - 0.45, p < 0.05) in both HF groups, and with NT-proBNP in HFpEF (r = - 0.63, p < 0.01). Conclusions miRNA expression profiles differed between HF phenotypes. The differential expression and association of miR-128a-3p with ECV may reflect the distinct vascular, interstitial, and cellular etiologies of HF phenotypes.
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Affiliation(s)
- Layde Rosane Paim
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Luis Miguel da Silva
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | | | - Roberto Schreiber
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Eduarda O.Z. Minin
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Larissa C.M. Bueno
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Elisangela C.P. Lopes
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Renan Yamaguti
- Faculdade de Engenharia Elétrica e de Computação – Universidade Estadual de Campinas, São Paulo, Brazil
| | - Andréa Coy-Canguçu
- Faculdade de Medicina – Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | | | - Andrei Sposito
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Thiago Quinaglia
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tomas G. Neilan
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Licio A. Velloso
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Michael Jerosch-Herold
- Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Liu J, Qu Y, Li J, He W, Chen X, Li X, Wang Y, Tang H, Yuan Y, Deng L, Chen G, Zheng T, Nie L, Zhou X, Song B, Tong N, Peng L. Myocardial tissue remodeling in early adult obesity and its association with regional adipose tissue distribution and ectopic fat deposits: a prospective study. Eur Radiol 2024; 34:970-980. [PMID: 37572193 DOI: 10.1007/s00330-023-10081-9] [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: 04/13/2023] [Revised: 06/16/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To evaluate the left ventricular (LV) myocardial tissue characteristics in early adult obesity and its association with regional adipose tissue and ectopic fat deposition. METHODS Forty-nine obese adults (mean body mass index: 29.9 ± 2.0 kg/m2) and 44 healthy controls were prospectively studied. LV native and post-contrast T1 values, extracellular volume fraction (ECV), regional adipose tissue (epicardial, visceral, and subcutaneous adipose tissue (EAT, VAT, and SAT)), and ectopic fat deposition (hepatic and pancreatic proton density fat fractions (H-PDFF and P-PDFF)) based on magnetic resonance imaging were compared. The association was assessed by multivariable linear regression. RESULTS The obese participants showed reduced global ECV compared to the healthy controls (p < 0.05), but there was no significant difference in global native or post-contrast T1 values between the two groups. Additionally, the obese individuals exhibited higher EAT, VAT, SAT, H-PDFF, and P-PDFF than the controls (p < 0.05). ECV was associated with insulin resistance, dyslipidemia, and systolic blood pressure (SBP) (p < 0.05). Multiple linear regression demonstrated that H-PDFF and SAT were independently associated with ECV in entire population (β = - 0.123 and - 0.012; p < 0.05). CONCLUSIONS Reduced myocardial ECV in patients with mild-to-moderate obesity and its relationship to SBP may indicate that cardiomyocyte hypertrophy, rather than extracellular matrix expansion, is primarily responsible for myocardial tissue remodeling in early adult obesity. Our findings further imply that H-PDFF and SAT are linked with LV myocardial tissue remodeling in this cohort beyond the growth difference and cardiovascular risk factors. CLINICAL TRIALS REGISTRATION Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476). CLINICAL RELEVANCE STATEMENT Myocardial fibrosis in severe obesity predicts poor prognosis. We showed that cardiomyocyte hypertrophy, not myocardial fibrosis, is the main myocardial tissue characteristic of early obesity. This finding raises the possibility that medical interventions, like weight loss, may prevent cardiac fibrosis. KEY POINTS • Myocardial tissue characteristics in early adult obesity are unclear. • Myocardial extracellular volume fraction (ECV) can be quantitatively evaluated using T1 mapping based on cardiac magnetic resonance imaging (MRI). • Cardiac MRI-derived ECV may noninvasively evaluate myocardial tissue remodeling in early adult obesity.
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Affiliation(s)
- Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yali Qu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Jing Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yinqiu Wang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Liping Deng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Guoyong Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Tianying Zheng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, 200126, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
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Gama FF, Patel K, Bennett J, Aziminia N, Pugliese F, Treibel T. Myocardial Evaluation in Patients with Aortic Stenosis by Cardiac Computed Tomography. ROFO-FORTSCHR RONTG 2023; 195:506-513. [PMID: 36854383 DOI: 10.1055/a-1999-7271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Aortic valve stenosis (AVS) is one of the most prevalent pathologies affecting the heart that can curtail expected survival and quality of life if not managed appropriately. CURRENT STATUS Cardiac computed tomography (CT) has long played a central role in this subset, mostly for severity assessment and for procedural planning. Although not as widely accepted as other imaging modalities for functional myocardial assessment [i. e., transthoracic echocardiogram (TTE), cardiac magnetic resonance (CMR)], this technique has recently increased its clinical application in this regard. FUTURE OUTLOOK The ability to provide morphological, functional, tissue, and preprocedural information highlights the potential of the "all-in-one" concept of cardiac CT as a potential reality for the near future for AVS assessment. In this review article, we sought to analyze the current applications of cardiac CT that allow a full comprehensive evaluation of aortic valve disease. KEY POINTS · Noninvasive myocardial tissue characterization stopped being an exclusive feature of cardiac magnetic resonance.. · Emerging acquisition methods make cardiac CT an accurate and widely accessible imaging modality.. · Cardiac CT has the potential to become a "one-stop" exam for comprehensive aortic stenosis assessment.. CITATION FORMAT · Gama FF, Patel K, Bennett J et al. Myocardial Evaluation in Patients with Aortic Stenosis by Cardiac Computed Tomography. Fortschr Röntgenstr 2023; DOI: 10.1055/a-1999-7271.
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Affiliation(s)
- Francisco F Gama
- Cardiology, Hospital Centre of West Lisbon Campus Hospital of Santa Cruz, Lisboa, Portugal.,Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Kush Patel
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Bennett
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikoo Aziminia
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Francesca Pugliese
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Treibel
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
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Li Y, Zheng G, Salimova E, Broughton BRS, Ricardo SD, de Veer M, Samuel CS. Simultaneous late-gadolinium enhancement and T1 mapping of fibrosis and a novel cell-based combination therapy in hypertensive mice. Biomed Pharmacother 2023; 158:114069. [PMID: 36502754 DOI: 10.1016/j.biopha.2022.114069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Fibrosis is a hallmark of chronic hypertension and disrupts the viability of human bone marrow-derived mesenchymal stromal cells (BM-MSCs) post-transplantation. This study thus, determined whether the anti-fibrotic drug, serelaxin (RLX), could enhance the therapeutic effects of BM-MSCs or BM-MSC-derived exosomes (BM-MSC-EXO) in hypertensive mice. Left ventricular (LV) fibrosis in particular was assessed using conventional histological staining and non-invasive cardiac magnetic resonance imaging (CMRI). CMRI was employed using a novel magnetisation prepared 2 rapid acquisition gradient echo (MP2RAGE) sequence to simultaneously perform late gadolinium enhancement imaging and T1 mapping. Adult male C57BL/6 mice were uninephrectomised, received deoxycorticosterone acetate and saline to drink (1 K/DOCA/salt) for 21 days, whilst control mice were given normal drinking water for the same time-period. On day 14 post-injury, subgroups of 1 K/DOCA/salt-hypertensive mice were treated with RLX alone or in combination with BM-MSCs or BM-MSC-EXO; or the mineralocorticoid receptor antagonist, spironolactone. At day 21 post-injury, LV and kidney histopathology was assessed, whilst LV fibrosis and function were additionally analysed by CMRI and echocardiography. 1 K/DOCA/salt-hypertensive mice developed kidney tubular injury, inflammation, fibrosis, and more moderate LV hypertrophy, fibrosis and diastolic dysfunction. RLX and BM-MSCs combined provided optimal protection against these pathologies and significantly reduced picrosirius red-stained organ fibrosis and MP2RAGE analysis of LV fibrosis. A significant correlation between MP2RAGE analysis and histologically-stained interstitial LV fibrosis was detected. It was concluded that the MP2RAGE sequence enhanced the non-invasive CMRI detection of LV fibrosis. Furthermore, combining RLX and BM-MSCs may represent a promising treatment option for hypertensive cardiorenal syndrome.
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Affiliation(s)
- Yifang Li
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute (BDI) and Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Gang Zheng
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Ekaterina Salimova
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Brad R S Broughton
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute (BDI) and Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Sharon D Ricardo
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute (BDI) and Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Michael de Veer
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Chrishan S Samuel
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute (BDI) and Department of Pharmacology, Monash University, Clayton, Victoria, Australia; Stem Cells and Development Program, Monash Biomedicine Discovery Institute (BDI) and Department of Pharmacology, Monash University, Clayton, Victoria, Australia; Department of Biochemistry and Molecular Biology, The University of Melbourne, Parkville, Victoria, Australia.
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7
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Fotaki A, Velasco C, Prieto C, Botnar RM. Quantitative MRI in cardiometabolic disease: From conventional cardiac and liver tissue mapping techniques to multi-parametric approaches. Front Cardiovasc Med 2023; 9:991383. [PMID: 36756640 PMCID: PMC9899858 DOI: 10.3389/fcvm.2022.991383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Cardiometabolic disease refers to the spectrum of chronic conditions that include diabetes, hypertension, atheromatosis, non-alcoholic fatty liver disease, and their long-term impact on cardiovascular health. Histological studies have confirmed several modifications at the tissue level in cardiometabolic disease. Recently, quantitative MR methods have enabled non-invasive myocardial and liver tissue characterization. MR relaxation mapping techniques such as T1, T1ρ, T2 and T2* provide a pixel-by-pixel representation of the corresponding tissue specific relaxation times, which have been shown to correlate with fibrosis, altered tissue perfusion, oedema and iron levels. Proton density fat fraction mapping approaches allow measurement of lipid tissue in the organ of interest. Several studies have demonstrated their utility as early diagnostic biomarkers and their potential to bear prognostic implications. Conventionally, the quantification of these parameters by MRI relies on the acquisition of sequential scans, encoding and mapping only one parameter per scan. However, this methodology is time inefficient and suffers from the confounding effects of the relaxation parameters in each single map, limiting wider clinical and research applications. To address these limitations, several novel approaches have been proposed that encode multiple tissue parameters simultaneously, providing co-registered multiparametric information of the tissues of interest. This review aims to describe the multi-faceted myocardial and hepatic tissue alterations in cardiometabolic disease and to motivate the application of relaxometry and proton-density cardiac and liver tissue mapping techniques. Current approaches in myocardial and liver tissue characterization as well as latest technical developments in multiparametric quantitative MRI are included. Limitations and challenges of these novel approaches, and recommendations to facilitate clinical validation are also discussed.
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Affiliation(s)
- Anastasia Fotaki
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,*Correspondence: Anastasia Fotaki,
| | - Carlos Velasco
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
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8
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Springer CS, Baker EM, Li X, Moloney B, Pike MM, Wilson GJ, Anderson VC, Sammi MK, Garzotto MG, Kopp RP, Coakley FV, Rooney WD, Maki JH. Metabolic activity diffusion imaging (MADI): II. Noninvasive, high-resolution human brain mapping of sodium pump flux and cell metrics. NMR IN BIOMEDICINE 2023; 36:e4782. [PMID: 35654761 DOI: 10.1002/nbm.4782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
We introduce a new 1 H2 O magnetic resonance approach: metabolic activity diffusion imaging (MADI). Numerical diffusion-weighted imaging decay simulations characterized by the mean cellular water efflux (unidirectional) rate constant (kio ), mean cell volume (V), and cell number density (ρ) are produced from Monte Carlo random walks in virtual stochastically sized/shaped cell ensembles. Because of active steady-state trans-membrane water cycling (AWC), kio reflects the cytolemmal Na+ , K+ ATPase (NKA) homeostatic cellular metabolic rate (c MRNKA ). A digital 3D "library" contains thousands of simulated single diffusion-encoded (SDE) decays. Library entries match well with disparate, animal, and human experimental SDE decays. The V and ρ values are consistent with estimates from pertinent in vitro cytometric and ex vivo histopathological literature: in vivo V and ρ values were previously unavailable. The library allows noniterative pixel-by-pixel experimental SDE decay library matchings that can be used to advantage. They yield proof-of-concept MADI parametric mappings of the awake, resting human brain. These reflect the tissue morphology seen in conventional MRI. While V is larger in gray matter (GM) than in white matter (WM), the reverse is true for ρ. Many brain structures have kio values too large for current, invasive methods. For example, the median WM kio is 22s-1 ; likely reflecting mostly exchange within myelin. The kio •V product map displays brain tissue c MRNKA variation. The GM activity correlates, quantitatively and qualitatively, with the analogous resting-state brain 18 FDG-PET tissue glucose consumption rate (t MRglucose ) map; but noninvasively, with higher spatial resolution, and no pharmacokinetic requirement. The cortex, thalamus, putamen, and caudate exhibit elevated metabolic activity. MADI accuracy and precision are assessed. The results are contextualized with literature overall homeostatic brain glucose consumption and ATP production/consumption measures. The MADI/PET results suggest different GM and WM metabolic pathways. Preliminary human prostate results are also presented.
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Affiliation(s)
- Charles S Springer
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Department of Chemical Physiology and Biochemistry, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric M Baker
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, Oregon, USA
| | - Brendan Moloney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Martin M Pike
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | - Gregory J Wilson
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Valerie C Anderson
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Manoj K Sammi
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark G Garzotto
- Department of Urology, Portland VA Center, Portland, Oregon, USA
- Department of Urology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ryan P Kopp
- Department of Urology, Portland VA Center, Portland, Oregon, USA
- Department of Urology, Oregon Health & Science University, Portland, Oregon, USA
| | - Fergus V Coakley
- Department of Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey H Maki
- Department of Radiology, Anschutz Medical Center, University of Colorado, Aurora, Colorado, USA
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9
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Gama F, Rosmini S, Bandula S, Patel KP, Massa P, Tobon-Gomez C, Ecke K, Stroud T, Condron M, Thornton GD, Bennett JB, Wechelakar A, Gillmore JD, Whelan C, Lachmann H, Taylor SA, Pugliese F, Fontana M, Moon JC, Hawkins PN, Treibel TA. Extracellular Volume Fraction by Computed Tomography Predicts Long-Term Prognosis Among Patients With Cardiac Amyloidosis. JACC Cardiovasc Imaging 2022; 15:2082-2094. [PMID: 36274040 DOI: 10.1016/j.jcmg.2022.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Light chain (AL) and transthyretin (ATTR) amyloid fibrils are deposited in the extracellular space of the myocardium, resulting in heart failure and premature mortality. Extracellular expansion can be quantified by computed tomography, offering a rapid, cheaper, and more practical alternative to cardiac magnetic resonance, especially among patients with cardiac devices or on renal dialysis. OBJECTIVES This study sought to investigate the association of extracellular volume fraction by computed tomography (ECVCT), myocardial remodeling, and mortality in patients with systemic amyloidosis. METHODS Patients with confirmed systemic amyloidosis and varying degrees of cardiac involvement underwent electrocardiography-gated cardiac computed tomography. Whole heart and septal ECVCT was analyzed. All patients also underwent clinical assessment, electrocardiography, echocardiography, serum amyloid protein component, and/or technetium-99m (99mTc) 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. ECVCT was compared across different extents of cardiac infiltration (ATTR Perugini grade/AL Mayo stage) and evaluated for its association with myocardial remodeling and all-cause mortality. RESULTS A total of 72 patients were studied (AL: n = 35, ATTR: n = 37; median age: 67 [IQR: 59-76] years, 70.8% male). Mean septal ECVCT was 42.7% ± 13.1% and 55.8% ± 10.9% in AL and ATTR amyloidosis, respectively, and correlated with indexed left ventricular mass (r = 0.426; P < 0.001), left ventricular ejection fraction (r = 0.460; P < 0.001), N-terminal pro-B-type natriuretic peptide (r = 0.563; P < 0.001), and high-sensitivity troponin T (r = 0.546; P < 0.001). ECVCT increased with cardiac amyloid involvement in both AL and ATTR amyloid. Over a mean follow-up of 5.3 ± 2.4 years, 40 deaths occurred (AL: n = 14 [35.0%]; ATTR: n = 26 [65.0%]). Septal ECVCT was independently associated with all-cause mortality in ATTR (not AL) amyloid after adjustment for age and septal wall thickness (HR: 1.046; 95% CI: 1.003-1.090; P = 0.037). CONCLUSIONS Cardiac amyloid burden quantified by ECVCT is associated with adverse cardiac remodeling as well as all-cause mortality among ATTR amyloid patients. ECVCT may address the need for better identification and risk stratification of amyloid patients, using a widely accessible imaging modality.
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Affiliation(s)
- Francisco Gama
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Stefania Rosmini
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Steve Bandula
- Centre for Medical Image Computing, Department of Medical Physics, University College London, London, United Kingdom
| | - Kush P Patel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Paolo Massa
- University Sant'Orsola Hospital, Bologna, Italy; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | | | - Karolin Ecke
- Canon Medical Systems Europe, Zoetermeer, the Netherlands
| | - Tyler Stroud
- Canon Medical Systems Europe, Zoetermeer, the Netherlands
| | - Mark Condron
- Canon Medical Systems Europe, Zoetermeer, the Netherlands
| | - George D Thornton
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jonathan B Bennett
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ashutosh Wechelakar
- Queen Mary University of London, London, United Kingdom; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Julian D Gillmore
- Queen Mary University of London, London, United Kingdom; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Carol Whelan
- Centre for Medical Image Computing, Department of Medical Physics, University College London, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Queen Mary University of London, London, United Kingdom; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Helen Lachmann
- Queen Mary University of London, London, United Kingdom; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Francesca Pugliese
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - Marianna Fontana
- Centre for Medical Image Computing, Department of Medical Physics, University College London, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Queen Mary University of London, London, United Kingdom; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Philip N Hawkins
- Queen Mary University of London, London, United Kingdom; National Amyloidosis Centre, Royal Free Hospital, University College London, London, United Kingdom
| | - Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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10
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Farrag NA, Thornhill RE, Prato FS, Skanes AC, Sullivan R, Sebben D, Butler J, Sykes J, Wilk B, Ukwatta E. Assessment of left atrial fibrosis progression in canines following rapid ventricular pacing using 3D late gadolinium enhanced CMR images. PLoS One 2022; 17:e0269592. [PMID: 35802680 PMCID: PMC9269919 DOI: 10.1371/journal.pone.0269592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with extracellular matrix (ECM) remodelling and often coexists with myocardial fibrosis (MF); however, the causality of these conditions is not well established. Objective We aim to corroborate AF to MF causality by quantifying left atrial (LA) fibrosis in cardiac magnetic resonance (CMR) images after persistent rapid ventricular pacing and subsequent AF using a canine model and histopathological validation. Methods Twelve canines (9 experimental, 3 control) underwent baseline 3D LGE-CMR imaging at 3T followed by insertion of a pacing device and 5 weeks of rapid ventricular pacing to induce AF (experimental) or no pacing (control). Following the 5 weeks, pacing devices were removed to permit CMR imaging followed by excision of the hearts and histopathological imaging. LA myocardial segmentation was performed manually at baseline and post-pacing to permit volumetric %MF quantification using the image intensity ratio (IIR) technique, wherein fibrosis was defined as pixels > mean LA myocardium intensity + 2SD. Results Volumetric %MF increased by an average of 2.11 ± 0.88% post-pacing in 7 of 9 experimental dogs. While there was a significant difference between paired %MF measurements from baseline to post-pacing in experimental dogs (P = 0.019), there was no significant change in control dogs (P = 0.019 and P = 0.5, Wilcoxon signed rank tests). The median %MF for paced animals was significantly greater than that of non-paced dogs at the 5-week post-insertion time point (P = 0.009, Mann Whitney U test). Histopathological imaging yielded an average %MF of 19.42 ± 4.80% (mean ± SD) for paced dogs compared to 1.85% in one control dog. Conclusion Persistent rapid ventricular pacing and subsequent AF leads to an increase in LA fibrosis volumes measured by the IIR technique; however, quantification is limited by inherent image acquisition parameters and observer variability.
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Affiliation(s)
- Nadia A. Farrag
- Department of Systems & Computer Engineering, Carleton University, Ottawa, ON, Canada
- * E-mail:
| | - Rebecca E. Thornhill
- Department of Systems & Computer Engineering, Carleton University, Ottawa, ON, Canada
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Frank S. Prato
- Department of Medical Imaging and Medical Biophysics, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Allan C. Skanes
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Rebecca Sullivan
- Department of Medical Imaging and Medical Biophysics, University of Western Ontario, London, ON, Canada
| | - David Sebben
- School of Engineering, University of Guelph, Guelph, ON, Canada
| | - John Butler
- Lawson Health Research Institute, London, ON, Canada
| | - Jane Sykes
- Lawson Health Research Institute, London, ON, Canada
| | - Benjamin Wilk
- Department of Medical Imaging and Medical Biophysics, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Eranga Ukwatta
- Department of Systems & Computer Engineering, Carleton University, Ottawa, ON, Canada
- School of Engineering, University of Guelph, Guelph, ON, Canada
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11
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Cuddy SAM, Jerosch-Herold M, Falk RH, Kijewski MF, Singh V, Ruberg FL, Sanchorawala V, Landau H, Maurer MS, Yee AJ, Bianchi G, Di Carli MF, Liao R, Kwong RY, Dorbala S. Myocardial Composition in Light-Chain Cardiac Amyloidosis More Than 1 Year After Successful Therapy. JACC Cardiovasc Imaging 2022; 15:594-603. [PMID: 34922860 PMCID: PMC8995332 DOI: 10.1016/j.jcmg.2021.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The goals of this study were to characterize myocardial composition during the active and remission phases of light-chain (AL) cardiac amyloidosis. BACKGROUND Cardiac dysfunction in AL amyloidosis is characterized by dual insults to the myocardium from infiltration and toxicity from light chains during the active phase and by infiltration alone in the remission phase. METHODS Prospectively enrolled subjects with cardiac AL amyloidosis (21 remission AL amyloidosis; age: 63.4 ± 7.3 years; 47.6% male; and 48 active AL amyloidosis; age: 62.5 ± 7.4 years; 60.4% male) underwent contrast-enhanced cardiac magnetic resonance with T1 and T2 mapping and measurement of extracellular volume (ECV). By definition, serum free light-chain levels were normal for at least 1 year following successful AL therapy in the remission group and abnormal in the active group. RESULTS Myocardial ECV was similarly expanded in the remission and active AL amyloidosis groups (0.488 ± 0.082 vs 0.519 ± 0.083, respectively; P = 0.15). However, myocardial T2 relaxation times (47.7 ± 3.2 ms vs 45.5 ± 3.0 ms; P = 0.008) as well as native T1 times (1,368 ms [IQR: 1,290-1,422 ms] vs 1,264 ms [IQR: 1,203-1,380 ms]; P = 0.024) were significantly higher in the remission compared to the active AL amyloidosis group. CONCLUSIONS Myocardial ECV is substantially expanded in the active AL and remission AL cardiac amyloidosis groups, but native T1 values were higher, suggesting a different myocardial composition. There is no evidence of myocardial edema in active AL cardiac amyloidosis. Future phenotyping studies of AL cardiac amyloidosis need to consider complementary myocardial markers that define the interstitial milieu in addition to changes in extracellular volume. (Molecular Imaging of Primary Amyloid Cardiomyopathy; NCT02641145).
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Affiliation(s)
- Sarah A M Cuddy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marie Foley Kijewski
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vasvi Singh
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vaishali Sanchorawala
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Landau
- Division of Medical Oncology, Memorial Sloan Kettering Medical Center, New York, New York, USA
| | - Matthew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew J Yee
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Giada Bianchi
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ronglih Liao
- Amyloidosis Program, Stanford University, Stanford, California, USA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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12
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Seno A, Antiochos P, Lichtenfeld H, Rickers E, Qamar I, Ge Y, Blankstein R, Steigner M, Aghayev A, Jerosch-Herold M, Kwong RY. Prognostic Value of T1 Mapping and Feature Tracking by Cardiac Magnetic Resonance in Patients With Signs and Symptoms Suspecting Heart Failure and No Clinical Evidence of Coronary Artery Disease. J Am Heart Assoc 2022; 11:e020981. [PMID: 35023344 PMCID: PMC9238540 DOI: 10.1161/jaha.121.020981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The ability of left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) by cardiac magnetic resonance for risk stratification in suspected heart failure is limited. We aimed to evaluate the incremental prognostic value of cardiac magnetic resonance‐assessed extracellular volume fraction (ECV) and global longitudinal strain (GLS) in patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease. Methods and Results A total of 474 consecutive patients (57±21 years of age, 56% men) with heart failure‐related symptoms and absence of coronary artery disease underwent cardiac magnetic resonance. After median follow‐up of 18 months, 59 (12%) experienced the outcome of all‐cause death or heart failure hospitalization (DeathCHF). In univariate analysis, cardiac magnetic resonance‐assessed LVEF, LGE, GLS, and ECV were all significantly associated with DeathCHF. Adjusted for a multivariable baseline model including age, sex, LVEF and LGE, ECV, and GLS separately maintained a significant association with DeathCHF (ECV, hazard ratio [HR], 1.44 per 1 SD increase; 95% CI 1.13–1.84; P=0.003, and GLS, HR, 1.78 per 1 SD increase; 95% CI, 1.06–2.96; P=0.028 respectively). Adding both GLS and ECV to the baseline model significantly improved model discrimination (C statistic from 0.749 to 0.782, P=0.017) and risk reclassification (integrated discrimination improvement 0.046 [0.015–0.076], P=0.003; continuous net reclassification improvement 0.378 [0.065–0.752], P<0.001) for DeathCHF, beyond LVEF and LGE. Conclusions In patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease, joint assessment of GLS and ECV provides incremental prognostic value for DeathCHF, independent of LVEF and LGE.
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Affiliation(s)
- Ayako Seno
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Panagiotis Antiochos
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Helena Lichtenfeld
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Eva Rickers
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Iqra Qamar
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Yin Ge
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Ron Blankstein
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA.,Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Michael Steigner
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Ayaz Aghayev
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Raymond Y Kwong
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA.,Cardiovascular Division Brigham and Women's Hospital Boston MA
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13
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Wang H, Ding L, Tian L, Tian Y, Liao L, Zhao J. Empagliflozin reduces diffuse myocardial fibrosis by extracellular volume mapping: A meta-analysis of clinical studies. Front Endocrinol (Lausanne) 2022; 13:917761. [PMID: 36034443 PMCID: PMC9404239 DOI: 10.3389/fendo.2022.917761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the effect of empagliflozin on diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping. RESEARCH METHODS AND PROCEDURES Databases including PubMed, Cochrane library, Embase, and Sinomed for clinical studies of empagliflozin on myocardial fibrosis were searched. Two authors extracted the data and evaluated study quality independently. Weighted mean difference (WMD) and 95% confidence intervals (CI) were used for continuous variables. Review Manager 5.3 was used to performed the analysis. RESULTS Six studies were included in this meta-analysis. One of the six studies was assessed as poor quality by the assessment of methodological quality; however, the remaining five studies were considered good. The WMD value of △extracellular volume (ECV) was merged by the fixed-effect model, and the pooled effect size was -1.48 (95% CI -1.76 to -1.21, P < 0.00001), which means in favor of empagliflozin. Heterogeneity analysis did not find any heterogeneity (chi2 = 0.39, P = 0.82, I 2 = 0%). In addition, empagliflozin had a tendency to reduce ECV compared to treatment before with no statistical significance (WMD = -0.29, 95% CI -1.26 to 0.67, P = 0.55; heterozygosity test, chi2 = 2.66, P = 0.45, I 2 = 0%). The WMD value of △native T1 was also merged by the fixed-effect model, but the pooled effect size showed neither statistical difference between empagliflozin and placebo treatment (WMD = -5.40, 95% CI -21.63 to 10.83, P = 0.51) nor heterogeneity (chi2 = 0.05, P = 0.83, I 2 = 0%). CONCLUSIONS Empagliflozin has cardiovascular benefits by reducing diffuse myocardial fibrosis. ECV could act as a non-invasive imaging tool to assess diffuse myocardial fibrosis and monitor disease progression. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=324804, identifier: CRD42022324804.
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Affiliation(s)
- Haipeng Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji’nan, China
| | - Lin Ding
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Jinan, China
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liwen Tian
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Ji’nan, China
| | - Yutian Tian
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Jinan, China
| | - Lin Liao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Jinan, China
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lin Liao, ; Junyu Zhao,
| | - Junyu Zhao
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational medicine, Shandong Institute of Nephrology, Jinan, China
- Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Lin Liao, ; Junyu Zhao,
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14
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de Souza TF, Silva TQ, Antunes-Correa L, Drobni ZD, Costa FO, Dertkigil SSJ, Nadruz W, Brenelli F, Sposito AC, Matos-Souza JR, Coelho OR, Neilan TG, Jerosch-Herold M, Coelho-Filho OR. Cardiac magnetic resonance assessment of right ventricular remodeling after anthracycline therapy. Sci Rep 2021; 11:17132. [PMID: 34429493 PMCID: PMC8385101 DOI: 10.1038/s41598-021-96630-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
There are limited data on the effects of anthracyclines on right ventricular (RV) structure, function, and tissue characteristics. The goal of this study was to investigate the effects of anthracyclines on the RV using cardiac magnetic resonance (CMR). This was a post-hoc analysis of a prospective study of 27 breast cancer (BC) patients (51.8 ± 8.9 years) using CMR prior, and up to 3-times after anthracyclines (240 mg/m2) to measure RV volumes and mass, RV extracellular volume (ECV) and cardiomyocyte mass (CM). Before anthracyclines, LVEF (69.4 ± 3.6%) and RVEF (55.6 ± 9%) were normal. The median follow-up after anthracyclines was 399 days (IQR 310–517). The RVEF reached its nadir (46.3 ± 6.8%) after 9-months (P < 0.001). RV mass-index and RV CM decreased to 13 ± 2.8 g/m2 and 8.13 ± 2 g/m2, respectively, at 16-months after anthracyclines. The RV ECV expanded from 0.26 ± 0.07 by 0.14 (53%) to 0.40 ± 0.1 (P < 0.001). The RV ECV expansion correlated with a decrease in RV mass-index (r = −0.46; P < 0.001) and the increase in CK-MB. An RV ESV index at baseline above its median predicted an increased risk of LV dysfunction post-anthracyclines. In BC patients treated with anthracyclines, RV atrophy, systolic dysfunction, and a parallel increase of diffuse interstitial fibrosis indicate a cardiotoxic response on a similar scale as previously seen in the systemic left ventricle.
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Affiliation(s)
- Thiago Ferreira de Souza
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Thiago Quinaglia Silva
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Lígia Antunes-Correa
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Zsofia D Drobni
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Osório Costa
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Sergio San Juan Dertkigil
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Wilson Nadruz
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Fabrício Brenelli
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Andrei C Sposito
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - José Roberto Matos-Souza
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Otávio Rizzi Coelho
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil
| | - Tomas G Neilan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Otávio Rizzi Coelho-Filho
- Division of Cardiology, Department of Medicine, Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Rua Tessália Viera de Camargo, 126, Campinas, SP, CEP 13083-887, Brazil.
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15
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Abstract
Heart failure affects 1-2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.
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Affiliation(s)
- Nishant Lahoti
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Richard J Jabbour
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Brian Xiangzhi Wang
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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16
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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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17
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Mason T, Coelho-Filho OR, Verma S, Chowdhury B, Zuo F, Quan A, Thorpe KE, Bonneau C, Teoh H, Gilbert RE, Leiter LA, Jüni P, Zinman B, Jerosch-Herold M, Mazer CD, Yan AT, Connelly KA. Empagliflozin Reduces Myocardial Extracellular Volume in Patients With Type 2 Diabetes and Coronary Artery Disease. JACC Cardiovasc Imaging 2021; 14:1164-1173. [PMID: 33454272 DOI: 10.1016/j.jcmg.2020.10.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES This study sought to evaluate the effects of empagliflozin on extracellular volume (ECV) in individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). BACKGROUND Empagliflozin has been shown to reduce left ventricular mass index (LVMi) in patients with T2DM and CAD. The effects on myocardial ECV are unknown. METHODS This was a prespecified substudy of the EMPA-HEART (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes) CardioLink-6 trial in which 97 participants were randomized to receive empagliflozin 10 mg daily or placebo for 6 months. Data from 74 participants were included: 39 from the empagliflozin group and 35 from the placebo group. The main outcome was change in left ventricular ECV from baseline to 6 months determined by cardiac magnetic resonance (CMR). Other outcomes included change in LVMi, indexed intracellular compartment volume (iICV) and indexed extracellular compartment volume (iECV), and the fibrosis biomarkers soluble suppressor of tumorgenicity (sST2) and matrix metalloproteinase (MMP)-2. RESULTS Baseline ECV was elevated in the empagliflozin group (29.6 ± 4.6%) and placebo group (30.6 ± 4.8%). Six months of empagliflozin therapy reduced ECV compared with placebo (adjusted difference: -1.40%; 95% confidence interval [CI]: -2.60 to -0.14%; p = 0.03). Empagliflozin therapy reduced iECV (adjusted difference: -1.5 ml/m2; 95% CI: -2.6 to -0.5 ml/m2; p = 0.006), with a trend toward reduction in iICV (adjusted difference: -1.7 ml/m2; 95% CI: -3.8 to 0.3 ml/m2; p = 0.09). Empagliflozin had no impact on MMP-2 or sST2. CONCLUSIONS In individuals with T2DM and CAD, 6 months of empagliflozin reduced ECV, iECV, and LVMi. No changes in MMP-2 and sST2 were seen. Further investigation into the mechanisms by which empagliflozin causes reverse remodeling is required. (Effects of Empagliflozin on Cardiac Structure in Patients With Type 2 Diabetes [EMPA-HEART]; NCT02998970).
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Affiliation(s)
- Tamique Mason
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Otavio R Coelho-Filho
- Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil; Division of Cardiology, Department of Medicine, State University of Campinas, Campinas, Brazil
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Biswajit Chowdhury
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Bonneau
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Richard E Gilbert
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Zinman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael Jerosch-Herold
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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18
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Domenech-Ximenos B, Sanz-de la Garza M, Prat-González S, Sepúlveda-Martínez A, Crispi F, Duran-Fernandez K, Perea RJ, Bijnens B, Sitges M. Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes. J Cardiovasc Magn Reson 2020; 22:62. [PMID: 32878630 PMCID: PMC7469354 DOI: 10.1186/s12968-020-00660-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intensive endurance exercise may induce a broad spectrum of right ventricular (RV) adaptation/remodelling patterns. Late gadolinium enhancement (LGE) has also been described in cardiovascular magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes. METHODS Ninety-three highly trained endurance athletes (> 12 h training/week at least during the last 5 years; 36 ± 6 years old; 53% male) and 72 age and gender-matched controls underwent a resting contrast CMR. In a subgroup of 28 athletes, T1 mapping was also performed. RESULTS High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and a slight reduction of biventricular ejection fraction, as compared to controls in both genders (p < 0.05). Focal LGE was significantly more prevalent in athletes than in healthy subjects (37.6% vs 2.8%; p < 0.001), with a typical pattern in the RV insertion points. In T1 mapping, those athletes who had focal LGE had higher extracellular volume (ECV) at the remote myocardium than those without (27 ± 2.2% vs 25.2 ± 2.1%; p < 0.05). CONCLUSIONS Highly trained endurance athletes showed a ten-fold increase in the prevalence of focal LGE as compared to control subjects, always confined to the hinge points. Additionally, those athletes with focal LGE demonstrated globally higher myocardial ECV values. This matrix remodelling and potential presence of myocardial fibrosis may be another feature of the athlete's heart, of which the clinical and prognostic significance remains to be determined.
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Affiliation(s)
- B Domenech-Ximenos
- Radiology Department, Hospital Clinic, Barcelona, Spain.
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - M Sanz-de la Garza
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - S Prat-González
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Sepúlveda-Martínez
- Barcelona Center for Maternal-Fetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Barcelona, Spain
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico - Universidad de Chile, Santiago de Chile, Chile
| | - F Crispi
- Barcelona Center for Maternal-Fetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Barcelona, Spain
| | - K Duran-Fernandez
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - R J Perea
- Radiology Department, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - B Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- BCN Medtech, Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - M Sitges
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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19
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Naresh NK, Misener S, Zhang Z, Yang C, Ruh A, Bertolino N, Epstein FH, Collins JD, Markl M, Procissi D, Carr JC, Allen BA. Cardiac MRI Myocardial Functional and Tissue Characterization Detects Early Cardiac Dysfunction in a Mouse Model of Chemotherapy-Induced Cardiotoxicity. NMR IN BIOMEDICINE 2020; 33:e4327. [PMID: 32567177 DOI: 10.1002/nbm.4327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Doxorubicin and doxorubicin-trastuzumab combination chemotherapy have been associated with cardiotoxicity that eventually leads to heart failure and may limit dose-effective cancer treatment. Current diagnostic strategies rely on decreased ejection fraction (EF) to diagnose cardiotoxicity. PURPOSE The aim of this study is to explore the potential of cardiac MR (CMR) imaging to identify imaging biomarkers in a mouse model of chemotherapy-induced cardiotoxicity. METHODS A cumulative dose of 25 mg/kg doxorubicin was administered over three weeks using subcutaneous pellets (n = 9, Dox). Another group (n = 9) received same dose of Dox and a total of 10 mg/kg trastuzumab (DT). Mice were imaged at baseline, 5/6 weeks and 10 weeks post-treatment on a 7T MRI system. The protocol included short-axis cine MRI covering the left ventricle (LV) and mid-ventricular short-axis tissue phase mapping (TPM), pre- and post-contrast T1 mapping, T2 mapping and Displacement Encoding with Stimulated Echoes (DENSE) strain encoded MRI. EF, peak myocardial velocities, native T1, T2, extracellular volume (ECV), and myocardial strain were quantified. N = 7 mice were sacrificed for histopathologic assessment of apoptosis at 5/6 weeks. RESULTS Global peak systolic longitudinal velocity was reduced at 5/6 weeks in Dox (0.6 ± 0.3 vs 0.9 ± 0.3, p = 0.02). In the Dox group, native T1 was reduced at 5/6 weeks (1.3 ± 0.2 ms vs 1.6 ± 0.2 ms, p = 0.02), and relatively normalized at week 10 (1.4 ± 0.1 ms vs 1.6 ± 0.2 ms, p > 0.99). There was no change in EF and other MRI parameters and histopathologic results demonstrated minimal apoptosis in all mice (~1-2 apoptotic cell/high power field), suggesting early-stage cardiotoxicity. CONCLUSIONS In a mouse model of chemotherapy-induced cardiotoxicity using doxorubicin and trastuzumab, advanced CMR shows promise in identifying treatment-related decrease in myocardial velocity and native T1 prior to the onset of cardiomyocyte apoptosis and reduction of EF.
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Affiliation(s)
- Nivedita K Naresh
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Sol Misener
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Zhouli Zhang
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Cynthia Yang
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Alexander Ruh
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Nicola Bertolino
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
- McCormick School of Engineering, Northwestern University, Chicago, IL, USA
| | - Daniele Procissi
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Bradley A Allen
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
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20
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Zhuang B, Cui C, Sirajuddin A, He J, Wang X, Yue G, Duan X, Wang H, Arai AE, Zhao S, Lu M. Detection of Myocardial Fibrosis and Left Ventricular Dysfunction with Cardiac MRI in a Hypertensive Swine Model. Radiol Cardiothorac Imaging 2020; 2:e190214. [PMID: 32914091 DOI: 10.1148/ryct.2020190214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/11/2022]
Abstract
Purpose To quantitatively evaluate the dynamic changes of extracellular volume (ECV) and native T1 in hypertensive swine over time using histologic findings as standard of reference. Materials and Methods Eighteen hypertensive (hypertension group) and six healthy (control group) swine aged 6-12 months were studied. Both groups underwent cardiac MRI, including pre- and postcontrast T1 mapping and late gadolinium enhancement (LGE) imaging at three time points: baseline, 1 month, and 3 months after hypertensive model induction. The left ventricular function, strain, and strain rate were also calculated using the cine images. Animals were killed after the last MRI examination. Histopathologic examination of the heart was performed later. Analysis of the relationship between strain, ECV, and native T1 was carried out by Pearson correlation and linear regression models. Results The mean systolic and diastolic pressure increased from 111 mg Hg and 68 mm Hg to 160 mm Hg and 97 mm Hg, respectively, over 3 months during developing hypertension (P = .03, .02, respectively). There was no LGE detected at any of three imaging times. The ECV and native T1 value of myocardium in the hypertension group increased over 3 months (ECV, increased from 21.5% ± 4.4 to 27.3% ± 5.4; native T1, increased from a mean of 1056 msec ± 32 [standard deviation] to 1218 msec ± 66; all P < .001). The collagen volume fraction (CVF) was calculated and correlated with ECV (r = 0.63, P = .01) and native T1 (r = 0.80, P < .001). In addition, ECV was associated with longitudinal diastolic strain rate (r =-.34, P = .04). Native T1 was associated with radial strain (r = -0.62, P < .001) as well as circumferential strain (r = 0.57, P < .001). Conclusion Native T1 and ECV correlated significantly with the CVF, indicating that early myocardial interstitial fibrosis exists in hypertensive heart disease. As hypertension progresses, the values of ECV fraction and T1 native increase. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Baiyan Zhuang
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Chen Cui
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Arlene Sirajuddin
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Jian He
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Xin Wang
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Guangxin Yue
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Xuejing Duan
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Hongyue Wang
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Andrew E Arai
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Shihua Zhao
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
| | - Minjie Lu
- Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.)
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21
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Fischer K, Obrist SJ, Erne SA, Stark AW, Marggraf M, Kaneko K, Guensch DP, Huber AT, Greulich S, Aghayev A, Steigner M, Blankstein R, Kwong RY, Gräni C. Feature Tracking Myocardial Strain Incrementally Improves Prognostication in Myocarditis Beyond Traditional CMR Imaging Features. JACC Cardiovasc Imaging 2020; 13:1891-1901. [PMID: 32682718 DOI: 10.1016/j.jcmg.2020.04.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study investigated the association of cardiovascular cardiac magnetic resonance (CMR) feature tracking (FT) with outcome in a patient cohort with myocarditis and evaluated the possible incremental prognostic benefit beyond clinical features and traditional CMR features. BACKGROUND CMR is used to diagnose and risk stratify patients with myocarditis. CMR-FT allows quantitative strain analysis of myocardial function; however, its prognostic benefit in myocarditis is unknown. METHODS Consecutive patients with clinically suspected myocarditis and presence of midmyocardial or epicardial late gadolinium enhancement (LGE) and/or myocardial edema in CMR were included. Clinical and CMR features were analyzed with regard to major adverse cardiovascular events (MACE) (i.e., hospitalization for heart failure, sustained ventricular tachycardia, and all-cause mortality). RESULTS Of 740 patients with clinically suspected myocarditis, 455 (61%) met our final diagnostic criteria based on CMR tissue characterization. At a median follow-up of 3.9 years, MACE occurred in 74 (16%) patients. In the univariable analysis, CMR-FT global longitudinal peak strain (GLS) was significantly associated with MACE. In a multivariable model adjusting for clinical variables (age, sex, body mass index, and acuteness of symptoms) and traditional CMR features (left ventricular ejection fraction [LVEF] and LGE extent), GLS remained independently associated with outcome (GLS hazard ratio: 1.21; 95% confidence interval: 1.08 to 1.36; p = 0.001) and incrementally improved prognostication (chi-square increases from 42.6 to 79.8 to 88.5; p < 0.001). CONCLUSIONS Myocardial strain using CMR-FT provides independent and incremental prognostic value over clinical features, LVEF, and LGE in patients with myocarditis. CMR-FT may serve as a novel marker to improve risk stratification in myocarditis. (CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571).
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Affiliation(s)
- Kady Fischer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah J Obrist
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie A Erne
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maximilian Marggraf
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kyoichi Kaneko
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Greulich
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Ayaz Aghayev
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Steigner
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Non-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Kwong
- Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Non-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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22
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Cojan-Minzat BO, Zlibut A, Muresan ID, Cionca C, Horvat D, Kiss E, Revnic R, Florea M, Ciortea R, Agoston-Coldea L. Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy. J Clin Med 2020; 9:jcm9061997. [PMID: 32630483 PMCID: PMC7355464 DOI: 10.3390/jcm9061997] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.
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Affiliation(s)
- Bianca Olivia Cojan-Minzat
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
- Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania; (R.R.); (M.F.)
| | - Alexandru Zlibut
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
| | - Ioana Danuta Muresan
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
| | - Carmen Cionca
- Department of Radiology, Affidea Hiperdia Diagnostic Imaging Center, 400015 Cluj-Napoca, Romania;
| | - Dalma Horvat
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
| | - Eva Kiss
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
| | - Radu Revnic
- Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania; (R.R.); (M.F.)
| | - Mira Florea
- Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania; (R.R.); (M.F.)
| | - Razvan Ciortea
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
- Department of Obstetrics and Gynecology, Emergency County Hospital, 400124 Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (B.O.C.-M.); (A.Z.); (I.D.M.); (D.H.); (E.K.); (R.C.)
- Department of Radiology, Affidea Hiperdia Diagnostic Imaging Center, 400015 Cluj-Napoca, Romania;
- 2nd Department of Internal Medicine, Emergency County Hospital, 400006 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +402-6459-1942; Fax: +402-6459-9817
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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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Anthracycline Therapy Is Associated With Cardiomyocyte Atrophy and Preclinical Manifestations of Heart Disease. JACC Cardiovasc Imaging 2019; 11:1045-1055. [PMID: 30092965 DOI: 10.1016/j.jcmg.2018.05.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/05/2018] [Accepted: 05/11/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The goal of this study was to demonstrate that cardiac magnetic resonance could reveal anthracycline-induced early tissue remodeling and its relation to cardiac dysfunction and left ventricular (LV) atrophy. BACKGROUND Serum biomarkers of cardiac dysfunction, although elevated after chemotherapy, lack specificity for the mechanism of myocardial tissue alterations. METHODS A total of 27 women with breast cancer (mean age 51.8 ± 8.9 years, mean body mass index 26.9 ± 3.6 kg/m2), underwent cardiac magnetic resonance before and up to 3 times after anthracycline therapy. Cardiac magnetic resonance variables were LV ejection fraction, normalized T2-weighted signal intensity for myocardial edema, extracellular volume (ECV), LV cardiomyocyte mass, intracellular water lifetime (τic; a marker of cardiomyocyte size), and late gadolinium enhancement. RESULTS At baseline, patients had a relatively low (10-year) Framingham cardiovascular event risk (median 5%), normal LV ejection fractions (mean 69.4 ± 3.6%), and normal LV mass index (51.4 ± 8.0 g/m2), a mean ECV of 0.32 ± 0.038, mean τic of 169 ± 69 ms, and no late gadolinium enhancement. At 351 to 700 days after anthracycline therapy (240 mg/m2), mean LV ejection fraction had declined by 12% to 58 ± 6% (p < 0.001) and mean LV mass index by 19 g/m2 to 36 ± 6 g/m2 (p < 0.001), and mean ECV had increased by 0.037 to 0.36 ± 0.04 (p = 0.004), while mean τic had decreased by 62 ms to 119 ± 54 ms (p = 0.004). Myocardial edema peaked at about 146 to 231 days (p < 0.001). LV mass index was associated with τic (β = 4.1 ± 1.5 g/m2 per 100-ms increase in τic, p = 0.007) but not with ECV. Cardiac troponin T (mean 4.6 ± 1.4 pg/ml at baseline) increased significantly after anthracycline treatment (p < 0.001). Total LV cardiomyocyte mass, estimated as: (1 - ECV) × LV mass, declined more rapidly after anthracycline therapy, with peak cardiac troponin T >10 pg/ml. There was no evidence for any significant interaction between 10-year cardiovascular event risk and the effect of anthracycline therapy. CONCLUSIONS A decrease in LV mass after anthracycline therapy may result from cardiomyocyte atrophy, demonstrating that mechanisms other than interstitial fibrosis and edema can raise ECV. The loss of LV cardiomyocyte mass increased with the degree of cardiomyocyte injury, assessed by peak cardiac troponin T after anthracycline treatment. (Doxorubicin-Associated Cardiac Remodeling Followed by CMR in Breast Cancer Patients; NCT03000036).
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25
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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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Deborde E, Dubourg B, Bejar S, Brehin AC, Normant S, Michelin P, Dacher JN. Differentiation between Fabry disease and hypertrophic cardiomyopathy with cardiac T1 mapping. Diagn Interv Imaging 2019; 101:59-67. [PMID: 31519470 DOI: 10.1016/j.diii.2019.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/03/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the potential of non-contrast myocardial T1 mapping on cardiovascular magnetic resonance examination (CMR) in differentiating patients with Fabry disease (FD) from those with hypertrophic cardiomyopathy (HCM) and healthy control subjects. MATERIALS AND METHODS Seventeen patients with FD (8 men, 9 women; mean age, 48 ±18 [SD] years; [range: 19-73 years]; 53% with left ventricular hypertrophy [LVH]) were matched with 36 patients with hypertrophic cardiomyopathy (HCM) (22 men, 14 women; mean age, 57±16 [SD] years; [range: 22-85 years]) and 70 healthy control subjects (34 men, 36 women; mean age, 38 ±15 [SD] years; [range: 18-65 years]). Cardiac T1 mapping was performed using the modified Look-Locker inversion (MOLLI®) sequence on a 1.5-T magnet. T1 values were calculated, on midventricular section, for septal left ventricular segments (S8-S9) and all mid-ventricular ones (global T1 values; S7-S12). Statistical analysis included unpaired Mann-Whitney test, receiver operating characteristic curve and likelihood ratios. RESULTS Septal native T1 values were significantly decreased in patients with FD (889±61 [SD] ms; range: 784-980ms) compared to those with HCM (995±48 [SD] ms; range: 935-1125ms) (P<0.001) and versus healthy controls (965±29 [SD] ms; range: 910-1028ms) (P<0.001). Global native T1 values were also significantly decreased in patients with FD (891±49 [SD] ms; range 794-970ms) compared to those with HCM (995±34 [SD] ms; range: 952-1086ms) (P<0.001) and versus healthy controls (966±27 [SD] ms; range: 920-1042ms) (P<0.001). A septal left ventricular native T1 cutoff value of 940ms could distinguish FD from HCM with 88% sensitivity (95% CI: 73-100%) and 92% specificity (95% CI: 83-100%). Positive likelihood ratio was 11, negative likelihood ratio was 0.12. Compared to controls, the same threshold could distinguish FD with 88% sensitivity (95% CI: 73-100%) and 86% specificity (95% CI: 78-94%). Positive likelihood ratio was 6.3, negative likelihood ratio was 0.14. T1 value was abnormal in 4 of 8 (50%) of FD patients who did not have LVH. CONCLUSION Native T1 values are significantly lower in patients with FD by comparison with those with HCM and healthy volunteers.
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Affiliation(s)
- E Deborde
- Department of Radiology, University Hospital of Rouen, 76031 Rouen, France; Department of Radiology, University Hospital of Strasbourg, 67098 Strasbourg, France.
| | - B Dubourg
- Department of Radiology, University Hospital of Rouen, 76031 Rouen, France; INSERM U1096, UFR Médecine Pharmacie, 76183 Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, 76000 Rouen, France
| | - S Bejar
- Department of Radiology, University Hospital of Rouen, 76031 Rouen, France
| | - A-C Brehin
- Department of Genetics, University Hospital of Rouen, 76031 Rouen, France
| | - S Normant
- Department of Radiology, University Hospital of Rouen, 76031 Rouen, France
| | - P Michelin
- Department of Radiology, University Hospital of Rouen, 76031 Rouen, France
| | - J-N Dacher
- Department of Radiology, University Hospital of Rouen, 76031 Rouen, France; INSERM U1096, UFR Médecine Pharmacie, 76183 Rouen, France; Institute for Research and Innovation in Biomedicine, University of Rouen, 76000 Rouen, France
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27
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Cardoso FB, Antunes-Correa LM, Silva TQAC, Silva LM, Toledo C, Ribeiro VC, Paim LR, Neilan TG, Velloso L, Nadruz W, Ramos CD, Dertkigil SS, Schreiber R, Sposito A, Matos-Souza JR, Berwanger O, Jerosch-Herold M, Coelho-Filho OR. Noninvasive imaging assessment of rehabilitation therapy in heart failure with preserved and reduced left ventricular ejection fraction (IMAGING-REHAB-HF): design and rationale. Ther Adv Chronic Dis 2019; 10:2040622319868376. [PMID: 31489153 PMCID: PMC6709440 DOI: 10.1177/2040622319868376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Studies have shown significant benefits of exercise therapy in heart failure
(HF) with a reduced ejection fraction (HFrEF) and HF with a preserved
ejection fraction (HFpEF). The mechanisms responsible for the beneficial
effect of exercise in HFrEF and HFpEF are still unclear. We hypothesized
that the effect of exercise on myocardial remodeling may explain its
beneficial effect. Methods: IMAGING-REHAB-HF is a single-center, randomized, controlled clinical trial
using cardiac magnetic resonance imaging, vasomotor endothelial function,
cardiac sympathetic activity imaging and serum biomarkers to compare the
effect of exercise therapy in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%).
Subjects will be assessed at baseline and after 4 months. The exercise
program will consist of three 60-min exercise sessions/week. The primary
endpoints are the effect of exercise on myocardial extracellular volume
(ECV), left ventricular (LV) systolic function, LV mass, LV mass-to-volume
and LV cardiomyocyte volume. Secondary endpoints include the effect of
exercise on vasomotor endothelial function, cardiac sympathetic activity and
plasmatic biomarkers. Patients will be allocated in a 2:1 fashion to
supervised exercise program or usual care. A total sample size of 90
patients, divided into two groups according to LVEF:HFpEF group (45
patients:30 in the intervention arm and 15 in the control arm) and HFrEF
group (45 patients:30 in the intervention arm and 15 in the control arm) –
will be necessary to achieve adequate power. Conclusion: This will be the first study to evaluate the benefits of a rehabilitation
program on cardiac remodeling in HF patients. The unique design of our study
may provide unique data to further elucidate the mechanisms involved in
reverse cardiac remodeling after exercise in HFpEF and HFrEF patients.
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Affiliation(s)
| | | | | | - Luis Miguel Silva
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Camilla Toledo
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Layde R Paim
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lício Velloso
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Celso Darío Ramos
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Sergio S Dertkigil
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Roberto Schreiber
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Andrei Sposito
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Otávio Berwanger
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Otávio Rizzi Coelho-Filho
- Discipline of Cardiology, Department of Internal Medicine, Hospital de Clínicas, State University of Campinas, UNICAMP, Rua Vital Brasil,251- Cidade Universitária 'Zeferino Vaz', Campinas, SP, CEP:13083-888, Brazil
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Nordlund D, Xanthis C, Bidhult S, Jablonowski R, Kanski M, Kopic S, Carlsson M, Engblom H, Aletras AH, Arheden H. Measuring extracellular volume fraction by MRI: First verification of values given by clinical sequences. Magn Reson Med 2019; 83:662-672. [PMID: 31418490 PMCID: PMC6900009 DOI: 10.1002/mrm.27938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
Purpose To verify MR measurements of myocardial extracellular volume fraction (ECV) based on clinically applicable T1‐mapping sequences against ECV measurements by radioisotope tracer in pigs and to relate the results to those obtained in volunteers. Methods Between May 2016 and March 2017, 8 volunteers (25 ± 4 years, 3 female) and 8 pigs (4 female) underwent ECV assessment with SASHA, MOLLI5(3b)3, MOLLI5(3s)3, and MOLLI5s(3s)3s. Myocardial ECV was measured independently in pigs using a radioisotope tracer method. Results In pigs, ECV in normal myocardium was not different between radioisotope (average ± standard deviation; 19 ± 2%) and SASHA (21 ± 2%; P = 0.086). ECV was higher by MOLLI5(3b)3 (26 ± 2%), MOLLI5(3s)3 (25 ± 2%), and MOLLI5s(3s)3s (25 ± 2%) compared with SASHA or radioisotope (P ≤ 0.001 for all). ECV in volunteers was higher by MOLLI5(3b)3 (26 ± 3%) and MOLLI5(3s)3 (26 ± 3%) than by SASHA (22 ± 3%; P = 0.022 and P = 0.033). No difference was found between MOLLI5s(3s)3s (25 ± 3%) and SASHA (P = 0.225). Native T1 of blood and myocardium as well as postcontrast T1 of myocardium was consistently lower using MOLLI compared with SASHA. ECV increased over time as measured by MOLLI5(3b)3 and MOLLI5(3s)3 for pigs (0.08% and 0.07%/min; P = 0.004 and P = 0.013) and by MOLLI5s(3s)3s for volunteers (0.07%/min; P = 0.032) but did not increase as measured by SASHA. Conclusion Clinically available MOLLI and SASHA techniques can be used to accurately estimate ECV in normal myocardium where MOLLI‐sequences show minor overestimation driven by underestimation of postcontrast T1 when compared with SASHA. The timing of imaging after contrast administration affected the measurement of ECV using some variants of the MOLLI sequence.
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Affiliation(s)
- David Nordlund
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Christos Xanthis
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.,Laboratory of Computing and Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sebastian Bidhult
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Robert Jablonowski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Sascha Kopic
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.,Laboratory of Computing and Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
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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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Vita T, Gräni C, Abbasi SA, Neilan TG, Rowin E, Kaneko K, Coelho-Filho O, Watanabe E, Mongeon FP, Farhad H, Rassi CH, Choi YL, Cheng K, Givertz MM, Blankstein R, Steigner M, Aghayev A, Jerosch-Herold M, Kwong RY. Comparing CMR Mapping Methods and Myocardial Patterns Toward Heart Failure Outcomes in Nonischemic Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2019; 12:1659-1669. [PMID: 30448130 PMCID: PMC6506397 DOI: 10.1016/j.jcmg.2018.08.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In patients with nonischemic dilated cardiomyopathy (NIDCM), native T1, partition coefficient (λGd), and extracellular volume fraction (ECV) mapping may offer prognostic values beyond late gadolinium enhancement (LGE), by scaling the range of myocardial changes. BACKGROUND In patients with NIDCM, LGE is seen in 30% of patients and it indicates adverse prognosis. METHODS The study mapped 6 anatomical locations using all 4 cardiac magnetic resonance (CMR) tissue-characterizing methods and associated with outcome. The authors performed T1 mapping of the myocardium and the blood pool, before and serially after contrast injection, using a Look-Locker cine gradient-echo technique to obtain T1 and the corresponding reciprocal R1 values. λGd values were derived from the slopes of the least-squares regression lines for myocardial versus blood R1, then adjusted to serum hematocrit to yield ECV. RESULTS Consecutive 240 NIDCM patients (49 ± 16 years of age; 38% women) underwent CMR for cardiac function, LGE, native T1, λGd, and ECV. After a median of 3.8 years, 36 (15%) experienced major adverse cardiac events (MACE), including 22 heart failure hospitalizations and 14 deaths. Nonischemic LGE was detected in 34%, whereas ECV was elevated (≥1 location) in 58%. Comparing the 4 methods, mean ECV and λGd both demonstrated strong association with MACE (both p < 0.001). In contrast to native T1 and LGE, ECV values from all 6 locations were associated with MACE and death, with the anteroseptum being the most significant (p < 0.0001). The number of abnormal ECV locations correlated linearly with annual MACE rates (p = 0.0003). Mean ECV was the only predictor to enter a prognostic model that contained age, sex, New York Heart Association functional class, and left ventricular ejection fraction. For every 10% increase, mean ECV portended to a 2.8-fold adjusted increase risk to MACE (p < 0.001). CONCLUSIONS In this study of patients with NIDCM, mapping the myocardial extent of abnormality using ECV offers prognostication toward heart failure outcomes incremental to LGE or native T1 mapping.
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Affiliation(s)
- Tomas Vita
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Gräni
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siddique A Abbasi
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tomas G Neilan
- Cardiac MR PET CT Program and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ethan Rowin
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyoichi Kaneko
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Otavio Coelho-Filho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eri Watanabe
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francois-Pierre Mongeon
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Hoshang Farhad
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Henrique Rassi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Steigner
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ayaz Aghayev
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Li X, Mangia S, Lee JH, Bai R, Springer CS. NMR shutter-speed elucidates apparent population inversion of 1 H 2 O signals due to active transmembrane water cycling. Magn Reson Med 2019; 82:411-424. [PMID: 30903632 PMCID: PMC6593680 DOI: 10.1002/mrm.27725] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022]
Abstract
Purpose The desire to quantitatively discriminate the extra‐ and intracellular tissue 1H2O MR signals has gone hand‐in‐hand with the continual, historic increase in MRI instrument magnetic field strength [B0]. However, recent studies have indicated extremely valuable, novel metabolic information can be readily accessible at ultra–low B0. The two signals can be distinguished, and the homeostatic activity of the cell membrane sodium/potassium pump (Na+,K+,ATPase) detected. The mechanism allowing 1H2O MRI to do this is the newly discovered active transmembrane water cycling (AWC) phenomenon, which we found using paramagnetic extracellular contrast agents at clinical B0 values. AWC is important because Na+,K+,ATPase can be considered biology’s most vital enzyme, and its in vivo steady‐state activity has not before been measurable, let alone amenable to mapping with high spatial resolution. Recent reports indicate AWC correlates with neuronal firing rate, with malignant tumor metastatic potential, and inversely with cellular reducing equivalent fraction. We wish to systematize the ways AWC can be precisely measured. Methods We present a theoretical longitudinal relaxation analysis of considerable scope: it spans the low‐ and high–field situations. Results We show the NMR shutter‐speed organizing principle is pivotal in understanding how trans–membrane steady–state water exchange kinetics are manifest throughout the range. Our findings illuminate an aspect, apparent population inversion, which is crucial in understanding ultra‐low field results. Conclusions Without an appreciation of apparent population inversion, significant misinterpretations of future data are likely. These could have unfortunate diagnostic consequences.
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Affiliation(s)
- Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon
| | - Silvia Mangia
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Jing-Huei Lee
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio
| | - Ruiliang Bai
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Charles S Springer
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon
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Incremental value of extracellular volume assessment by cardiovascular magnetic resonance imaging in risk stratifying patients with suspected myocarditis. Int J Cardiovasc Imaging 2019; 35:1067-1078. [DOI: 10.1007/s10554-019-01552-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/02/2019] [Indexed: 01/27/2023]
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Ali SI, Li Y, Adam M, Xie M. Evaluation of Left Ventricular Systolic Function and Mass in Primary Hypertensive Patients by Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:39-49. [PMID: 30027675 DOI: 10.1002/jum.14687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 06/08/2023]
Abstract
Hypertension is an independent risk factor for cardiovascular diseases. The accurate evaluation of cardiovascular risk is of paramount importance in the management of hypertensive patients. Conventional echocardiographic methods have provided the assessment of left ventricular systolic function and mass for many years. Tissue Doppler imaging, 3-dimensional echocardiography, and speckle tracking echocardiography are newer echocardiographic modalities for the left ventricular systolic function and mass quantification. The major emphasis of this review is to evaluate the left ventricular systolic function and mass by conventional and newly developed echocardiographic in hypertensive patients.
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Affiliation(s)
- Shima Ibrahim Ali
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum North, Sudan
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mohamed Adam
- Colleges of Applied Medical Science, Radiology Department, King Khalid University, Kingdom of Saudi Arabia
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Springer CS. Using 1H 2O MR to measure and map sodium pump activity in vivo. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 291:110-126. [PMID: 29705043 DOI: 10.1016/j.jmr.2018.02.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 05/26/2023]
Abstract
The cell plasma membrane Na+,K+-ATPase [NKA] is one of biology's most [if not the most] significant enzymes. By actively transporting Na+ out [and K+ in], it maintains the vital trans-membrane ion concentration gradients and the membrane potential. The forward NKA reaction is shown in the Graphical Abstract [which is elaborated in the text]. Crucially, NKA does not operate in isolation. There are other transporters that conduct K+ back out of [II, Graphical Abstract] and Na+ back into [III, Graphical Abstract] the cell. Thus, NKA must function continually. Principal routes for ATP replenishment include mitochondrial oxidative phosphorylation, glycolysis, and creatine kinase [CrK] activity. However, it has never been possible to measure, let alone map, this integrated, cellular homeostatic NKA activity in vivo. Active trans-membrane water cycling [AWC] promises a way to do this with 1H2O MR. Inthe Graphical Abstract, the AWC system is characterized by active contributions totheunidirectional rate constants for steady-state water efflux and influx, respectively, kio(a) and koi(a). The discovery, validation, and initial exploration of active water cycling are reviewed here. Promising applications in cancer, cardiological, and neurological MRI are covered. This initial work employed paramagnetic Gd(III)chelate contrast agents [CAs]. However, the significant problems associated with in vivo CA use are also reviewed. A new analysis of water diffusion-weighted MRI [DWI] is presented. Preliminary results suggest a non-invasive way to measure the cell number density [ρ (cells/μL)], the mean cell volume [V (pL)], and the cellular NKA metabolic rate [cMRNKA(fmol(ATP)/s/cell)] with high spatial resolution. These crucial cell biology properties have not before been accessible invivo. Furthermore, initial findings indicate their absolute values can be determined.
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Affiliation(s)
- Charles S Springer
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97239, United States.
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Puntmann VO, Zeiher AM, Nagel E. T1 and T2 mapping in myocarditis: seeing beyond the horizon of Lake Louise criteria and histopathology. Expert Rev Cardiovasc Ther 2018; 16:319-330. [DOI: 10.1080/14779072.2018.1455499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Valentina O. Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
- Department of Cardiology, Division of Internal Medicine III, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas M. Zeiher
- Department of Cardiology, Division of Internal Medicine III, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
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Bai R, Springer CS, Plenz D, Basser PJ. Fast, Na + /K + pump driven, steady-state transcytolemmal water exchange in neuronal tissue: A study of rat brain cortical cultures. Magn Reson Med 2017; 79:3207-3217. [PMID: 29106751 DOI: 10.1002/mrm.26980] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE Water homeostasis and transport play important roles in brain function (e.g., ion homeostasis, neuronal excitability, cell volume regulation, etc.). However, specific mechanisms of water transport across cell membranes in neuronal tissue have not been completely elaborated. METHODS The kinetics of transcytolemmal water exchange were measured in neuronal tissue using simultaneous, real-time fluorescence and nuclear magnetic resonance (NMR) measurements of perfused, active brain organotypic cortical cultures. Perfusion with a paramagnetic MRI contrast agent, gadoteridol, allows NMR determination of the unidirectional rate constant for steady-state cellular water efflux (kio ), and the mole fraction of intracellular water ( pi), related to the average cell volume (V). Changes in intracellular calcium concentration [Cai2+] were used as a proxy for neuronal activity and were monitored by fluorescence imaging. RESULTS The kio value, averaged over all cultures (N = 99) at baseline, was 2.02 (±1.72) s-1 , indicating that on average, the equivalent of the entire intracellular water volume turns over twice each second. To probe possible molecular pathways, the specific Na+ -K+ -ATPase (NKA) inhibitor, ouabain (1 mM), was transiently introduced into the perfusate. This caused significant transient changes (N = 8): [Cai2+] rose ∼250%, V rose ∼89%, and kio fell ∼45%, with a metabolically active kio contribution probably eliminated by ouabain saturation. CONCLUSIONS These results suggest that transcytolemmal water exchange in neuronal tissue involves mechanisms affected by NKA activity as well as passive pathways. The active pathway may account for half of the basal homeostatic water flux. Magn Reson Med 79:3207-3217, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Ruiliang Bai
- Section on Quantitative Imaging and Tissue Sciences, DIBGI, NICHD, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles S Springer
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Dietmar Plenz
- Section on Critical Brain Dynamics, LSN, NIMH, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter J Basser
- Section on Quantitative Imaging and Tissue Sciences, DIBGI, NICHD, National Institutes of Health, Bethesda, Maryland, USA
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Gräni C, Eichhorn C, Bière L, Murthy VL, Agarwal V, Kaneko K, Cuddy S, Aghayev A, Steigner M, Blankstein R, Jerosch-Herold M, Kwong RY. Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis. J Am Coll Cardiol 2017; 70:1964-1976. [PMID: 29025553 DOI: 10.1016/j.jacc.2017.08.050] [Citation(s) in RCA: 284] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Diagnosing myocarditis is challenged by nonspecific clinical signs and symptoms and low accuracy of endomyocardial biopsy. Cardiac magnetic resonance imaging (CMR) provides both cardiac anatomy and tissue characterization in this setting, but the prognostic value of this method as a primary assessment tool in patients with suspected myocarditis remains limited. OBJECTIVES This study sought to determine cardiac event-free survival of a consecutive cohort with suspected myocarditis with regard to CMR findings. METHODS Six hundred seventy patients with suspected myocarditis underwent CMR including late gadolinium enhancement (LGE) parameters between 2002 and 2015 and were included and followed. We performed multivariable model for major adverse cardiovascular events (MACE) and determined the continuous net reclassification improvement by LGE markers. RESULTS At a median follow-up of 4.7 years (interquartile range [IQR]: 2.3 to 7.3 years), 98 patients experienced a MACE. Two hundred ninety-four (44%) patients showed LGE presence, which was associated with a more than doubling risk of MACE (hazard ratio [HR]: 2.22; 95% confidence interval [CI]: 1.47 to 3.35; p < 0.001). Annualized MACE rates were 4.8% and 2.1% corresponding to LGE presence and absence, respectively (p < 0.001). In the multivariable model, LGE presence maintained significant association with MACE (HR: 1.72; 95% CI: 1.08 to 2.76; p = 0.023). The computed continuous net reclassification improvement was 0.39 (95% CI: 0.10 to 0.67) when LGE presence was added to the multivariable model for MACE. Regarding location and pattern, septal and midwall LGE showed strongest associations with MACE (HR: 2.55; 95% CI: 1.77 to 3.83 and HR: 2.39; 95% CI: 1.54 to 3.69, respectively; both p < 0.001). A patchy distribution portended to a near 3-fold increased hazard to MACE (HR: 2.93; 95% CI: 1.79 to 4.80; p < 0.001). LGE extent (per 10% increase) corresponded to a 79% increase in risk of MACE (HR: 1.79; 95% CI: 1.25 to 2.57; p = 0.002). A normal CMR study corresponded to low annual MACE and death rates of 0.8% and 0.3%, respectively. CONCLUSIONS CMR tissue characterization provides effective risk stratification in patients with suspected myocarditis.
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Affiliation(s)
- Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christian Eichhorn
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Loïc Bière
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Vikram Agarwal
- Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyoichi Kaneko
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah Cuddy
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ayaz Aghayev
- Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Steigner
- Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Piechnik SK, Jerosch-Herold M. Myocardial T1 mapping and extracellular volume quantification: an overview of technical and biological confounders. Int J Cardiovasc Imaging 2017; 34:3-14. [PMID: 28849419 PMCID: PMC5851695 DOI: 10.1007/s10554-017-1235-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022]
Abstract
Novel tissue biomarkers based on the spin–lattice relaxation time T1, a fundamental property in the theory of magnetic resonance physics, have emerged as a new approach for myocardial tissue characterization with many validated clinical applications. This article is intended as an overview of the physical and physiological mechanisms underlying the interpretation and the accuracy of any practical measurement of T1, or derived biomarkers such as extravascular volume fraction, and also includes a discussion of potential pitfalls. Numerous caveats und knowledge gaps related to the precise interpretation of T1-based biomarkers remain, which are being addressed incrementally through ongoing research. Equally important, further careful standardization will pave the way for a wider clinical translation of these novel T1-based biomarkers of tissue remodeling, which have been well validated for their sensitivity to pathophysiological changes, though for the most part in single-center studies.
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Affiliation(s)
- Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX39DU, UK
| | - Michael Jerosch-Herold
- Brigham and Women's Hospital, and Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA.
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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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Wu LM, An DAL, Yao QY, Ou YRZ, Lu Q, Jiang M, Xu JR. Hypertrophic cardiomyopathy and left ventricular hypertrophy in hypertensive heart disease with mildly reduced or preserved ejection fraction: insight from altered mechanics and native T1 mapping. Clin Radiol 2017; 72:835-843. [PMID: 28552325 DOI: 10.1016/j.crad.2017.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/19/2017] [Accepted: 04/24/2017] [Indexed: 01/19/2023]
Abstract
AIM To explore the relationship between extracellular volume (ECV), native T1, and systolic strain in hypertrophic cardiomyopathy (HCM) and hypertensive patients with left ventricular hypertrophy (HTN LVH) with mildly reduced or preserved ejection fraction. MATERIALS AND METHODS T1 mapping was performed in 45 patients with late gadolinium enhancement positive (LGE+) HCM (mean age, 53±6 years), 11 patients with LGE- (LGE-) HCM (mean age, 56±5 years), and 20 patients with HTN LVH (mean age, 55±6 years) on at 3 T magnetic resonance imaging (MRI) using the modified look-locker inversion-recovery (MOLLI) pulse sequence. Mean T1 value, ECV and circumferential strain parameters were determined for each patient. RESULTS Overall, the HCM patients had higher native T1 values (1242.92±68.94) and ECV (0.31±0.05) in comparison to those of the HTN LVH patients (1197±46.80, 0.27±0.04; p<0.05). In the subgroup analysis, the HCM LGE+ patients had the highest native T1 values among the three groups. The HCM LGE+ patients had higher ECV than the LGE- patients. HCM LGE- patients had higher ECV than HTN LVH patients (p<0.05). Peak systolic circumferential strain and early diastolic strain rates were reduced in the HCM LGE+ patients in comparison to the HCM LGE- and HTN LVH patients (p<0.05). Reduced peak systolic and early diastolic circumferential strain rates were associated with increased levels of ECV and native T1 values among all the patients. CONCLUSION HCM LGE+ patients had higher native T1 values, higher ECV, and an associated reduction in early diastolic strain rates and peak systolic circumferential strains when compared to the HCM LGE- and HTN LVH patients with mildly reduced or preserved ejection fraction.
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Affiliation(s)
- L-M Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - D-A L An
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Q-Y Yao
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y-R Z Ou
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Q Lu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - M Jiang
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - J-R Xu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
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Puntmann VO, Peker E, Chandrashekhar Y, Nagel E. T1 Mapping in Characterizing Myocardial Disease: A Comprehensive Review. Circ Res 2017; 119:277-99. [PMID: 27390332 DOI: 10.1161/circresaha.116.307974] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/20/2016] [Indexed: 01/06/2023]
Abstract
Cardiovascular magnetic resonance provides insights into myocardial structure and function noninvasively, with high diagnostic accuracy and without ionizing radiation. Myocardial tissue characterization in particular gives cardiovascular magnetic resonance a prime role among all the noninvasive cardiovascular investigations. Late gadolinium enhancement imaging is an established method for visualizing replacement scar, providing diagnostic and prognostic information in a variety of cardiac conditions. Late gadolinium enhancement, however, relies on the regional segregation of tissue characteristics to generate the imaging contrast. Thus, myocardial pathology that is diffuse in nature and affecting the myocardium in a rather uniform and global distribution is not well visualized with late gadolinium enhancement. Examples include diffuse myocardial inflammation, fibrosis, hypertrophy, and infiltration. T1 mapping is a novel technique allowing to diagnose these diffuse conditions by measurement of T1 values, which directly correspond to variation in intrinsic myocardial tissue properties. In addition to providing clinically meaningful indices, T1-mapping measurements also allow for an estimation of extracellular space by calculation of extracellular volume fraction. Multiple lines of evidence suggest a central role for T1 mapping in detection of diffuse myocardial disease in early disease stages and complements late gadolinium enhancement in visualization of the regional changes in common advanced myocardial disease. As a quantifiable measure, it may allow grading of disease activity, monitoring progress, and guiding treatment, potentially as a fast contrast-free clinical application. We present an overview of clinically relevant technical aspects of acquisition and processing, and the current state of art and evidence, supporting its clinical use.
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Affiliation(s)
- Valentina O Puntmann
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Elif Peker
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Y Chandrashekhar
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Eike Nagel
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.).
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Farhad H, Staziaki PV, Addison D, Coelho-Filho OR, Shah RV, Mitchell RN, Szilveszter B, Abbasi SA, Kwong RY, Scherrer-Crosbie M, Hoffmann U, Jerosch-Herold M, Neilan TG. Characterization of the Changes in Cardiac Structure and Function in Mice Treated With Anthracyclines Using Serial Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.003584. [PMID: 27923796 DOI: 10.1161/circimaging.115.003584] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anthracyclines are cardiotoxic; however, there are limited data characterizing the serial changes in cardiac structure and function after anthracyclines. The aim of this study was to use cardiac magnetic resonance to characterize anthracycline-induced cardiotoxicity in mice. METHODS AND RESULTS This was a longitudinal cardiac magnetic resonance and histological study of 45 wild-type male mice randomized to doxorubicin (n=30, 5 mg/kg of doxorubicin/week for 5 weeks) or placebo (n=15). A cardiac magnetic resonance was performed at baseline and at 5, 10, and 20 weeks after randomization. Measures of primary interest included left ventricular ejection fraction, myocardial edema (multiecho short-axis spin-echo acquisition), and myocardial fibrosis (Look-Locker gradient echo). In doxorubicin-treated mice versus placebo, there was an increase in myocardial edema at 5 weeks (T2 values of 32±4 versus 21±3 ms; P<0.05), followed by a reduction in left ventricular ejection fraction (54±6 versus 63±5%; P<0.05) and an increase in myocardial fibrosis (extracellular volume of 0.34±0.03 versus 0.27±0.03; P<0.05) at 10 weeks. There was a strong association between the early (5 weeks) increase in edema and the subacute (10 weeks) increase in fibrosis (r=0.90; P<0.001). Both the increase in edema and fibrosis predicted the late doxorubicin-induced mortality in mice (P<0.001). CONCLUSIONS Our data suggest that, in mice, anthracycline-induced cardiotoxicity is associated with an early increase in cardiac edema and a subsequent increase in myocardial fibrosis. The early increase in edema and subacute increase in fibrosis are strongly linked and are both predictive of late mortality.
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Affiliation(s)
- Hoshang Farhad
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pedro V Staziaki
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Daniel Addison
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Otavio R Coelho-Filho
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ravi V Shah
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Richard N Mitchell
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Balint Szilveszter
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Siddique A Abbasi
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Kwong
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marielle Scherrer-Crosbie
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Jerosch-Herold
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tomas G Neilan
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Fibrosis quantification in Hypertensive Heart Disease with LVH and Non-LVH: Findings from T1 mapping and Contrast-free Cardiac Diffusion-weighted imaging. Sci Rep 2017; 7:559. [PMID: 28373647 PMCID: PMC5428770 DOI: 10.1038/s41598-017-00627-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 03/08/2017] [Indexed: 01/19/2023] Open
Abstract
This study assessed the extent of fibrosis and the relationship between the ADC value and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH) and hypertensive patients without LVH (HTN non-LVH) using cardiac diffusion-weighted imaging and T1 mapping. T1 mapping was performed in 13 HTN LVH (mean age, 56.23 ± 3.30 years), 17 HTN non-LVH (mean age, 56.41 ± 2.78 years), and 12 normal control subjects (mean age, 55.67 ± 3.08 years) with 3.0 T MRI using cardiac diffusion-weighted imaging and T1 mapping. HTN LVH subjects had higher native T1 (1233.12 ± 79.01) compared with controls (1133.88 ± 27.40) (p < 0.05). HTN LVH subjects had higher ECV (0.28 ± 0.03) compared with HTN non-LVH subjects (0.26 ± 0.02) or controls (0.24 ± 0.03) (p < 0.05). HTN LVH subjects had higher ADC (2.23 ± 0.34) compared with HTN non-LVH subjects (1.88 ± 0.27) or controls (1.61 ± 0.38), (p < 0.05). Positive associations were noted between LVMI and ADC (Spearman = 0.450, p < 0.05) and between LVMI and ECV (Spearman = 0.181, p < 0.05). ADC was also related to an increase in ECV (R2 = 0.210). Increased levels of ADC were associated with reduced peak systolic and early diastolic circumferential strain rates across all subjects. Contrast-free DW-CMR is an alternative sequence to ECV for the evaluation of fibrosis extent in HTN LVH and HTN non-LVH, while native T1 has limited value.
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Treibel TA, Fontana M, Steeden JA, Nasis A, Yeung J, White SK, Sivarajan S, Punwani S, Pugliese F, Taylor SA, Moon JC, Bandula S. Automatic quantification of the myocardial extracellular volume by cardiac computed tomography: Synthetic ECV by CCT. J Cardiovasc Comput Tomogr 2017; 11:221-226. [PMID: 28268091 DOI: 10.1016/j.jcct.2017.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/11/2017] [Accepted: 02/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The quantification of extracellular volume fraction (ECV) by Cardiac Computed Tomography (CCT) can identify changes in the myocardial interstitium due to fibrosis or infiltration. Current methodologies require laboratory blood hematocrit (Hct) measurement - which complicates the technique. The attenuation of blood (HUblood) is known to change with anemia. We hypothesized that the relationship between Hct and HUblood could be calibrated to rapidly generate a synthetic ECV without formally measuring Hct. METHODS The association between Hct and HUblood was derived from forty non-contrast thoracic CT scans using regression analysis. Synthetic Hct was then used to calculate synthetic ECV, and in turn compared with ECV using blood Hct in a validation cohort with mild interstitial expansion due to fibrosis (aortic stenosis, n = 28, ECVCT = 28 ± 4%) and severe interstitial expansion due to amyloidosis (n = 27; ECVCT = 54 ± 11%, p < 0.001). For histological validation, synthetic ECV was correlated with collagen volume fraction (CVF) in a separate cohort with aortic stenosis (n = 18). All CT scans were performed at 120 kV and 160 mAs. RESULTS HUblood was a good predictor of Hct (R2 = 0.47; p < 0.01), with the regression model (Hct = [0.51 * HUblood] + 17.4) describing the association. Synthetic ECV correlated well with conventional ECV (R2 = 0.96; p < 0.01) with minimal bias and 2SD difference of 5.7%. Synthetic ECV correlated as well as conventional ECV with histological CVF (both R2 = 0.50, p < 0.01). Finally, we implemented an automatic ECV plug-in for offline analysis. CONCLUSION Synthetic ECV by CCT provides instantaneous quantification of the myocardial extracellular space without the need for blood sampling.
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Affiliation(s)
- Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK.
| | - Marianna Fontana
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK
| | - Jennifer A Steeden
- Institute of Cardiovascular Science, University College London, London, UK; UCL Centre for Medical Image Computing, Department of Medical Physics, London, UK
| | - Arthur Nasis
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Jason Yeung
- Centre for Medical Imaging, University College London, London, UK
| | - Steven K White
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK
| | - Sri Sivarajan
- Centre for Medical Imaging, University College London, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | | | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK
| | - Steve Bandula
- Centre for Medical Imaging, University College London, London, UK
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Heydari B, Abdullah S, Pottala JV, Shah R, Abbasi S, Mandry D, Francis SA, Lumish H, Ghoshhajra BB, Hoffmann U, Appelbaum E, Feng JH, Blankstein R, Steigner M, McConnell JP, Harris W, Antman EM, Jerosch-Herold M, Kwong RY. Effect of Omega-3 Acid Ethyl Esters on Left Ventricular Remodeling After Acute Myocardial Infarction: The OMEGA-REMODEL Randomized Clinical Trial. Circulation 2016; 134:378-91. [PMID: 27482002 DOI: 10.1161/circulationaha.115.019949] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects, but their role in modifying cardiac structures and tissue characteristics in patients who have had an acute myocardial infarction while receiving current guideline-based therapy remains unknown. METHODS In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute myocardial infarction were randomly assigned 1:1 to 6 months of high-dose omega-3 fatty acids (n=180) or placebo (n=178). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and after study therapy. The primary study endpoint was change in left ventricular systolic volume index. Secondary endpoints included change in noninfarct myocardial fibrosis, left ventricular ejection fraction, and infarct size. RESULTS By intention-to-treat analysis, patients randomly assigned to omega-3 fatty acids experienced a significant reduction of left ventricular systolic volume index (-5.8%, P=0.017), and noninfarct myocardial fibrosis (-5.6%, P=0.026) in comparison with placebo. Per-protocol analysis revealed that those patients who achieved the highest quartile increase in red blood cell omega-3 index experienced a 13% reduction in left ventricular systolic volume index in comparison with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy. CONCLUSIONS Treatment of patients with acute myocardial infarction with high-dose omega-3 fatty acids was associated with reduction of adverse left ventricular remodeling, noninfarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00729430.
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Affiliation(s)
- Bobak Heydari
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Shuaib Abdullah
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - James V Pottala
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Ravi Shah
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Siddique Abbasi
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Damien Mandry
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Sanjeev A Francis
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Heidi Lumish
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Brian B Ghoshhajra
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Udo Hoffmann
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Evan Appelbaum
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Jiazhuo H Feng
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Ron Blankstein
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Michael Steigner
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Joseph P McConnell
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - William Harris
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Elliott M Antman
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Michael Jerosch-Herold
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.)
| | - Raymond Y Kwong
- From Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., R.B., M.S., M.J.-H., R.Y.K.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (B.H., S.A., R.S., S.A., D.M., J.H.F., E.M.A., R.Y.K.); Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Fall (J.V.P., W.H.); Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (R.S., S.A.F.); Department of Radiology, Massachusetts General Hospital, Boston (H.L., B.B.G., U.F.); Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.A.); Health Diagnostic Laboratory, Inc., Richmond, VA (J.P.M.); and OmegaQuant Analytics, LLC, Sioux Falls, SD (W.H.).
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Hinojar R, Nagel E, Puntmann VO. Advances in Cardiovascular MRI using Quantitative Tissue Characterisation Techniques: Focus on Myocarditis. Eur Cardiol 2016; 11:20-24. [PMID: 30310443 DOI: 10.15420/ecr.2016:18:2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Tissue characterisation capabilities are continuing to evolve and proving to be valuable in the non-invasive diagnosis of clinically-heterogeneous manifestations of myocarditis. The authors investigate how cardiovascular magnetic resonance imaging offers an increasingly reliable alternative to invasive biopsy for clinically-stable patients, and how this tool - with further longitudinal study - will improve the overall understanding of the natural course of myocarditis.
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Affiliation(s)
- Rocio Hinojar
- Institute for experimental and translational cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany.,Department of Cardiology, University Hospital Ramón y Cajal, Alcala University, Madrid, Spain
| | - Eike Nagel
- Institute for experimental and translational cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Valentina O Puntmann
- Institute for experimental and translational cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany.,Department of Cardiology, Division of Internal Medicine III, Goethe University Hospital Frankfurt, Frankfurt, Germany
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47
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Myocardial tissue remodeling after orthotopic heart transplantation: a pilot cardiac magnetic resonance study. Int J Cardiovasc Imaging 2016; 34:15-24. [DOI: 10.1007/s10554-016-0937-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/08/2016] [Indexed: 01/09/2023]
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Suzuki T, Nazarian S, Jerosch-Herold M, Chugh SS. Imaging for assessment of sudden death risk: current role and future prospects. Europace 2016; 18:1491-1500. [PMID: 27098112 DOI: 10.1093/europace/euv456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Abstract
Sudden cardiac death (SCD) remains a major public health problem and there is an urgent need to maximize the impact of primary prevention using the implantable defibrillator. While implantable defibrillators are of utility for prevention of SCD, current methods of selecting candidates have significant shortcomings. Major advancements have occurred in the field of cardiac imaging, with significant potential to identify novel cardiac substrates for improved prediction. While assessment of the left ventricular ejection fraction remains the current major predictor, it is likely that several novel imaging markers will be incorporated into future risk stratification approaches. The goal of this review is to discuss the current status and future potential of cardiac imaging modalities to enhance risk stratification for SCD.
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Affiliation(s)
- Takeki Suzuki
- Division of Cardiology, Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Saman Nazarian
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sumeet S Chugh
- The Heart Institute, Advanced Health Sciences Pavilion Suite A3100, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA
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49
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Goldfarb JW, Zhao W. Effects of transcytolemmal water exchange on the assessment of myocardial extracellular volume with cardiovascular MRI. NMR IN BIOMEDICINE 2016; 29:499-506. [PMID: 26866306 DOI: 10.1002/nbm.3488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 12/13/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Quantitative analysis of the myocardial interstitial space is gaining increased interest as a biomarker in the MRI and clinical cardiovascular communities. To investigate the effect of water exchange on the calculation of myocardial extracellular volume (ECV), we employed two tissue models: the standard ECV two-point model (SM) and the shutter speed model (SSM). Twenty individuals (18 men and two women; age 61.9 ± 10.3 years) underwent MRI at 1.5 T with pre-contrast and post-contrast dynamic T1 quantification. Means, standard deviations and ranges for SM and SSM model parameters were calculated. Infarct and viable myocardial model parameters as well as apparent ECV values calculated with the SM and SSM were statistically compared. Viable ECV(SM) remained temporally constant (27.3-28.0%: P = 0.5) and infarcted myocardial ECV(SM) changed significantly (49.3-58.8%; P < 0.001), reaching a steady-state value after 15 min. The intracellular lifetime of water was three times greater in infarcted myocardium when compared with viable myocardium (τi: 66.6 ± 115 versus 208.7 ± 72.7 ms) and accompanied a twofold increase in ECV (ECV(SSM) : 30.3 ± 11.1 versus 71.0 ± 13.1%; P < 0.001). There was a consistent significant difference in ECV values of infarcted myocardium at different timepoints between the SM and SSM, but not viable myocardium, presumably due to slower water exchange. In summary, we found a significant change in apparent ECV and water exchange in infarcted myocardium when compared with viable myocardium. This was visualized by changes in dynamic contrast enhanced curve shapes and quantified using the SSM as not only an increase in apparent ECV but also a decrease in water exchange.
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Affiliation(s)
- James W Goldfarb
- Department of Research and Education, Saint Francis Hospital, Roslyn, New York, USA
- Program in Biomedical Engineering, SUNY Stony Brook, Stony Brook, New York, USA
| | - Wenguo Zhao
- Department of Research and Education, Saint Francis Hospital, Roslyn, New York, USA
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50
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Everett RJ, Stirrat CG, Semple SIR, Newby DE, Dweck MR, Mirsadraee S. Assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 2016; 71:768-78. [PMID: 27005015 DOI: 10.1016/j.crad.2016.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
Myocardial fibrosis can arise from a range of pathological processes and its presence correlates with adverse clinical outcomes. Cardiac magnetic resonance (CMR) can provide a non-invasive assessment of cardiac structure, function, and tissue characteristics, which includes late gadolinium enhancement (LGE) techniques to identify focal irreversible replacement fibrosis with a high degree of accuracy and reproducibility. Importantly the presence of LGE is consistently associated with adverse outcomes in a range of common cardiac conditions; however, LGE techniques are qualitative and unable to detect diffuse myocardial fibrosis, which is an earlier form of fibrosis preceding replacement fibrosis that may be reversible. Novel T1 mapping techniques allow quantitative CMR assessment of diffuse myocardial fibrosis with the two most common measures being native T1 and extracellular volume (ECV) fraction. Native T1 differentiates normal from infarcted myocardium, is abnormal in hypertrophic cardiomyopathy, and may be particularly useful in the diagnosis of Anderson-Fabry disease and amyloidosis. ECV is a surrogate measure of the extracellular space and is equivalent to the myocardial volume of distribution of the gadolinium-based contrast medium. It is reproducible and correlates well with fibrosis on histology. ECV is abnormal in patients with cardiac failure and aortic stenosis, and is associated with functional impairment in these groups. T1 mapping techniques promise to allow earlier detection of disease, monitor disease progression, and inform prognosis; however, limitations remain. In particular, reference ranges are lacking for T1 mapping values as these are influenced by specific CMR techniques and magnetic field strength. In addition, there is significant overlap between T1 mapping values in healthy controls and most disease states, particularly using native T1, limiting the clinical application of these techniques at present.
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Affiliation(s)
- R J Everett
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK.
| | - C G Stirrat
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S I R Semple
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - D E Newby
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - M R Dweck
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S Mirsadraee
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
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