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Pontillo G, Tranfa M, Scaravilli A, Monti S, Capuano I, Riccio E, Rizzo M, Brunetti A, Palma G, Pisani A, Cocozza S. In vivo demonstration of globotriaosylceramide brain accumulation in Fabry Disease using MR Relaxometry. Neuroradiology 2024; 66:1593-1601. [PMID: 38771548 PMCID: PMC11322198 DOI: 10.1007/s00234-024-03380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE How to measure brain globotriaosylceramide (Gb3) accumulation in Fabry Disease (FD) patients in-vivo is still an open challenge. The objective of this study is to provide a quantitative, non-invasive demonstration of this phenomenon using quantitative MRI (qMRI). METHODS In this retrospective, monocentric cross-sectional study conducted from November 2015 to July 2018, FD patients and healthy controls (HC) underwent an MRI scan with a relaxometry protocol to compute longitudinal relaxation rate (R1) maps to evaluate gray (GM) and white matter (WM) lipid accumulation. In a subgroup of 22 FD patients, clinical (FAbry STabilization indEX -FASTEX- score) and biochemical (residual α-galactosidase activity) variables were correlated with MRI data. Quantitative maps were analyzed at both global ("bulk" analysis) and regional ("voxel-wise" analysis) levels. RESULTS Data were obtained from 42 FD patients (mean age = 42.4 ± 12.9, M/F = 16/26) and 49 HC (mean age = 42.3 ± 16.3, M/F = 28/21). Compared to HC, FD patients showed a widespread increase in R1 values encompassing both GM (pFWE = 0.02) and WM (pFWE = 0.02) structures. While no correlations were found between increased R1 values and FASTEX score, a significant negative correlation emerged between residual enzymatic activity levels and R1 values in GM (r = -0.57, p = 0.008) and WM (r = -0.49, p = 0.03). CONCLUSIONS We demonstrated the feasibility and clinical relevance of non-invasively assessing cerebral Gb3 accumulation in FD using MRI. R1 mapping might be used as an in-vivo quantitative neuroimaging biomarker in FD patients.
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Affiliation(s)
- Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Alessandra Scaravilli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Serena Monti
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Ivana Capuano
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Manuela Rizzo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Giuseppe Palma
- Institute of Nanotechnology, National Research Council, Lecce, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
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Gravina M, Casavecchia G, Mangini F, Mautone F, Ruggeri D, Guglielmi G, Macarini L, Brunetti ND. Magnetic resonance mapping for the assessment of cardiomyopathies and myocardial disease. Int J Cardiol 2024; 415:132440. [PMID: 39153509 DOI: 10.1016/j.ijcard.2024.132440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/02/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
In recent years, the use of cardiac magnetic resonance (CMR) has grown exponentially in clinical practice. The keys for this success are represented by the possibility of tissue characterization, cardiac volumes and myocardial perfusion assessment, biventricular function evaluation, with no use of ionizing radiations and with an extremely interesting profile of reproducibility. The use of late gadolinium enhancement (LGE) nearly compares a non-invasive biopsy for cardiac fibrosis quantification. LGE, however, is partly unable to detect diffuse myocardial disease. These limits are overcome by new acquisition techniques, mainly T1 and T2 mapping, which allow the diagnosis and characterization of various cardiomyopathies, both ischemic and non-ischemic, such as amyloidosis (high T1), Fabry's disease (low T1), hemochromatosis (low T1), dilated and hypertrophic cardiomyopathy and myocarditis. In this review we detail and summarize principal evidence on the use of T1 and T2 mapping for the study and clinical management of cardiomyopathies.
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Affiliation(s)
- Matteo Gravina
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Francesco Mangini
- Cardiac Magnetic Resonance Unit, "Di Summa-Perrino" Hospital, Brindisi, Italy
| | - Francesco Mautone
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Debora Ruggeri
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Luca Macarini
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
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Iorio A, Lucà F, Pozzi A, Rao CM, Chimenti C, Di Fusco SA, Rossini R, Caretta G, Cornara S, Giubilato S, Di Matteo I, Di Nora C, Pilleri A, Gelsomino S, Ceravolo R, Riccio C, Grimaldi M, Colivicchi F, Oliva F, Gulizia MM. Anderson-Fabry Disease: Red Flags for Early Diagnosis of Cardiac Involvement. Diagnostics (Basel) 2024; 14:208. [PMID: 38248084 PMCID: PMC10814042 DOI: 10.3390/diagnostics14020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosome storage disorder resulting from an X-linked inheritance of a mutation in the galactosidase A (GLA) gene encoding for the enzyme alpha-galactosidase A (α-GAL A). This mutation results in a deficiency or absence of α-GAL A activity, with a progressive intracellular deposition of glycosphingolipids leading to organ dysfunction and failure. Cardiac damage starts early in life, often occurring sub-clinically before overt cardiac symptoms. Left ventricular hypertrophy represents a common cardiac manifestation, albeit conduction system impairment, arrhythmias, and valvular abnormalities may also characterize AFD. Even in consideration of pleiotropic manifestation, diagnosis is often challenging. Thus, knowledge of cardiac and extracardiac diagnostic "red flags" is needed to guide a timely diagnosis. Indeed, considering its systemic involvement, a multidisciplinary approach may be helpful in discerning AFD-related cardiac disease. Beyond clinical pearls, a practical approach to assist clinicians in diagnosing AFD includes optimal management of biochemical tests, genetic tests, and cardiac biopsy. We extensively reviewed the current literature on AFD cardiomyopathy, focusing on cardiac "red flags" that may represent key diagnostic tools to establish a timely diagnosis. Furthermore, clinical findings to identify patients at higher risk of sudden death are also highlighted.
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Affiliation(s)
- Annamaria Iorio
- Cardiology Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Andrea Pozzi
- Cardiology Department, Valduce Hospital, 23845 Como, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Cristina Chimenti
- Department of Clinic, Internistic, Cardiovascular, Anesthesiologic and Geriatric Sciences, La Sapienza University of Rome, 00142 Rome, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Rome 1, 00135 Rome, Italy
| | - Roberta Rossini
- Cardiology Unit, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Giorgio Caretta
- Levante Ligure Sant’Andrea Hospital, ASL 5 Liguria, 19121 La Spezia, Italy
| | - Stefano Cornara
- Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy
| | - Simona Giubilato
- Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy
| | - Irene Di Matteo
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
| | - Concetta Di Nora
- Department of Cardiothoracic Science, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy
| | - Anna Pilleri
- Cardiology Brotzu Hospital, 09121 Cagliari, Italy
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Massimo Grimaldi
- Cardiology Department, F. Miulli Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Rome 1, 00135 Rome, Italy
| | - Fabrizio Oliva
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy
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Stankowski K, Figliozzi S, Battaglia V, Catapano F, Francone M, Monti L. Fabry Disease: More than a Phenocopy of Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:7061. [PMID: 38002674 PMCID: PMC10671939 DOI: 10.3390/jcm12227061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Fabry disease (FD) is a genetic lysosomal storage disease with frequent cardiovascular involvement, whose presence is a major determinant of adverse clinical outcomes. As a potentially treatable cause of left ventricular hypertrophy (LVH) and heart failure with preserved ejection fraction, the early recognition of FD is crucial to initiate enzyme replacement therapy and improve long-term prognosis. Multimodality imaging plays a central role in the evaluation of patients with FD and helps in the differential diagnosis of other conditions presenting with LVH. In the present review, we explore the current applications of multimodality cardiac imaging, in particular echocardiography and cardiovascular magnetic resonance, in the diagnosis, prognostic assessment, and follow-up of patients with FD.
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Affiliation(s)
- Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Stefano Figliozzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Vincenzo Battaglia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
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Kottam A, Hanneman K, Schenone A, Daubert MA, Sidhu GD, Gropler RJ, Garcia MJ. State-of-the-Art Imaging of Infiltrative Cardiomyopathies: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2023; 16:e000081. [PMID: 37916407 DOI: 10.1161/hci.0000000000000081] [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] [Indexed: 11/03/2023]
Abstract
Infiltrative cardiomyopathies comprise a broad spectrum of inherited or acquired conditions caused by deposition of abnormal substances within the myocardium. Increased wall thickness, inflammation, microvascular dysfunction, and fibrosis are the common pathological processes that lead to abnormal myocardial filling, chamber dilation, and disruption of conduction system. Advanced disease presents as heart failure and cardiac arrhythmias conferring poor prognosis. Infiltrative cardiomyopathies are often diagnosed late or misclassified as other more common conditions, such as hypertrophic cardiomyopathy, hypertensive heart disease, ischemic or other forms of nonischemic cardiomyopathies. Accurate diagnosis is also critical because clinical features, testing methodologies, and approach to treatment vary significantly even within the different types of infiltrative cardiomyopathies on the basis of the type of substance deposited. Substantial advances in noninvasive cardiac imaging have enabled accurate and early diagnosis. thereby eliminating the need for endomyocardial biopsy in most cases. This scientific statement discusses the role of contemporary multimodality imaging of infiltrative cardiomyopathies, including echocardiography, nuclear and cardiac magnetic resonance imaging in the diagnosis, prognostication, and assessment of response to treatment.
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Ponsiglione A, De Giorgi M, Ascione R, Nappi C, Sanduzzi L, Pisani A, Dell'Aversana S, Cuocolo A, Imbriaco M. Advanced CMR Techniques in Anderson-Fabry Disease: State of the Art. Diagnostics (Basel) 2023; 13:2598. [PMID: 37568960 PMCID: PMC10417643 DOI: 10.3390/diagnostics13152598] [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: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Anderson-Fabry disease (AFD) is a rare multisystem X-linked lysosomal storage disorder caused by α-galactosidase A enzyme deficiency. Long-term cardiac involvement in AFD results in left ventricular hypertrophy and myocardial fibrosis, inducing several complications, mainly arrhythmias, valvular dysfunction, and coronary artery disease. Cardiac magnetic resonance (CMR) represents the predominant noninvasive imaging modality for the assessment of cardiac involvement in the AFD, being able to comprehensively assess cardiac regional anatomy, ventricular function as well as to provide tissue characterization. This review aims to explore the role of the most advanced CMR techniques, such as myocardial strain, T1 and T2 mapping, perfusion and hybrid imaging, as diagnostic and prognostic biomarkers.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Ascione
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Luca Sanduzzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Serena Dell'Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Endo Y, Kobayashi K, Shibo H, Amanuma M, Kuhara S. Using Dictionary Matching to Improve the Accuracy of MOLLI Myocardial T1 Analysis and Measurements of Heart Rate Variability. Magn Reson Med Sci 2023; 22:389-399. [PMID: 35732413 PMCID: PMC10449558 DOI: 10.2463/mrms.tn.2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 11/09/2022] Open
Abstract
We analyzed modified Look-Locker inversion recovery (MOLLI) T1 measurements by applying a dictionary matching strategy and aimed to acquire T1 measurements more accurately than those acquired by the conventional three-parameter matching analysis. We particularly clarified the robustness of this method for measuring heart rate (HR) variability. A phantom experiment using a 3T MRI system was performed for various HRs. The ideal MOLLI signal corresponding to the scan parameter in the MRI experiment was simulated over a wide range of T1 values according to the dictionary. The unknown T1 values were determined by finding the simulated signals in the dictionary corresponding to the measured signals using pattern matching. The measured T1 values showed that the proposed analysis improved the accuracy of T1 measurements compared to those acquired by traditional analysis by up to 10%. In addition, the variability of measurements at several HRs was reduced by up to 100 ms.
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Affiliation(s)
- Yuta Endo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Kuninori Kobayashi
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Haruna Shibo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Makoto Amanuma
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Shigehide Kuhara
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
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Averbuch T, White JA, Fine NM. Anderson-Fabry disease cardiomyopathy: an update on epidemiology, diagnostic approach, management and monitoring strategies. Front Cardiovasc Med 2023; 10:1152568. [PMID: 37332587 PMCID: PMC10272370 DOI: 10.3389/fcvm.2023.1152568] [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: 01/27/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by deficient activity of the enzyme alpha-galactosidase. While AFD is recognized as a progressive multi-system disorder, infiltrative cardiomyopathy causing a number of cardiovascular manifestations is recognized as an important complication of this disease. AFD affects both men and women, although the clinical presentation typically varies by sex, with men presenting at a younger age with more neurologic and renal phenotype and women developing a later onset variant with more cardiovascular manifestations. AFD is an important cause of increased myocardial wall thickness, and advances in imaging, in particular cardiac magnetic resonance imaging and T1 mapping techniques, have improved the ability to identify this disease non-invasively. Diagnosis is confirmed by the presence of low alpha-galactosidase activity and identification of a mutation in the GLA gene. Enzyme replacement therapy remains the mainstay of disease modifying therapy, with two formulations currently approved. In addition, newer treatments such as oral chaperone therapy are now available for select patients, with a number of other investigational therapies in development. The availability of these therapies has significantly improved outcomes for AFD patients. Improved survival and the availability of multiple agents has presented new clinical dilemmas regarding disease monitoring and surveillance using clinical, imaging and laboratory biomarkers, in addition to improved approaches to managing cardiovascular risk factors and AFD complications. This review will provide an update on clinical recognition and diagnostic approaches including differentiation from other causes of increased ventricular wall thickness, in addition to modern strategies for management and follow-up.
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Affiliation(s)
- Tauben Averbuch
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Center, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M. Fine
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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Licordari R, Trimarchi G, Teresi L, Restelli D, Lofrumento F, Perna A, Campisi M, de Gregorio C, Grimaldi P, Calabrò D, Costa F, Versace AG, Micari A, Aquaro GD, Di Bella G. Cardiac Magnetic Resonance in HCM Phenocopies: From Diagnosis to Risk Stratification and Therapeutic Management. J Clin Med 2023; 12:jcm12103481. [PMID: 37240587 DOI: 10.3390/jcm12103481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/06/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by the thickening of the heart muscle, which can lead to symptoms such as chest pain, shortness of breath, and an increased risk of sudden cardiac death. However, not all patients with HCM have the same underlying genetic mutations, and some have conditions that resemble HCM but have different genetic or pathophysiological mechanisms, referred to as phenocopies. Cardiac magnetic resonance (CMR) imaging has emerged as a powerful tool for the non-invasive assessment of HCM and its phenocopies. CMR can accurately quantify the extent and distribution of hypertrophy, assess the presence and severity of myocardial fibrosis, and detect associated abnormalities. In the context of phenocopies, CMR can aid in the differentiation between HCM and other diseases that present with HCM-like features, such as cardiac amyloidosis (CA), Anderson-Fabry disease (AFD), and mitochondrial cardiomyopathies. CMR can provide important diagnostic and prognostic information that can guide clinical decision-making and management strategies. This review aims to describe the available evidence of the role of CMR in the assessment of hypertrophic phenotype and its diagnostic and prognostic implications.
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Affiliation(s)
- Roberto Licordari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Lucio Teresi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Davide Restelli
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Francesca Lofrumento
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Alessia Perna
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Mariapaola Campisi
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Patrizia Grimaldi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Danila Calabrò
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Francesco Costa
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy
| | | | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy
| | - Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
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Shalmon T, Thavendiranathan P, Seidman MA, Wald RM, Karur GR, Harvey PJ, Akhtari S, Osuntokun T, Tselios K, Gladman DD, Hanneman K. Cardiac Magnetic Resonance Imaging T1 and T2 Mapping in Systemic Lupus Erythematosus in Relation to Antimalarial Treatment. J Thorac Imaging 2023; 38:W33-W42. [PMID: 36917505 DOI: 10.1097/rti.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
PURPOSE Patients with systemic lupus erythematosus (SLE) are at risk of cardiac disease including antimalarial-induced cardiomyopathy (AMIC). The purpose of this study is to evaluate cardiac magnetic resonance imaging parametric mapping findings in SLE patients with AMIC and investigate the relationship of T1/T2 mapping to antimalarial (AM) treatment duration. MATERIALS AND METHODS All patients with SLE who had undergone cardiac magnetic resonance imaging with T1/T2 mapping for evaluation of suspected cardiac disease between 2018 and 2021 were evaluated and compared with healthy controls. To facilitate comparison between scanners, T1/T2 values were converted to a z -score using scanner-specific local reference values. Patients were classified into 3 groups: AMIC, myocarditis, and other (no AMIC or myocarditis). RESULTS Forty-five SLE patients (47±17 y, 80% female; 8 [18%] with AMIC and 7 [16%] with myocarditis) and 30 healthy controls (39±15 y, 60% female) were included. Patients with AMIC had higher T1 and T2 compared with controls ( z -score 1.1±1.3 vs. 0±0.6, P =0.01 and 1.7±1.1 vs. 0±1.0, P <0.01, respectively) and lower values compared with those with myocarditis (3.7±1.6, P <0.01 and 4.0±2.0, P <0.01, respectively). T1 correlated negatively with AM treatment duration in patients without AMIC or myocarditis ( r =-0.36, P =0.048) and positively in patients with AMIC ( r =0.92, P =0.001). AM treatment duration did not correlate significantly with T1 in patients with myocarditis or with T2 in any group. CONCLUSIONS The relationship between T1 and AM treatment duration differed between groups. Native T1 decreases with longer treatment in patients without AMIC or myocarditis, possibility due to glycosphingolipid accumulation. In patients with AMIC, increasing T1 with longer treatment could reflect fibrosis.
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Affiliation(s)
- Tamar Shalmon
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Paaladinesh Thavendiranathan
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
| | | | - Rachel M Wald
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
| | - Gauri Rani Karur
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
| | - Paula J Harvey
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto
| | - Shadi Akhtari
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto
| | - Tosin Osuntokun
- Division of Cardiology, Department of Medicine, Women's College Hospital, University of Toronto
| | - Kostantinos Tselios
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kate Hanneman
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto
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11
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Nickander J, Cole B, Nordin S, Vijapurapu R, Steeds RP, Moon JC, Kellman P, Ugander M, Kozor R. Increased cardiac involvement in Fabry disease using blood-corrected native T1 mapping. Sci Rep 2023; 13:4420. [PMID: 36932097 PMCID: PMC10023696 DOI: 10.1038/s41598-023-31211-9] [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: 07/18/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Fabry disease (FD) is a rare lysosomal storage disorder resulting in myocardial sphingolipid accumulation which is detectable by cardiovascular magnetic resonance as low native T1. However, myocardial T1 contains signal from intramyocardial blood which affects variability and consequently measurement precision and accuracy. Correction of myocardial T1 by blood T1 increases precision. We therefore deployed a multicenter study of FD patients (n = 218) and healthy controls (n = 117) to investigate if blood-correction of myocardial native T1 increases the number of FD patients with low T1, and thus reclassifies FD patients as having cardiac involvement. Cardiac involvement was defined as a native T1 value 2 standard deviations below site-specific means in healthy controls for both corrected and uncorrected measures. Overall low T1 was 135/218 (62%) uncorrected vs. 145/218 (67%) corrected (p = 0.02). With blood-correction, 13/83 previously normal patients were reclassified to low T1. This reclassification appears clinically relevant as 6/13 (46%) of reclassified had focal late gadolinium enhancement or left ventricular hypertrophy as signs of cardiac involvement. Blood-correction of myocardial native T1 increases the proportion of FD subjects with low myocardial T1, with blood-corrected results tracking other markers of cardiac involvement. Blood-correction may potentially offer earlier detection and therapy initiation, but merits further prospective studies.
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Affiliation(s)
- Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
| | - Ben Cole
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ravi Vijapurapu
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Charles Perkins Center, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Royal North Shore Hospital, North Shore Private Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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12
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Umer M, Kalra DK. Cardiac MRI in Fabry disease. Front Cardiovasc Med 2023; 9:1075639. [PMID: 36818911 PMCID: PMC9931723 DOI: 10.3389/fcvm.2022.1075639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Fabry disease is a rare, progressive X-linked inherited disorder of glycosphingolipid metabolism due to a deficiency of α-galactosidase A enzyme. It leads to the accumulation of globotriaosylceramide within lysosomes of multiple organs, predominantly the vascular, renal, cardiac, and nervous systems. Fabry cardiomyopathy is characterized by increased left ventricular wall thickness/mass, functional abnormalities, valvular heart disease, arrhythmias, and heart failure. Early diagnosis and treatment are critical to avoid cardiac or renal complications that can significantly reduce life expectancy in untreated FD. This review will focus on the role of cardiovascular magnetic resonance imaging in the diagnosis, clinical decision-making, and monitoring of treatment efficacy.
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13
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Multimodality Imaging in Sarcomeric Hypertrophic Cardiomyopathy: Get It Right…on Time. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010171. [PMID: 36676118 PMCID: PMC9863627 DOI: 10.3390/life13010171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) follows highly variable paradigms and disease-specific patterns of progression towards heart failure, arrhythmias and sudden cardiac death. Therefore, a generalized standard approach, shared with other cardiomyopathies, can be misleading in this setting. A multimodality imaging approach facilitates differential diagnosis of phenocopies and improves clinical and therapeutic management of the disease. However, only a profound knowledge of the progression patterns, including clinical features and imaging data, enables an appropriate use of all these resources in clinical practice. Combinations of various imaging tools and novel techniques of artificial intelligence have a potentially relevant role in diagnosis, clinical management and definition of prognosis. Nonetheless, several barriers persist such as unclear appropriate timing of imaging or universal standardization of measures and normal reference limits. This review provides an overview of the current knowledge on multimodality imaging and potentialities of novel tools, including artificial intelligence, in the management of patients with sarcomeric HCM, highlighting the importance of specific "red alerts" to understand the phenotype-genotype linkage.
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14
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Role of cardiovascular magnetic resonance in the clinical evaluation of left ventricular hypertrophy: a 360° panorama. Int J Cardiovasc Imaging 2022; 39:793-809. [PMID: 36543912 DOI: 10.1007/s10554-022-02774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
Left ventricular hypertrophy (LVH) is a frequent imaging finding in the general population. In order to identify the precise etiology, a comprehensive diagnostic approach should be adopted, including the prevalence of each entity that may cause LVH, family history, clinical, electrocardiographic and imaging findings. By providing a detailed evaluation of the myocardium, cardiovascular magnetic resonance (CMR) has assumed a central role in the differential diagnosis of left ventricular hypertrophy, with the technique of parametric imaging allowing more refined tissue characterization. This article aims to establish a parallel between pathophysiological features and imaging findings through the broad spectrum of LVH entities, emphasizing the role of CMR in the differential diagnosis.
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15
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Cardiac Magnetic Resonance in Fabry Disease: Morphological, Functional, and Tissue Features. Diagnostics (Basel) 2022; 12:diagnostics12112652. [DOI: 10.3390/diagnostics12112652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Fabry disease (FD) is an X-linked inheritable storage disease caused by a deficiency of alpha-galactosidase causing lysosomal overload of sphingolipids. FD cardiomyopathy is characterized by left ventricular (LV) hypertrophy and should be considered in differential diagnosis with all the other causes of LV hypertrophy. An early diagnosis of FD is very important because the enzyme replacement therapy (ERT) may change the fate of patients by blocking both cardiac and systemic involvement and improving prognosis. Diagnosis may be relatively easy in young patients with the typical signs and symptoms of FD, but in male patients with late onset of disease and in females, diagnosis may be very challenging. Morphological and functional aspects are not specific to FD, which cannot be diagnosed or excluded by echocardiography. Cardiac magnetic resonance (CMR) with tissue characterization capability is an accurate technique for the differential diagnosis of LV hypertrophy. The finding of decreased myocardial T1 value in LV hypertrophy is specific to FD. Late gadolinium enhancement (LGE) is found in the late stage of the disease, but it is useful to predict the cardiac response to ERT and to stratify the prognosis.
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16
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Umer M, Motwani M, Jefferies JL, Kalra DK. Cardiac involvement in Fabry Disease and the Role of Multimodality Imaging in Diagnosis and Disease Monitoring. Curr Probl Cardiol 2022; 48:101439. [DOI: 10.1016/j.cpcardiol.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
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17
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Gagnon LR, Sadasivan C, Yogasundaram H, Oudit GY. Review of Hydroxychloroquine Cardiotoxicity: Lessons From the COVID-19 Pandemic. Curr Heart Fail Rep 2022; 19:458-466. [PMID: 36167917 PMCID: PMC9514702 DOI: 10.1007/s11897-022-00581-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review The coronavirus disease 2019 (COVID-19) pandemic has popularized the usage of hydroxychloroquine and chloroquine (HCQ/CQ) as treatments for COVID-19. Previously used as anti-malarial and now commonly used in rheumatologic conditions, preliminary in vitro studies have demonstrated these medications also have anti-viral properties. Retinopathy and neuromyopathy are well recognized complications of using these treatments; however, cardiotoxicity is under-recognized. This review will discuss the implications and cardiotoxicity of HCQ/CQ, their mechanisms of action, and their utility in COVID-19. Recent Findings Early clinical trials demonstrated a modest benefit of HCQ in COVID-19, causing a push for the usage of it. However, further large multi-center randomized control centers, demonstrated no benefit, and even a trend towards worse outcomes. The predominant cardiac complication observed with HCQ in COVID-19 was cardiac arrhythmias and prolonging of the QT interval. However, with chronic usage of HCQ/CQ, the development of heart failure (HF) and cardiomyopathy (CM) can occur. Summary Although, most adverse cardiac events related to HCQ/CQ usage in COVID-19 were secondary to conduction disorders given the short duration of treatment, HCQ/CQ can cause CM and HF, with chronic usage. Given the insufficient evidence, HCQ/CQ usage in COVID-19 is not routinely recommended, especially with novel therapies now being developed and used. Additionally, usage of HCQ/CQ should prompt initial cardiac evaluation with ECG, and yearly monitoring, with consideration for advanced imaging if clinically warranted. The diagnosis of HCQ/CQ cardiomyopathy is important, as prompt cessation can allow for recovery when these changes are still reversible.
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Affiliation(s)
- Luke R Gagnon
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Chandu Sadasivan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. .,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. .,Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada.
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18
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Vidula MK, Bravo PE, Chirinos JA. The Role of Multimodality Imaging in the Evaluation of Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:443-457. [DOI: 10.1016/j.ccl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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19
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Hongo K. Cardiac involvement in Fabry disease - A non-invasive assessment and the role of specific therapies. Mol Genet Metab 2022; 137:179-186. [PMID: 36088815 DOI: 10.1016/j.ymgme.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
Fabry disease is an X-linked inherited metabolic disorder due to the pathogenic mutation of the GLA gene, which codes lysosomal enzyme alpha-galactosidase A. The resultant accumulation of glycosphingolipids causes various systemic symptoms in childhood and adolescence, and major organ damage in adulthood. Cardiac involvement is important as the most frequent cause of death in Fabry disease patients. Progressive left ventricular hypertrophy with varying degrees of contractile dysfunction as well as conduction abnormalities and arrhythmias are typical cardiac features, and these findings can be evaluated in detail via non-invasive modalities, such as an electrocardiogram, echocardiography and cardiac magnetic resonance. In addition, specific therapies of enzyme replacement therapy and pharmacological chaperone therapy are available, and their beneficial effects on cardiac involvement have been reported. This minireview highlights recent evidence concerning non-invasive modalities for assessing cardiac involvement in Fabry disease and the effects of enzyme replacement therapy and pharmacological chaperone therapy on the findings of those modalities.
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Affiliation(s)
- Kenichi Hongo
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, 105-8461 Tokyo, Japan.
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20
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Acampa W, D'Antonio A, Imbriaco M, Pisani A, Cuocolo A. Multimodality imaging approach to Fabry cardiomyopathy: Any role for nuclear cardiology? J Nucl Cardiol 2022; 29:1439-1445. [PMID: 32378117 DOI: 10.1007/s12350-020-02124-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 11/29/2022]
Abstract
Anderson-Fabry disease (AFD) is a multisystem X-linked disorder of lipid metabolism frequently associated with progressive glycosphingolipid accumulation in cardiac, renal, and nervous cells. The diagnosis of AFD is usually assessed by enzyme assay and genetic tests, but advanced cardiac imaging can be useful in detecting early signs of the disease. Echocardiography and cardiac magnetic resonance are the first-line imaging modalities to investigate cardiac involvement in AFD, but the recent introduction of new molecular and hybrid imaging techniques opens to a wider range of diagnostic applications. This article aims to provide an overview of nuclear cardiology techniques in diagnosis and clinical management of AFD.
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Affiliation(s)
- Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
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21
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Christidi A, Mavrogeni SI. Rare Metabolic and Endocrine Diseases with Cardiovascular Involvement: Insights from Cardiovascular Magnetic Resonance - A Review. Horm Metab Res 2022; 54:339-353. [PMID: 35526533 DOI: 10.1055/a-1846-4878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
The identification of rare diseases with cardiovascular involvement poses significant diagnostic challenges due to the rarity of the diseases, but also due to the lack of knowledge and expertise. Most of them remain underrecognized and undiagnosed, leading to clinical mismanagement and affecting the patients' prognosis, as these diseases are per definition life-threatening or chronic debilitating. This article reviews the cardiovascular involvement of the most well-known rare metabolic and endocrine diseases and their diagnostic approach through the lens of cardiovascular magnetic resonance (CMR) imaging and its prognostic role, highlighting its fundamental value compared to other imaging modalities.
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Affiliation(s)
- Aikaterini Christidi
- Cardiovascular Magnetic Resonance, Euromedica General Clinic, Thessaloniki, Greece
| | - Sophie I Mavrogeni
- Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece, Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Athens, Greece
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22
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Ponsiglione A, Gambardella M, Green R, Cantoni V, Nappi C, Ascione R, De Giorgi M, Cuocolo R, Pisani A, Petretta M, Cuocolo A, Imbriaco M. Cardiovascular magnetic resonance native T1 mapping in Anderson-Fabry disease: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2022; 24:31. [PMID: 35606874 PMCID: PMC9125845 DOI: 10.1186/s12968-022-00859-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND T1 mapping is an established cardiovascular magnetic resonance (CMR) technique that can characterize myocardial tissue. We aimed to determine the weighted mean native T1 values of Anderson-Fabry disease (AFD) patients and the standardized mean differences (SMD) as compared to healthy control subjects. METHODS A comprehensive literature search of the PubMed, Scopus and Web of Science databases was conducted according to the PRISMA statement to retrieve original studies reporting myocardial native T1 values in AFD patients and healthy controls. A random effects model was used to calculate SMD, and meta-regression analysis was conducted to explore heterogeneity sources. Subgroup analysis was also performed according to scanner field strength and sequence type. RESULTS From a total of 151 items, 14 articles were included in the final analysis accounting for a total population of 982 subjects. Overall, the weighted mean native T1 values was 984 ± 47 ms in AFD patients and 1016 ± 26 ms in controls (P < 0.0001) with a pooled SMD of - 2.38. In AFD patients there was an inverse correlation between native T1 values and male gender (P = 0.002) and left ventricular hypertrophy (LVH) (P < 0.001). Subgroup analyses confirmed lower T1 values in AFD patients compared to controls with a pooled SMD of - 2.54, - 2.28, - 2.46 for studies performed on 1.5T with modified Look-Locker inversion recovery (MOLLI), shortened MOLLI and saturation-recovery single-shot acquisition, respectively and of - 2.41 for studies conducted on 3T. CONCLUSIONS Our findings confirm a reduction of native T1 values in AFD patients compared to healthy controls and point out that the degree of T1 shortening in AFD is influenced by gender and LVH. Although T1 mapping is useful in proving cardiac involvement in AFD patients, there is need to standardize shreshold values according to imaging equipment and protocols.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Michele Gambardella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Interdepartmental Research Center on Management and Innovation in Healthcare (CIRMIS), University of Naples Federico II, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
- Interdepartmental Research Center on Management and Innovation in Healthcare (CIRMIS), University of Naples Federico II, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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23
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Ogier AC, Bustin A, Cochet H, Schwitter J, van Heeswijk RB. The Road Toward Reproducibility of Parametric Mapping of the Heart: A Technical Review. Front Cardiovasc Med 2022; 9:876475. [PMID: 35600490 PMCID: PMC9120534 DOI: 10.3389/fcvm.2022.876475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
Parametric mapping of the heart has become an essential part of many cardiovascular magnetic resonance imaging exams, and is used for tissue characterization and diagnosis in a broad range of cardiovascular diseases. These pulse sequences are used to quantify the myocardial T1, T2, T2*, and T1ρ relaxation times, which are unique surrogate indices of fibrosis, edema and iron deposition that can be used to monitor a disease over time or to compare patients to one another. Parametric mapping is now well-accepted in the clinical setting, but its wider dissemination is hindered by limited inter-center reproducibility and relatively long acquisition times. Recently, several new parametric mapping techniques have appeared that address both of these problems, but substantial hurdles remain for widespread clinical adoption. This review serves both as a primer for newcomers to the field of parametric mapping and as a technical update for those already well at home in it. It aims to establish what is currently needed to improve the reproducibility of parametric mapping of the heart. To this end, we first give an overview of the metrics by which a mapping technique can be assessed, such as bias and variability, as well as the basic physics behind the relaxation times themselves and what their relevance is in the prospect of myocardial tissue characterization. This is followed by a summary of routine mapping techniques and their variations. The problems in reproducibility and the sources of bias and variability of these techniques are reviewed. Subsequently, novel fast, whole-heart, and multi-parametric techniques and their merits are treated in the light of their reproducibility. This includes state of the art segmentation techniques applied to parametric maps, and how artificial intelligence is being harnessed to solve this long-standing conundrum. We finish up by sketching an outlook on the road toward inter-center reproducibility, and what to expect in the future.
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Affiliation(s)
- Augustin C. Ogier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Aurelien Bustin
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Juerg Schwitter
- Cardiac MR Center, Cardiology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Ruud B. van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Ruud B. van Heeswijk
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24
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Fadl SA, Revels JW, Rezai Gharai L, Hanneman K, Dana F, Proffitt EK, Grizzard JD. Cardiac MRI of Hereditary Cardiomyopathy. Radiographics 2022; 42:625-643. [PMID: 35275782 DOI: 10.1148/rg.210147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hereditary cardiomyopathy comprises a heterogeneous group of diseases of the cardiac muscle that are characterized by the presence of genetic mutations. Cardiac MRI is central to evaluation of patients with cardiomyopathy owing to its ability to allow evaluation of many different tissue properties in a single examination. For example, cine MRI is the standard of care for assessment of myocardial structure and function. It clearly shows regions of asymmetric wall thickening that are typical of hypertrophic cardiomyopathy and allows it to be differentiated from other hereditary disorders such as Fabry disease or transthyretin cardiac amyloidosis that produce concentric hypertrophy. Late gadolinium enhancement provides a different tissue property and allows these latter two causes of concentric hypertrophy to be distinguished on the basis of their enhancement appearances (Fabry disease shows midwall basal inferolateral enhancement, and amyloidosis shows global subendocardial enhancement). Native T1 mapping may similarly allow differentiation between Fabry disease and amyloidosis without the use of contrast material. T2*-weighted MRI is important in the detection and quantification of iron overload cardiomyopathy. Other hereditary entities for which comprehensive MRI has proven essential include Danon disease, familial dilated cardiomyopathy, hereditary muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy, and ventricular noncompaction. As a result of the diagnostic power of cardiac MRI, cardiac MRI examinations are being requested with increasing frequency, not only in academic centers but also in community practices. The genetic background, pathophysiologic characteristics, and clinical presentation of patients with hereditary cardiomyopathy are described; the characteristic cardiac MRI features of hereditary cardiomyopathy are discussed; and the role of MRI in risk stratification, treatment, and prognostication in patients with cardiomyopathy is reviewed. ©RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Shaimaa A Fadl
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Jonathan W Revels
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Leila Rezai Gharai
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Kate Hanneman
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Franklin Dana
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Elizabeth Kate Proffitt
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - John D Grizzard
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
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25
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Sozzi FB, Iacuzio L, Belmonte M, Schiavone M, Bursi F, Gherbesi E, Levy F, Canetta C, Carugo S. Early diagnosis of cardiomyopathies by cardiac magnetic resonance. Overview of the main criteria. Monaldi Arch Chest Dis 2022; 92. [PMID: 35416001 DOI: 10.4081/monaldi.2022.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/15/2022] [Indexed: 01/05/2023] Open
Abstract
Cardiomyopathies (CMPs) are diseases of the heart muscle. They include a variety of myocardial disorders that manifest with various structural and functional phenotypes and are frequently genetic. Myocardial disease caused by known cardiovascular causes (such as hypertension, ischemic heart disease, or valvular disease) should be distinguished from CMPs for classification and management purposes. Identification of various CMP phenotypes relies primarily upon echocardiographic evaluation. In selected cases, cardiac magnetic resonance imaging (CMR) or computed tomography may be useful to identify and localize fatty infiltration, inflammation, scar/fibrosis, focal hypertrophy, and better visualize the left ventricular apex and right ventricle. CMR imaging has emerged as a comprehensive tool for the diagnosis and follow-up of patients with CMPs. The accuracy and reproducibility in evaluating cardiac structures, the unique ability of non-invasive tissue characterization and the lack of ionizing radiation, make CMR very attractive as a potential "all-in-one technique". Indeed, it provides valuable data to confirm or establish the diagnosis, screen subclinical cases, identify aetiology, establish the prognosis. Additionally, it provides information for setting a risk stratification (based on evaluation of proved independent prognostic factors as ejection fraction, end-systolic-volume, myocardial fibrosis) and follow-up. Last, it helps to monitor the response to the therapy. In this review, the pivotal role of CMR in the comprehensive evaluation of patients with CMP is discussed, highlighting the key features guiding differential diagnosis and the assessment of prognosis.
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Affiliation(s)
- Fabiola B Sozzi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Marta Belmonte
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan.
| | - Elisa Gherbesi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Ciro Canetta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | - Stefano Carugo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
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26
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Ezgu F, Alpsoy E, Bicik Bahcebasi Z, Kasapcopur O, Palamar M, Onay H, Ozdemir BH, Topcuoglu MA, Tufekcioglu O. Expert opinion on the recognition, diagnosis and management of children and adults with Fabry disease: a multidisciplinary Turkey perspective. Orphanet J Rare Dis 2022; 17:90. [PMID: 35236382 PMCID: PMC8889663 DOI: 10.1186/s13023-022-02215-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
This consensus statement by a panel of Fabry experts aimed to identify areas of consensus on conceptual, clinical and therapeutic aspects of Fabry disease (FD) and to provide guidance to healthcare providers on best practice in the management of pediatric and adult patients with FD. This consensus statement indicated the clinical heterogeneity of FD as well as a large number of pathogenic variants in the GLA gene, emphasizing a need for an individualized approach to patient care. The experts reached consensus on the critical role of a high index of suspicion in symptomatic patients and screening of certain at-risk groups to reveal timely and accurate diagnosis of FD along with an increased awareness of the treating physician about the different kinds of pathogenic variants and their clinical implications. The experts emphasized the crucial role of timely recognition of FD with minimal delay from symptom onset to definite diagnosis in better management of FD patients, given the likelihood of changing the disease's natural history, improving the patients' quality of life and the prognosis after enzyme replacement therapy (ERT) administered through a coordinated, multidisciplinary care approach. In this regard, this consensus document is expected to increase awareness among physicians about unique characteristics of FD to assist clinicians in recognizing FD with a well-established clinical suspicion consistent with pathogenic variants and gender-based heterogeneous clinical manifestations of FD and in translating this information into their clinical practice for best practice in the management of patients with FD.
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Affiliation(s)
- Fatih Ezgu
- Department of Pediatrics, Division of Pediatric Metabolism and Division of Pediatric Genetics, Gazi University Faculty of Medicine, 06560, Ankara, Turkey.
| | - Erkan Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Zerrin Bicik Bahcebasi
- Clinic of Nephrology, Kartal Dr. Lutfu Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | - Omac Tufekcioglu
- University of Health Sciences Department of Cardiology, Ankara City Hospital, Ankara, Turkey
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27
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Antonopoulos AS, Boutsikou M, Simantiris S, Angelopoulos A, Lazaros G, Panagiotopoulos I, Oikonomou E, Kanoupaki M, Tousoulis D, Mohiaddin RH, Tsioufis K, Vlachopoulos C. Machine learning of native T1 mapping radiomics for classification of hypertrophic cardiomyopathy phenotypes. Sci Rep 2021; 11:23596. [PMID: 34880319 PMCID: PMC8654857 DOI: 10.1038/s41598-021-02971-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/08/2021] [Indexed: 01/11/2023] Open
Abstract
We explored whether radiomic features from T1 maps by cardiac magnetic resonance (CMR) could enhance the diagnostic value of T1 mapping in distinguishing health from disease and classifying cardiac disease phenotypes. A total of 149 patients (n = 30 with no heart disease, n = 30 with LVH, n = 61 with hypertrophic cardiomyopathy (HCM) and n = 28 with cardiac amyloidosis) undergoing a CMR scan were included in this study. We extracted a total of 850 radiomic features and explored their value in disease classification. We applied principal component analysis and unsupervised clustering in exploratory analysis, and then machine learning for feature selection of the best radiomic features that maximized the diagnostic value for cardiac disease classification. The first three principal components of the T1 radiomics were distinctively correlated with cardiac disease type. Unsupervised hierarchical clustering of the population by myocardial T1 radiomics was significantly associated with myocardial disease type (chi2 = 55.98, p < 0.0001). After feature selection, internal validation and external testing, a model of T1 radiomics had good diagnostic performance (AUC 0.753) for multinomial classification of disease phenotype (normal vs. LVH vs. HCM vs. cardiac amyloid). A subset of six radiomic features outperformed mean native T1 values for classification between myocardial health vs. disease and HCM phenocopies (AUC of T1 vs. radiomics model, for normal: 0.549 vs. 0.888; for LVH: 0.645 vs. 0.790; for HCM 0.541 vs. 0.638; and for cardiac amyloid 0.769 vs. 0.840). We show that myocardial texture assessed by native T1 maps is linked to features of cardiac disease. Myocardial radiomic phenotyping could enhance the diagnostic yield of T1 mapping for myocardial disease detection and classification.
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Affiliation(s)
- Alexios S Antonopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Spyridon Simantiris
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Angelopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Panagiotopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitris Tousoulis
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Raad H Mohiaddin
- CMR Unit, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Konstantinos Tsioufis
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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28
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Rubino M, Monda E, Lioncino M, Caiazza M, Palmiero G, Dongiglio F, Fusco A, Cirillo A, Cesaro A, Capodicasa L, Mazzella M, Chiosi F, Orabona P, Bossone E, Calabrò P, Pisani A, Germain DP, Biagini E, Pieroni M, Limongelli G. Diagnosis and Management of Cardiovascular Involvement in Fabry Disease. Heart Fail Clin 2021; 18:39-49. [PMID: 34776082 DOI: 10.1016/j.hfc.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fabry disease (FD, OMIM 301500) is an X-linked lysosomal storage disease caused by pathogenic variants in the GLA gene. Cardiac involvement is common in FD and is responsible for impaired quality of life and premature death. The classic cardiac involvement is a nonobstructive form of hypertrophic cardiomyopathy, usually manifesting as concentric left ventricular hypertrophy, with subsequent arrhythmogenic intramural fibrosis. Treatment of patients with FD should be directed to prevent the disease progression to irreversible organ damage and organ failure. The aim of this review is to describe the current state of knowledge regarding cardiovascular involvement in FD, focusing on clinical and instrumental features, cardiovascular management, and targeted therapy.
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Affiliation(s)
- Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Francesca Dongiglio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Laura Capodicasa
- Department of Nephrology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Marialuisa Mazzella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Paolo Orabona
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Via A. Cardarelli, Naples 80131, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Antonio Pisani
- Department of Public Health, University Federico II of Naples, Via Pansini, Naples 80131, Italy
| | - Dominique P Germain
- French Referral Centre for Fabry Disease, Division of Medical Genetics, Hôpital Raymond-Poincare, AP-HP, Garches 92380, France
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
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29
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Nakou E, Patel RK, Fontana M, Bucciarelli-Ducci C. Cardiovascular Magnetic Resonance Parametric Mapping Techniques: Clinical Applications and Limitations. Curr Cardiol Rep 2021; 23:185. [PMID: 34762189 DOI: 10.1007/s11886-021-01607-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Parametric mapping represents a significant innovation in cardiovascular magnetic resonance (CMR) tissue characterisation, allowing the quantification of myocardial changes based on changes on T1, T2 and T2* relaxation times and extracellular volume (ECV). Its clinical use is rapidly expanding, but it requires availability of dedicated equipment as well as expertise in image acquisition and analysis. This review focuses on the principles of CMR parametric mapping, its current clinical applications, important limitations, as well as future directions of this technique in cardiovascular medicine. RECENT FINDINGS There is increasing evidence that CMR parametric mapping techniques provide accurate diagnostic and prognostic tools that can be applied to and support the clinical management of patients with a range of cardiovascular disease. The unique capability of CMR myocardial tissue characterisation in cardiovascular diseases has further expanded by the introduction of parametric mapping. Its use in clinical practice presents opportunities but has also limitations.
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Affiliation(s)
- Eleni Nakou
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust and University of Bristol, Bristol, UK
| | - Rishi K Patel
- Department of Medicine, National Amyloid Centre, Royal Free Hospital, University College London, London, UK
| | - Marianna Fontana
- Department of Medicine, National Amyloid Centre, Royal Free Hospital, University College London, London, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Clinical Partnership, Guys and St Thomas NHS Trust and King's College, London, SW3 6NP, UK.
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30
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Gaspar AS, Maltês S, Marques H, Nunes RG, Ferreira A. Myocardial T1 mapping with magnetic resonance imaging – a useful tool to understand the diseased heart. Rev Port Cardiol 2021; 41:61-69. [DOI: 10.1016/j.repc.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 01/19/2023] Open
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31
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Roller FC, Brose A, Richter M, Schüssler A, Harth S, Tanislav C, Krombach GA. Value of Left Ventricular Feature Tracking Strain Analysis for Detection of Early Cardiac Involvement in Fabry Disease (FD). J Clin Med 2021; 10:jcm10163734. [PMID: 34442030 PMCID: PMC8397220 DOI: 10.3390/jcm10163734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: Detection of cardiac involvement in Fabry disease (FD) is of high importance for treatment management. Native T1 mapping especially showed great potential for detection of early cardiac manifestations. Echocardiographic studies showed strain abnormalities in FD patients, but data on MRI feature tracking strain analysis (FT-SA) is limited. Therefore, the aim of our study was to evaluate the potential of FT-SA compared to native T1 and the FD specific biomarker Globotriaosylsphingosine (LysoGb3). Methods: 28 consecutive FD patients (18 female; 47.8 years ± 17.4 standard deviation (SD)) and 28 control subjects (18 female; 46.6 years ± 18.2 SD) underwent cardiac MRI at 1.5 Tesla. Global native T1 times and left ventricular FT-SA were evaluated. Results were correlated to serum Lyso-Gb3-levels. Results: Native T1 times, global longitudinal (GLS) and global radial strain (GRS) were significantly reduced in FD patients (p < 0.0064, p = 0.0009 and p = 0.0184, respectively). Moreover, native T1 times and GLS were significantly lower in Lyso-Gb3 positive FD patients (p < 0.005 and p = 0.03). GLS, native T1 times showed significant moderate correlations to LysoGb3 (p = 0.002 and p < 0.001). Furthermore, GLS and native T1 times reduce when LysoGb3 was elevated and increasingly with presence of left ventricular hypertrophy (LVH) or late gadolinium enhancement (LGE). Conclusions: Native T1 times and strain values differ significantly between FD patients and control subjects and showed promising correlations to the FD specific biomarker LysoGb3. We therefore conclude that strain abnormalities occur early beside native T1 reductions in cardiac FD involvement. Large scale trials are needed to verify our findings.
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Affiliation(s)
- Fritz Christian Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
- Correspondence:
| | - Alexander Brose
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Martin Richter
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Armin Schüssler
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Sebastian Harth
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany;
| | - Gabriele Anja Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; (A.B.); (M.R.); (A.S.); (S.H.); (G.A.K.)
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32
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Putko BN, Savu A, Kaul P, Ezekowitz J, Dyck JR, Anderson TJ, White JA, Paterson DI, Thompson RB, Oudit GY. Left atrial remodelling, mid-regional pro-atrial natriuretic peptide, and prognosis across a range of ejection fractions in heart failure. Eur Heart J Cardiovasc Imaging 2021; 22:220-228. [PMID: 32356860 DOI: 10.1093/ehjci/jeaa041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/19/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS Measures of structural and functional remodelling of the left atrium (LA) are emerging as useful biomarkers in heart failure (HF). We hypothesized that LA volume and its contribution to stroke volume (SV) would predict a composite endpoint of HF hospitalization or death in patients with HF. METHODS AND RESULTS We recruited 57 controls and 86 patients with HF, including preserved and reduced left ventricular ejection fraction (LVEF). Cardiac magnetic resonance imaging was used to evaluate LA volumes and contribution to LV SV. Plasma mid-region pro-atrial natriuretic peptide (MR-proANP) was evaluated. LA volume was negatively correlated with LVEF (P = 0.001) and positively correlated with LV mass in HFrEF (P < 0.001) but not in HFpEF. LA volume at end-diastole was associated with the composite endpoint in HFrEF (hazard ratio 1.26, 95% confidence interval 1.01-1.54; P = 0.044), but not HFpEF (1.06, 0.85-1.30; P = 0.612), per 10 mL/m increase. Active contribution to SV was negatively associated with the composite endpoint in HFpEF (0.32, 0.14-0.66; P = 0.001), but not HFrEF (0.91, 0.38-2.1; P = 0.828) per 10% increase. MR-proANP was associated with the composite endpoint in HFpEF (1.46, 1.03-1.94; P = 0.034), but not in HFrEF (1.14, 0.88-1.37; P = 0.278), per 100 pM increase. CONCLUSION We found different relationships between LA remodelling and biomarkers in HFrEF and HFpEF. Our results support the hypothesis that the pathophysiologic underpinnings of HFpEF and HFrEF are different, and atrial remodelling encompasses distinct components for each HF subtype.
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Affiliation(s)
- Brendan N Putko
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Anamaria Savu
- Canadian VIGOUR Centre, University of Alberta, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Padma Kaul
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada.,Canadian VIGOUR Centre, University of Alberta, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Justin Ezekowitz
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada.,Canadian VIGOUR Centre, University of Alberta, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Jason R Dyck
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9
| | - James A White
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9
| | - D Ian Paterson
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street NW, Edmonton, Alberta, T6G 2V2, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada.,Department of Physiology, University of Alberta, 7-55 Medical Sciences Building, 8613-114 Street NW, Edmonton, Alberta, T6G 2H7, Canada
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33
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Caredda G, Bassareo PP, Cherchi MV, Pontone G, Suri JS, Saba L. Anderson-fabry disease: role of traditional and new cardiac MRI techniques. Br J Radiol 2021; 94:20210020. [PMID: 34233483 PMCID: PMC8523192 DOI: 10.1259/bjr.20210020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Anderson-Fabry (FD) disease is a rare X-linked disorder caused by different mutations in the Galactosidase α (GLA) gene, which leads to α-galactosidase A enzyme deficiency and the storage of glycosphingolipids in different kinds of organs, included the heart. This results in myocardial inflammation and left ventricular hypertrophy (LVH) and fibrosis. Echocardiography and cardiac magnetic resonance (C-MRI), in particular with new techniques, such as mapping analysis, late gadolinium enhancement (LGE) assessment and strain imaging, are important tools that allow a correct diagnosis, discriminating FD from other hypertrophic heart conditions. C-MRI is able to detect tissue alterations in the early stages of the disease, when an appropriate treatment could be more effective, and it has a fundamental role in monitoring therapy.
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Affiliation(s)
- Gloria Caredda
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Pier Paolo Bassareo
- Mater Misericordiae University Hospital and Our Lady's Children's Hospital, University College of Dublin, Dublin, Ireland
| | - Maria Valeria Cherchi
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | | | - Jasjit S Suri
- Stroke Diagnosis and Monitoring Division, AtheroPointTM, Roseville, California, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
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34
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Ranganath PG, Tower-Rader A. Utility of Cardiac Magnetic Resonance Imaging in the Diagnosis, Prognosis, and Treatment of Infiltrative Cardiomyopathies. Curr Cardiol Rep 2021; 23:87. [PMID: 34081227 DOI: 10.1007/s11886-021-01518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Diagnosis of infiltrative cardiomyopathies can be challenging despite differences in clinical manifestations due to overlapping cardiac manifestations. We review the salient findings by cardiac magnetic resonance imaging that aids in diagnosis, as well the potential implications for prognosis and treatment. RECENT FINDINGS Cardiac magnetic resonance imaging has added substantially to our understanding of various infiltrative cardiomyopathies, and the addition of late gadolinium enhancement imaging and parametric mapping has yielded additional insights regarding potential diagnoses, prognosis, and therapy. Cardiac magnetic resonance imaging should be employed in the setting of suspected hypertrophic or infiltrative cardiomyopathies to aid in diagnosis. In the setting of cardiac amyloidosis and Fabry disease, there is data to suggest that cardiac magnetic resonance imaging is useful for risk stratification as well as for monitoring response to therapy.
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Affiliation(s)
| | - Albree Tower-Rader
- Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Yawkey 5B, Boston, MA, 02114, USA.
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Vidula MK, Bravo PE. Multimodality imaging for the diagnosis of infiltrative cardiomyopathies. Heart 2021; 108:98-104. [PMID: 34039679 DOI: 10.1136/heartjnl-2020-318001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/18/2021] [Indexed: 11/04/2022] Open
Abstract
Infiltrative cardiomyopathies result from the deposition or anomalous storage of specific substances in the heart, leading to impaired cardiac function and heart failure. In this review, we describe the utility of a variety of imaging modalities for the diagnosis of infiltrative cardiomyopathies and provide algorithms for clinicians to use to evaluate patients with these disorders. We have divided infiltrative cardiomyopathies into two different categories: (1) infiltrative cardiomyopathies characterised by increased wall thickness (eg, cardiac amyloidosis and Anderson-Fabry disease (AFD)) and (2) infiltrative cardiomyopathies that can mimic ischaemic or dilated cardiomyopathies (eg, cardiac sarcoidosis (CS) and iron overload cardiomyopathy). Echocardiography is the first modality of choice for the evaluation of cardiomyopathies in either category, and the differential can be narrowed using cardiac magnetic resonance (CMR) and nuclear imaging techniques. The diagnosis of cardiac amyloidosis is supported with key findings seen on echocardiography, CMR and nuclear imaging, whereas AFD can be suggested by unique features on CMR. CMR and nuclear imaging are also important modalities for the diagnosis of CS, while iron overload cardiomyopathy is mostly diagnosed using tissue characterisation on CMR. Overall, multimodality imaging is necessary for the accurate non-invasive diagnosis of infiltrative cardiomyopathies, which is important to ensure appropriate treatment and prognostication.
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Affiliation(s)
- Mahesh K Vidula
- Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paco E Bravo
- Radiology and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ordovas KG, Baldassarre LA, Bucciarelli-Ducci C, Carr J, Fernandes JL, Ferreira VM, Frank L, Mavrogeni S, Ntusi N, Ostenfeld E, Parwani P, Pepe A, Raman SV, Sakuma H, Schulz-Menger J, Sierra-Galan LM, Valente AM, Srichai MB. Cardiovascular magnetic resonance in women with cardiovascular disease: position statement from the Society for Cardiovascular Magnetic Resonance (SCMR). J Cardiovasc Magn Reson 2021; 23:52. [PMID: 33966639 PMCID: PMC8108343 DOI: 10.1186/s12968-021-00746-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023] Open
Abstract
This document is a position statement from the Society for Cardiovascular Magnetic Resonance (SCMR) on recommendations for clinical utilization of cardiovascular magnetic resonance (CMR) in women with cardiovascular disease. The document was prepared by the SCMR Consensus Group on CMR Imaging for Female Patients with Cardiovascular Disease and endorsed by the SCMR Publications Committee and SCMR Executive Committee. The goals of this document are to (1) guide the informed selection of cardiovascular imaging methods, (2) inform clinical decision-making, (3) educate stakeholders on the advantages of CMR in specific clinical scenarios, and (4) empower patients with clinical evidence to participate in their clinical care. The statements of clinical utility presented in the current document pertain to the following clinical scenarios: acute coronary syndrome, stable ischemic heart disease, peripartum cardiomyopathy, cancer therapy-related cardiac dysfunction, aortic syndrome and congenital heart disease in pregnancy, bicuspid aortic valve and aortopathies, systemic rheumatic diseases and collagen vascular disorders, and cardiomyopathy-causing mutations. The authors cite published evidence when available and provide expert consensus otherwise. Most of the evidence available pertains to translational studies involving subjects of both sexes. However, the authors have prioritized review of data obtained from female patients, and direct comparison of CMR between women and men. This position statement does not consider CMR accessibility or availability of local expertise, but instead highlights the optimal utilization of CMR in women with known or suspected cardiovascular disease. Finally, the ultimate goal of this position statement is to improve the health of female patients with cardiovascular disease by providing specific recommendations on the use of CMR.
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Affiliation(s)
| | | | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, UK
- Bristol National Institute of Health Research (NIHR) Biomedical , Research Centre, Bristol, UK
- University Hospitals Bristol, Bristol, UK
- University of Bristol, Bristol, UK
| | - James Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- Medical College of Wisconsin, Wisconsin, USA
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
- Kapodistrian University of Athens, Athens, Greece
| | - Ntobeko Ntusi
- University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R., Pisa, Italy
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University, Indianapolis, USA
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Mie, Japan
| | - Jeanette Schulz-Menger
- harite Hospital, University of Berlin, Berlin, Germany
- HELIOS-Clinics Berlin-Buch, Berlin, Germany
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Cardiac Imaging in Anderson-Fabry Disease: Past, Present and Future. J Clin Med 2021; 10:jcm10091994. [PMID: 34066467 PMCID: PMC8124634 DOI: 10.3390/jcm10091994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/04/2023] Open
Abstract
Anderson-Fabrydisease is an X-linked lysosomal storage disorder caused by a deficiency in the lysosomal enzyme α-galactosidase A. This results in pathological accumulation of glycosphingolipids in several tissues and multi-organ progressive dysfunction. The typical clinical phenotype of Anderson-Fabry cardiomyopathy is progressive hypertrophic cardiomyopathy associated with rhythm and conduction disturbances. Cardiac imaging plays a key role in the evaluation and management of Anderson-Fabry disease patients. The present review highlights the value and perspectives of standard and advanced cardiovascular imaging in Anderson-Fabry disease.
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Hypertrophic Cardiomyopathy and Primary Restrictive Cardiomyopathy: Similarities, Differences and Phenocopies. J Clin Med 2021; 10:jcm10091954. [PMID: 34062949 PMCID: PMC8125617 DOI: 10.3390/jcm10091954] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) and primary restrictive cardiomyopathy (RCM) have a similar genetic background as they are both caused mainly by variants in sarcomeric genes. These “sarcomeric cardiomyopathies” also share diastolic dysfunction as the prevalent pathophysiological mechanism. Starting from the observation that patients with HCM and primary RCM may coexist in the same family, a characteristic pathophysiological profile of HCM with restrictive physiology has been recently described and supports the hypothesis that familiar forms of primary RCM may represent a part of the phenotypic spectrum of HCM rather than a different genetic cardiomyopathy. To further complicate this scenario some infiltrative (amyloidosis) and storage diseases (Fabry disease and glycogen storage diseases) may show either a hypertrophic or restrictive phenotype according to left ventricular wall thickness and filling pattern. Establishing a correct etiological diagnosis among HCM, primary RCM, and hypertrophic or restrictive phenocopies is of paramount importance for cascade family screening and therapy.
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Linhart A, Paleček T. Narrative review on Morbus Fabry: diagnosis and management of cardiac manifestations. Cardiovasc Diagn Ther 2021; 11:650-660. [PMID: 33968642 DOI: 10.21037/cdt-20-593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder due to reduced or undetectable α-galactosidase A (AGAL-A) enzyme activity caused by pathogenic variants in the AGAL-A gene (GLA). Tissue and organ changes are caused by widespread progressive accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lysoGb3). The classical form of FD is multisystemic with cutaneous (angiokeratomas), neurological (peripheral neuropathy, premature stroke), renal (proteinuria and renal insufficiency), and cardiac involvement. Later onset variants may be limited to the heart. The objective of this review is to summarize the current knowledge on cardiac manifestations of FD and effects of targeted therapy. Cardiac involvement is characterized by progressive hypertrophy, fibrosis, arrhythmias, heart failure and sudden cardiac death (SCD). Targeted therapy is based on enzyme replacement therapy (ERT). Recently, small molecular chaperone, migalastat, became available for patients carrying amenable pathogenic GLA variants. The management of cardiac complications requires a complex approach. Several measures differ from standard clinical guidelines. Betablockers should be used with caution due to bradycardia risk, amiodarone avoided if possible, and anticoagulation used from the first appearance of atrial fibrillation. In Fabry cardiomyopathy SCD calculators are inappropriate. The awareness of FD manifestations is essential for early identification of patients and timely treatment initiation.
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Affiliation(s)
- Aleš Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital, Prague, Czech Republic.,First Faculty of Medicine, Charles University, U Nemocnice 2, 128 08 Praha 2, Czech Republic
| | - Tomáš Paleček
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital, Prague, Czech Republic.,First Faculty of Medicine, Charles University, U Nemocnice 2, 128 08 Praha 2, Czech Republic
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Alabed S, Saunders L, Garg P, Shahin Y, Alandejani F, Rolf A, Puntmann VO, Nagel E, Wild JM, Kiely DG, Swift AJ. Myocardial T1-mapping and extracellular volume in pulmonary arterial hypertension: A systematic review and meta-analysis. Magn Reson Imaging 2021; 79:66-75. [PMID: 33745961 DOI: 10.1016/j.mri.2021.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Elevated myocardial T1-mapping and extracellular volume (ECV) measured on cardiac MR (CMR) imaging is associated with myocardial abnormalities such as oedema or fibrosis. This meta-analysis aims to provide a summary of T1-mapping and ECV values in pulmonary arterial hypertension (PAH) and compare their values with controls. METHODS We searched CENTRAL, MEDLINE, Embase, and Web of Science in August 2020. We included CMR studies reporting T1-mapping or ECV values in adults with any type of PAH. We calculated the mean difference of T1-values and ECV between PAH and controls. RESULTS We included 12 studies with 674 participants. T1-values were significantly higher in PAH with the highest mean difference (MD) recorded at the RV insertion points (RVIP) (108 milliseconds (ms), 95% confidence intervals (CI) 89 to 128), followed by the RV free wall (MD 91 ms, 95% CI 56 to 126). The pooled mean T1-value in PAH at the RVIP was 1084, 95% CI (1071 to 1097) measured using 1.5 Tesla Siemens systems. ECV was also higher in PAH with an MD of 7.5%, 95% CI (5.9 to 9.1) at the RV free wall. CONCLUSION T1 mapping values in PAH patients are on average 9% higher than healthy controls when assessed under the same conditions including the same MRI system, magnetic field strength or sequence used for acquisition. The highest T1 and ECV values are at the RVIP. T1 mapping and ECV values in PH are higher than the values reported in cardiomyopathies and were associated with poor RV function and RV dilatation.
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Affiliation(s)
- Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK.
| | - Laura Saunders
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; INSIGNEO, Institute for in silico medicine, University of Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK; Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
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Calabrese E, Rodriguez Botta G, Rosenfeld DP. New mutation in Fabry disease: c.448delG, first phenotypic description. Mol Genet Metab Rep 2021; 27:100708. [PMID: 33732617 PMCID: PMC7937572 DOI: 10.1016/j.ymgmr.2021.100708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Fabry disease (FD) (Anderson-Fabry disease, OMIM 301500) is a genetic disorder caused by a pathogenic variant in the GLA gene on chromosome Xq22 that produces a deficiency in the lysosomal enzyme alpha-galactosidase A. It is transmitted as an X-linked trait, although de novo mutations have been described. The objective of this report is to describe the clinical characteristics of a patient with FD who is a carrier of a mutation not previously studied, in order to provide information on the genotype-phenotype correlation in this pathology. 38-year-old patient who consulted Neurology for positional vertigo. He also reported acroparesthesia, anhidrosis, heat intolerance and episodes of abdominal pain, with postprandial discomfort from 10 years of age. Physical examination showed horizonto-rotatory nystagmus in both looks, the rest of the neurological evaluation did not present abnormalities. The presence of umbilical and thighs angiokeratomas was identified. Determination of Alpha-Galactosidase in blood was requested: 0.34 μmol/l/h (2.10–10.51 μmol/l/h). Genetic analysis detected a deletion of a guanine at position 448, in exon 3 of the GLA gene (c.448delG). This mutation was considered to be pathogenic, confirming the diagnosis of FD, although it is not described in the data bases. Genetic counseling and a family pedifree study were performed without finding relatives with this variant of the GLA gene or a family history of FD, which suggests a de novo mutation.
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Affiliation(s)
- Esteban Calabrese
- INECO Neurociencias Grupo Oroño, Rosario, Santa Fe, Argentina
- Hospital Español, Rosario, Santa Fe, Argentina
- Corresponding author at: INECO Neurociencias Grupo Oroño, Rosario, Santa Fe, Argentina.
| | | | - Dra Paula Rosenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, La Plata, Argentina
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Zhao L, Zhang C, Tian J, Saiedi M, Ma C, Li N, Fang F, Ma X, Selvanayagam J. Quantification of myocardial deformation in patients with Fabry disease by cardiovascular magnetic resonance feature tracking imaging. Cardiovasc Diagn Ther 2021; 11:91-101. [PMID: 33708481 DOI: 10.21037/cdt-20-897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiac involvement is a major contributor of morbidity and mortality in Fabry disease (FD). Early detection and accurate evaluation of the disease progression is important in management. Cardiovascular magnetic resonance (CMR) derived feature fracking (FT) is a validated quantitative method of assessing myocardial deformation which may reflect early changes of myocardial function and track disease severity. We sought to evaluate the utility of CMR-FT as a measure of myocardial dysfunction in FD. Methods Twenty FD patients (12 males, 40.8±14.9 years) and 20 age and sex matched healthy controls (10 males, 40.5±7.2 years) were prospectively enrolled. Subjects underwent CMR including cine, pre-/post-contrast T1 mapping and late gadolinium enhancement (LGE). FD patients were divided into three groups; group 1: patients without left ventricular hypertrophy (LVH) and LGE negative; group 2: patients with LVH positive, LGE either positive or negative; group 3: patients with LGE positive, LV wall thinning and heart failure. FT derived strain indices were measured and its associations with other processes were investigated. Results In FD patients, 14 (70%) had LVH and 4 (20%) had LGE. Compared with normal controls, LV global longitudinal strain (GLS) were reduced significantly in all three Fabry groups (all P<0.05), global circumferential strain (GCS) were reduced only in group 2 and group 3 (P<0.05). Among three FD groups, there were significant differences of LV GLS, GCS, native T1 value and extracellular volume fraction (ECV) (all P<0.01), group 1 had mild LV strain indices impairment, group 3 had the most severe LV strain indices. When compared between FD subgroups, GLS and GCS showed significant difference between each two groups (all P<0.05). There were weak correlations between the LV functional parameters (ejection fraction, LV mass index), maximal wall thickness, T1 mapping indices (native T1, ECV) and LV strain indices. The strongest relation was between global longitudinal early diastolic strain rate and native T1 value (r=0.783, P<0.01). Conclusions CMR strain imaging identifies myocardial deformation in FD in different stages. Strain imaging can track disease severity and may be an alternative method for follow-up of FD patients.
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Affiliation(s)
- Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Tian
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Madiha Saiedi
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Chenyao Ma
- Department of Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ning Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Department of Sleep Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaohai Ma
- Department of Interventional Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Joseph Selvanayagam
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
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Panovský R, Doubková M, Holeček T, Máchal J, Feitová V, Masárová L, Opatřil L, Mojica-Pisciotti ML, Kincl V. Myocardial T 1 mapping using SMART 1 Map and MOLLI mapping in asymptomatic patients with recent extracardiac sarcoidosis. NMR IN BIOMEDICINE 2020; 33:e4388. [PMID: 32749740 DOI: 10.1002/nbm.4388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease affecting in particular the respiratory tract. Cardiac magnetic resonance (CMR), including a measurement of T1 relaxation time, could potentially detect early stadia of sarcoidosis of the heart. The study aims to assess T1 mapping in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis. METHODS One hundred and twenty patients with extracardiac sarcoidosis and without any heart disease history were included. One hundred and thirteen of them underwent a CMR examination. The mean time from the diagnosis of sarcoidosis was 0.8 (0.2-3.3) years. Cine images for the assessment of left ventricular (LV) functional parameters and pre- and post-contrast saturation method using adaptive recovery times for cardiac T1 mapping (SMART1 Map) and modified Look-Locker inversion recovery (MOLLI) images were acquired for the assessment of native T1 relaxation time and extracellular volume (ECV). The measured parameters were compared between sarcoidosis patients and 22 controls. RESULTS The sarcoidosis patients had normal global and regional systolic LV function-LV ejection fraction 65 ± 5% versus 66 ± 7% (p NS). The mean native T1 relaxation times were not prolonged-1465 ± 93 ms versus 1480 ± 88 ms (p NS) measured by SMART1 Map and 1317 ± 60 ms versus 1313 ± 83 ms (p NS) measured using a MOLLI sequence. Similarly, the mean ECV values did not increase-16.9 ± 3.9% versus 17.9 ± 3.7% (p NS) measured by SMART1 Map and 30.9 ± 2.9% versus 31.6 ± 8.3% (p NS) measured using a MOLLI sequence. CONCLUSION Myocardial native T1 relaxation times were not prolonged and ECV was not increased in asymptomatic patients with extracardiac sarcoidosis.
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Affiliation(s)
- Roman Panovský
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Doubková
- Department of Pulmonary Diseases and Tuberculosis, Masaryk University Faculty of Medicine and University Hospital, Brno, Czech Republic
| | - Tomáš Holeček
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - Jan Máchal
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Věra Feitová
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - Lucia Masárová
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Opatřil
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mary Luz Mojica-Pisciotti
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimír Kincl
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Abstract
PURPOSE OF REVIEW Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. RECENT FINDINGS The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH.
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Affiliation(s)
- Matthew K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Role of CMR Mapping Techniques in Cardiac Hypertrophic Phenotype. Diagnostics (Basel) 2020; 10:diagnostics10100770. [PMID: 33003571 PMCID: PMC7601617 DOI: 10.3390/diagnostics10100770] [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: 08/31/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
Non-ischemic cardiomyopathies represent a heterogeneous group of myocardial diseases potentially leading to heart failure, life-threatening arrhythmias, and eventually death. Myocardial dysfunction is associated with different underlying pathological processes, ultimately inducing changes in morphological appearance. Thus, classification based on presenting morphological phenotypes has been proposed, i.e., dilated, hypertrophic, restrictive, and right ventricular cardiomyopathies. In light of the key diagnostic and prognostic role of morphological and functional features, cardiovascular imaging has emerged as key element in the clinical workflow of suspected cardiomyopathies, and above all, cardiovascular magnetic resonance (CMR) represents the ideal technique to be used: thanks to its physical principles, besides optimal spatial and temporal resolutions, incomparable contrast resolution allows to assess myocardial tissue abnormalities in detail. Traditionally, weighted images and late enhancement images after gadolinium-based contrast agent administration have been used to perform tissue characterization, but in the last decade quantitative assessment of pre-contrast longitudinal relaxation time (native T1), post-contrast longitudinal relaxation time (post-contrast T1) and transversal relaxation time (T2), all displayed with dedicated pixel-wise color-coded maps (mapping), has contributed to give precious knowledge insight, with positive influence of diagnostic accuracy and prognosis assessment, mostly in the setting of the hypertrophic phenotype. This review aims to describe the available evidence of the role of mapping techniques in the assessment of hypertrophic phenotype, and to suggest their integration in the routine CMR evaluation of newly diagnosed cardiomyopathies with increased wall thickness.
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Cardiovascular magnetic resonance (CMR) in restrictive cardiomyopathies. Radiol Med 2020; 125:1072-1086. [PMID: 32970272 PMCID: PMC7593297 DOI: 10.1007/s11547-020-01287-8] [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: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
The restrictive cardiomyopathies constitute a heterogeneous group of myocardial diseases with a different pathogenesis and overlapping clinical presentations. Diagnosing them frequently poses a challenge. Echocardiography, electrocardiograms and laboratory tests may show non-specific changes. In this context, cardiac magnetic resonance (CMR) may play a crucial role in defining the diagnosis and guiding treatments, by offering a robust myocardial characterization based on the inherent magnetic properties of abnormal tissues, thus limiting the use of endomyocardial biopsy. In this review article, we explore the role of CMR in the assessment of a wide range of myocardial diseases causing restrictive patterns, from iron overload to cardiac amyloidosis, endomyocardial fibrosis or radiation-induced heart disease. Here, we emphasize the incremental value of novel relaxometric techniques such as T1 and T2 mapping, which may recognize different storage diseases based on the intrinsic magnetic properties of the accumulating metabolites, with or without the use of gadolinium-based contrast agents. We illustrate the importance of these CMR techniques and their great support when contrast media administration is contraindicated. Finally, we describe the useful role of cardiac computed tomography for diagnosis and management of restrictive cardiomyopathies when CMR is contraindicated.
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Yang EY, Shah DJ. Cardiac Magnetic Resonance in Nonischemic Cardiomyopathies. Methodist Debakey Cardiovasc J 2020; 16:97-105. [PMID: 32670469 DOI: 10.14797/mdcj-16-2-97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has emerged as a key modality to assess nonischemic cardiomyopathies. Its ability to detect cardiac morphology and function with fast cine imaging, myocardial edema with T2-based techniques, and fibrosis with late gadolinium enhancement techniques has enabled noninvasive characterization of cardiac tissue, thus helping clinicians assess cardiovascular risk and determine the most effective management strategy. Active investigations into parametric imaging techniques will further expand the potential clinical applications of CMR for cardiac tissue characterization. This review discusses the use of CMR techniques in characterizing the major morphofunctional phenotypes of nonischemic cardiomyopathies.
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Affiliation(s)
- Eric Y Yang
- HOUSTON METHODIST HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Dipan J Shah
- HOUSTON METHODIST HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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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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Linhart A, Germain DP, Olivotto I, Akhtar MM, Anastasakis A, Hughes D, Namdar M, Pieroni M, Hagège A, Cecchi F, Gimeno JR, Limongelli G, Elliott P. An expert consensus document on the management of cardiovascular manifestations of Fabry disease. Eur J Heart Fail 2020; 22:1076-1096. [PMID: 32640076 DOI: 10.1002/ejhf.1960] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by pathogenic variants in the α-galactosidase A (GLA) gene that leads to reduced or undetectable α-galactosidase A enzyme activity and progressive accumulation of globotriaosylceramide and its deacylated form globotriaosylsphingosine in cells throughout the body. FD can be multisystemic with neurological, renal, cutaneous and cardiac involvement or be limited to the heart. Cardiac involvement is characterized by progressive cardiac hypertrophy, fibrosis, arrhythmias, heart failure and sudden cardiac death. The cardiac management of FD requires specific measures including enzyme replacement therapy or small pharmacological chaperones in patients carrying amenable pathogenic GLA gene variants and more general management of cardiac symptoms and complications. In this paper, we summarize current knowledge of FD-related heart disease and expert consensus recommendations for its management.
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Affiliation(s)
- Aleš Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dominique P Germain
- Division of Medical Genetics, University of Versailles and AP-HP Paris-Saclay, Paris, France
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mohammed M Akhtar
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Mehdi Namdar
- Department of Internal Medicine Specialties, Cardiology, Electrophysiology, University Hospital of Geneva, Geneva, Switzerland
| | - Maurizio Pieroni
- Cardiomyopathy Clinic, Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Albert Hagège
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM CMR970, Paris Cardiovascular Research Center PARCC, Paris, France
| | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Juan R Gimeno
- Hospital C. Universitario Virgen Arrixaca, Murcia, Spain
| | - Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", AORN Colli, Ospedale Monaldi, Naples, Italy
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
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Increased Spread of Native T1 Values Assessed With MRI as a Marker of Cardiac Involvement in Fabry Disease. AJR Am J Roentgenol 2020; 216:355-361. [PMID: 32755161 DOI: 10.2214/ajr.20.23102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE. Cardiac involvement is the leading cause of mortality in Fabry disease. Noninvasive markers of cardiac involvement are needed to identify patients at high risk. The purpose of this study was to evaluate the diagnostic potential of segmental native T1 spread as an imaging biomarker in Fabry disease. SUBJECTS AND METHODS. In this prospective study, 43 patients with confirmed Fabry disease (mean ± SD age, 46±14 years; 70% women) and 17 healthy control subjects (mean ± SD age, 44 ±13 years; 53% women) underwent 3-T cardiac MRI including modified Look-Locker inversion recovery T1 mapping. Segmental native T1 spread was calculated as the difference between maximum and minimum segmental native T1 values, expressed as an absolute value and as a relative percentage of global native T1. RESULTS. Absolute and relative segmental native T1 spreads were significantly higher in patients with Fabry disease than in healthy control subjects (absolute median, 115 vs 98 ms [p = 0.004]; relative median, 9.9% vs 8.0% [p < 0.001]) and correlated positively with quantitative late gadolinium enhancement (absolute, r = 0.434, p < 0.001; relative, r = 0.436, p < 0.001), indexed left ventricular mass (absolute, r = 0.316, p = 0.01; relative, r = 0.347, p = 0.007), and global longitudinal strain (absolute, r = 0.289, p = 0.03; relative, r = 0.277, p = 0.03). Relative segmental native T1 spread differentiated patients with Fabry disease from healthy control subjects (odds ratio, 1.44 [95% CI, 1.10-1.89]; p = 0.009). Interob-server agreement was excellent for both absolute (intraclass correlation coefficient, 0.932) and relative (intraclass correlation coefficient, 0.926) segmental native T1 spread. CONCLUSION. Increased native T1 spread is a reproducible imaging biomarker of cardiac involvement in Fabry disease and may be particularly useful in the evaluation of patients who cannot undergo late gadolinium enhancement imaging.
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