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Miao Q, Hua S, Gong Y, Lyu Z, Qian P, Liu C, Jin W, Hu P, Qi H. Free-Breathing Non-Contrast T1ρ Dispersion MRI of Myocardial Interstitial Fibrosis in Comparison with Extracellular Volume Fraction. J Cardiovasc Magn Reson 2024:101093. [PMID: 39245148 DOI: 10.1016/j.jocmr.2024.101093] [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: 07/19/2024] [Revised: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Myocardial fibrosis is a common feature in various cardiac diseases. It causes adverse cardiac remodeling and is associated with poor clinical outcomes. Late gadolinium enhancement (LGE) and extracellular volume fraction (ECV) are the standard MRI techniques for detecting focal and diffuse myocardial fibrosis. However, these contrast-enhanced techniques require the administration of gadolinium contrast agents, which is not applicable to patients with gadolinium contraindications. To eliminate the need of contrast agents, we develop and apply an endogenous free-breathing T1ρ dispersion imaging technique (FB-MultiMap) for diagnosing diffuse myocardial fibrosis in a cohort with suspected cardiomyopathies. METHODS The proposed FB-MultiMap technique, enabling T2, T1ρ and their difference (myocardial fibrosis index, mFI) quantification in a single scan was developed in phantoms and 15 healthy subjects. In the clinical study, 55 patients with suspected cardiomyopathies were imaged using FB-MultiMap, conventional native T1 mapping, LGE, and ECV imaging. The accuracy of the endogenous parameters for predicting increased ECV was evaluated using receiver operating characteristic (ROC) curve analysis. In addition, the correlation of native T1, T1ρ, and mFI with ECV was respectively assessed using Pearson correlation coefficients. RESULTS FB-MultiMap showed a good agreement with conventional separate breath-hold mapping techniques in phantoms and healthy subjects. Considering all the patients, T1ρ was more accurate than mFI and native T1 for predicting increased ECV, with area under the curve (AUC) values of 0.91, 0.79 and 0.75, respectively, and showed stronger correlation with ECV (correlation coefficient r: 0.72 vs. 0.52 vs. 0.40). In the subset of 47 patients with normal T2 values, the diagnostic performance of mFI was significantly strengthened (AUC=0.90, r=0.83), outperforming T1ρ and native T1. CONCLUSION The proposed free-breathing T1ρ dispersion imaging technique enabling simultaneous quantification of T2, T1ρ and mFI in a single scan has shown great potential for diagnosing diffuse myocardial fibrosis in patients with complex cardiomyopathies without contrast agents.
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Affiliation(s)
- Qinfang Miao
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Sha Hua
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Gong
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfeng Lyu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Pengfang Qian
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Chun Liu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Wei Jin
- Department of Cardiovascular Medicine, Heart Failure Center, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China; Shanghai Clinical Research and Trial Center, Shanghai, China.
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2
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Saric P, Bois JP, Giudicessi JR, Rosenbaum AN, Kusmirek JE, Lin G, Chareonthaitawee P. Imaging of Cardiac Sarcoidosis: An Update and Future Aspects. Semin Nucl Med 2024; 54:701-716. [PMID: 38480041 DOI: 10.1053/j.semnuclmed.2024.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 08/20/2024]
Abstract
Cardiac sarcoidosis (CS), an increasingly recognized disease of unknown etiology, is associated with significant morbidity and mortality. Given the limited diagnostic yield of traditional endomyocardial biopsy (EMB), there is increasing reliance on multimodality cardiovascular imaging in the diagnosis and management of CS, with EMB being largely supplanted by the use of 18F-fluorodeoxyglucose (FDG-PET) and cardiac magnetic resonance imaging (CMR). This article aims to provide a comprehensive review of imaging modalities currently utilized in the screening, diagnosis, and monitoring of CS, while highlighting the latest developments in each area.
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Affiliation(s)
- Petar Saric
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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3
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Zainal H, Rolf A, Zhou H, Vasquez M, Escher F, Keller T, Vasa-Nicotera M, Zeiher AM, Schultheiss HP, Nagel E, Puntmann VO. Comparison of diagnostic algorithms in clinically suspected viral myocarditis: agreement between cardiac magnetic resonance, endomyocardial biopsy and troponin T. J Cardiovasc Magn Reson 2024:101087. [PMID: 39191369 DOI: 10.1016/j.jocmr.2024.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/01/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
AIMS Myocardial inflammation is increasingly detected non-invasively by tissue mapping with cardiovascular magnetic resonance (CMR). Intraindividual agreement with endomyocardial biopsy (EMB) or marker of myocardial injury, high-sensitive troponin (hs-cTnT) in patients with clinically suspected viral myocarditis not understood. METHODS AND RESULTS Prospective multicentre study of consecutive patients with clinically suspected myocarditis who underwent blood testing for hs-cTnT, CMR and EMB as a part of diagnostic work-up. EMB was considered positive based on immunohistological criteria in line with the ESC definitions. CMR diagnoses employed tissue mapping using sequence-specific cut-off for native T1 and T2 mapping; active inflammation was defined as T1≥2SD and T2≥2SD above the mean of normal range. Hs-cTnT of greater than 13.9ng/1 was considered significant. A total of 114 patients (age (mean±SD) 54±16, 65% males) were included, of which 79(69%) had positive EMB-criteria, 64(56%) CMR criteria, and a total of 58 (51%) positive troponin. Agreement between EMB and CMR diagnostic criteria was poor (CMR vs. ESC: AUCs: 0.51 (0.39-0.62)). The agreement between the significant hs-cTnT rise and CMR-based diagnosis of myocarditis was good (AUC: 0.84 (0.68-0.92); p<0.001), but poor for EMB (0.50 (0.40-0.61). Hs-cTnT was significantly associated with native T1 and T2, hs-CRP and NT-pro BNP (r=0.37, r=0.35, r=0.30, r=0.25 p<0.001), but not immunohistochemical criteria or viral presence. CONCLUSIONS In clinically suspected viral myocarditis, all diagnostic approaches reflect the pathophysiological elements of myocardial inflammation, however the differing underlying drivers only partially overlap. The EMB and CMR diagnostic algorithms are neither interchangeable in terms of interpretation of myocardial inflammation nor in their relationship with myocardial injury.
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Affiliation(s)
- Hafisyatul Zainal
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Hui Zhou
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Moises Vasquez
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Cardiology Department, Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | | | - Till Keller
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiac regeneration, Goethe University Frankfurt, Frankfurt-am Main, Germany
| | - Andreas M Zeiher
- Department of Cardiac regeneration, Goethe University Frankfurt, Frankfurt-am Main, Germany
| | | | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiac regeneration, Goethe University Frankfurt, Frankfurt-am Main, Germany.
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4
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Tong J, Vogiatzakis N, Andres MS, Senechal I, Badr A, Ramalingam S, Rosen SD, Lyon AR, Nazir MS. Complementary use of cardiac magnetic resonance and 18 F-FDG positron emission tomography imaging in suspected immune checkpoint inhibitor myocarditis. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:53. [PMID: 39175028 PMCID: PMC11340117 DOI: 10.1186/s40959-024-00250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 07/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) myocarditis is an uncommon but potentially fatal complication of immunotherapy. Cardiac imaging is essential to make timely diagnoses as there are critical downstream implications for patients. OBJECTIVE To determine the agreement of cardiac magnetic resonance (CMR) and 18 F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) in patients with suspected ICI myocarditis. METHODS Patients with suspected ICI myocarditis, who underwent CMR and 18 F-FDG-PET imaging at a single cardio-oncology service from 2017 to 2023, were enrolled. CMR was performed according to recommended guidelines for assessment of myocarditis. 18 F-FDG-PET imaging was performed following 18 h carbohydrate-free fast. Imaging was analysed by independent reviewers to determine the presence or absence of ICI myocarditis. RESULTS Twelve patients (mean age 60 ± 15 years old, 7 [58%] male) underwent both CMR and 18 F-FDG-PET imaging. Three (25%) met the 2018 Lake Louise Criteria for CMR diagnosis of myocarditis; 4 (33%) had evidence of myocardial inflammation as determined by 18 F-FDG-PET. Amongst those with positive 18 F-FDG-PET, mean standard uptake value (SUV) was 3.5 ± 1.7. There was agreement between CMR and PET in 7 cases (CMR and PET positive (n = 1), CMR and PET negative (n = 6)) and discordance in 5 cases (CMR positive and PET negative (n = 2), CMR negative and PET positive (n = 3)). CONCLUSION Both CMR and PET provide complementary clinical information in diagnostic of ICI myocarditis. CMR informs on myocardial oedema, whilst 18 F-FDG-PET provides information on glucose metabolism reflecting monocyte and lymphocytic activity. Future studies should investigate the role of hybrid PET-CMR for the timely diagnosis of ICI myocarditis.
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Affiliation(s)
- Jieli Tong
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nikolaos Vogiatzakis
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Maria Sol Andres
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Isabelle Senechal
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ahmed Badr
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sivatharshini Ramalingam
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Stuart D Rosen
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Muhummad Sohaib Nazir
- Cardio-Oncology Service, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
- School of Biomedical Engineering and Imaging Sciences, King's College London, Guy's and St Thomas' Hospital, London, UK.
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Manzke M, Iseke S, Böttcher B, Klemenz AC, Weber MA, Meinel FG. Development and performance evaluation of fully automated deep learning-based models for myocardial segmentation on T1 mapping MRI data. Sci Rep 2024; 14:18895. [PMID: 39143126 PMCID: PMC11324648 DOI: 10.1038/s41598-024-69529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
To develop a deep learning-based model capable of segmenting the left ventricular (LV) myocardium on native T1 maps from cardiac MRI in both long-axis and short-axis orientations. Models were trained on native myocardial T1 maps from 50 healthy volunteers and 75 patients using manual segmentation as the reference standard. Based on a U-Net architecture, we systematically optimized the model design using two different training metrics (Sørensen-Dice coefficient = DSC and Intersection-over-Union = IOU), two different activation functions (ReLU and LeakyReLU) and various numbers of training epochs. Training with DSC metric and a ReLU activation function over 35 epochs achieved the highest overall performance (mean error in T1 10.6 ± 17.9 ms, mean DSC 0.88 ± 0.07). Limits of agreement between model results and ground truth were from -35.5 to + 36.1 ms. This was superior to the agreement between two human raters (-34.7 to + 59.1 ms). Segmentation was as accurate for long-axis views (mean error T1: 6.77 ± 8.3 ms, mean DSC: 0.89 ± 0.03) as for short-axis images (mean error ΔT1: 11.6 ± 19.7 ms, mean DSC: 0.88 ± 0.08). Fully automated segmentation and quantitative analysis of native myocardial T1 maps is possible in both long-axis and short-axis orientations with very high accuracy.
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Affiliation(s)
- Mathias Manzke
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Simon Iseke
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Benjamin Böttcher
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Ann-Christin Klemenz
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
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Gananandan K, Wiese S, Møller S, Mookerjee RP. Cardiac dysfunction in patients with cirrhosis and acute decompensation. Liver Int 2024; 44:1832-1841. [PMID: 38712826 DOI: 10.1111/liv.15896] [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: 01/22/2024] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Abstract
The prevalence of cirrhotic cardiomyopathy (CCM) has been reported as high as 60%-70% in patients with liver cirrhosis and is associated with various negative outcomes. There has been a growing understanding of CCM over recent years. Indeed, the development of imaging techniques has enabled new diagnostic criteria to be proposed by the Cirrhotic Cardiomyopathy Consortium. However, important unanswered questions remain over pathophysiological mechanisms, optimal diagnostic modalities and potential treatment options. While there has been an increasing volume of literature evaluating CCM, there is a lack of clarity on its implications in acute decompensation, acute-on-chronic liver failure and following interventions such as transjugular intrahepatic portosystemic shunt insertion and liver transplantation. This review aims to summarise the literature in these challenging domains and suggest where future research should focus. We conclude that systemic inflammation and structural myocardial changes are likely to be crucial in the pathophysiology of the disease, but the relative contribution of different components remains elusive. Furthermore, future studies need to use standardised diagnostic criteria for CCM as well as incorporate newer imaging techniques assessing both myocardial structure and function. Finally, while specific treatments are currently lacking, therapeutics targeting systemic inflammation, microbial dysbiosis and bacterial translocation are promising targets and warrant further research.
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Affiliation(s)
- Kohilan Gananandan
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
| | - Signe Wiese
- Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Copenhagen, Denmark
- Gastroenterology Unit, Medical Division, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Møller
- Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rajeshwar P Mookerjee
- Liver Failure Group, Institute for Liver and Digestive Health, University College London, London, UK
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Mangini F, Scarcia M, Biederman RWW, Calbi R, Spinelli F, Casavecchia G, Brunetti ND, Gravina M, Fiore C, Suma S, Milo M, Turchetti C, Pesce E, Caramia R, Lombardi F, Grimaldi M. Cardiac magnetic resonance imaging in the evaluation and management of mitral valve prolapse - a comprehensive review. Echocardiography 2024; 41:e15894. [PMID: 39078395 DOI: 10.1111/echo.15894] [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: 06/12/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/31/2024] Open
Abstract
Mitral valve prolapse is a common valve disorder that usually has a benign prognosis unless there is significant regurgitation or LV impairment. However, a subset of patients are at an increased risk of ventricular arrhythmias and sudden cardiac death, which has led to the recognition of "arrhythmic mitral valve prolapse" as a clinical entity. Emerging risk factors include mitral annular disjunction and myocardial fibrosis. While echocardiography remains the primary method of evaluation, cardiac magnetic resonance has become crucial in managing this condition. Cine magnetic resonance sequences provide accurate characterization of prolapse and annular disjunction, assessment of ventricular volumes and function, identification of early dysfunction and remodeling, and quantitative assessment of mitral regurgitation when integrated with flow imaging. However, the unique strength of magnetic resonance lies in its ability to identify tissue changes. T1 mapping sequences identify diffuse fibrosis, in turn related to early ventricular dysfunction and remodeling. Late gadolinium enhancement sequences detect replacement fibrosis, an independent risk factor for ventricular arrhythmias and sudden cardiac death. There are consensus documents and reviews on the use of cardiac magnetic resonance specifically in arrhythmic mitral valve prolapse. However, in this article, we propose an algorithm for the broader use of cardiac magnetic resonance in managing this condition in various scenarios. Future advancements may involve implementing techniques for tissue characterization and flow analysis, such as 4D flow imaging, to identify patients with ventricular dysfunction and remodeling, increased arrhythmic risk, and more accurate grading of mitral regurgitation, ultimately benefiting patient selection for surgical therapy.
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Affiliation(s)
- Francesco Mangini
- Department of Cardiology, Ospedale Regionale "Miulli", Acquaviva delle Fonti, BA, Italy
| | - Maria Scarcia
- Department of Cardiology, Ospedale Regionale "Miulli", Acquaviva delle Fonti, BA, Italy
| | - Robert W W Biederman
- Cardiology Department, Roper St Francis Healthcare, Charleston, South Carolina, USA
| | - Roberto Calbi
- Department of Cardiology, Ospedale Regionale "Miulli", Acquaviva delle Fonti, BA, Italy
| | - Francesco Spinelli
- Department of Cardiology, Ospedale Regionale "Miulli", Acquaviva delle Fonti, BA, Italy
| | | | | | - Matteo Gravina
- Radiology Department, University of Foggia, Foggia, Italy
| | - Corrado Fiore
- Department of Cardiology, Citta di Lecce Hospital, Novoli (Lecce), Puglia, Italy
| | - Sergio Suma
- Department of Cardiology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Maria Milo
- Department of Cardiology, Ospedale "Di Summa - Perrino," ASL Br, Brindisi, Italy
| | | | - Ernesto Pesce
- Madonna della Bruna Outpatients Clinic, Matera, Italy
| | - Remo Caramia
- Department of Anesthesiology, Ospedale "Camberlingo," ASL Br, Francavilla Fontana, Italy
| | - Francesca Lombardi
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
| | - Massimo Grimaldi
- Department of Cardiology, Ospedale Regionale "Miulli", Acquaviva delle Fonti, BA, Italy
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8
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Si D, Guo R, Cheng L, Kong X, Herzka DA, Ding H. Free-breathing three-dimensional simultaneous myocardial T 1 and T 2 mapping based on multi-parametric SAturation-recovery and Variable-flip-Angle. J Cardiovasc Magn Reson 2024; 26:101065. [PMID: 39059610 PMCID: PMC11347066 DOI: 10.1016/j.jocmr.2024.101065] [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: 01/11/2024] [Revised: 06/29/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Quantitative myocardial tissue characterization with T1 and T2 parametric mapping can provide an accurate and complete assessment of tissue abnormalities across a broad range of cardiomyopathies. However, current clinical T1 and T2 mapping tools rely predominantly on two-dimensional (2D) breath-hold sequences. Clinical adoption of three-dimensional (3D) techniques is limited by long scan duration. The aim of this study is to develop and validate a time-efficient 3D free-breathing simultaneous T1 and T2 mapping sequence using multi-parametric SAturation-recovery and Variable-flip-Angle (mSAVA). METHODS mSAVA acquires four volumes for simultaneous whole-heart T1 and T2 mapping. We validated mSAVA using simulations, phantoms, and in-vivo experiments at 3T in 11 healthy subjects and 11 patients with diverse cardiomyopathies. T1 and T2 values by mSAVA were compared with modified Look-Locker inversion recovery (MOLLI) and gradient and spin echo (GraSE), respectively. The clinical performance of mSAVA was evaluated against late gadolinium enhancement (LGE) imaging in patients. RESULTS Phantom T1 and T2 by mSAVA showed a strong correlation to reference sequences (R2 = 0.98 and 0.99). In-vivo imaging with an imaging resolution of 1.5 × 1.5 × 8 mm3 could be achieved. Myocardial T1 and T2 of healthy subjects by mSAVA were 1310 ± 46 and 44.6 ± 2.0 ms, respectively, with T1 standard deviation higher than MOLLI (105 ± 12 vs 60 ± 16 ms) and T2 standard deviation lower than GraSE (4.5 ± 0.8 vs 5.5 ± 1.0 ms). mSAVA T1 and T2 maps presented consistent findings in patients undergoing LGE. Myocardial T1 and T2 of all patients by mSAVA were 1421 ± 79 and 47.2 ± 3.3 ms, respectively. CONCLUSION mSAVA is a fast 3D technique promising for clinical whole-heart T1 and T2 mapping.
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Affiliation(s)
- Dongyue Si
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Rui Guo
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Lan Cheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - Daniel A Herzka
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Haiyan Ding
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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9
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Kronberger C, Mascherbauer K, Willixhofer R, Duca F, Rettl R, Binder-Rodriguez C, Poledniczek M, Ermolaev N, Donà C, Koschutnik M, Nitsche C, Camuz Ligios L, Beitzke D, Badr Eslam R, Bergler-Klein J, Kastner J, Kammerlander AA. Native skeletal muscle T1-time on cardiac magnetic resonance: A predictor of outcome in patients with heart failure with preserved ejection fraction. Eur J Intern Med 2024:S0953-6205(24)00314-5. [PMID: 39048334 DOI: 10.1016/j.ejim.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is associated with heart failure (HF) hospitalizations and death. Previous studies have shown that altered muscle composition is associated with higher risk of adverse outcome in HFpEF patients. AIM The purpose of our study was to investigate the association between skeletal muscle composition, as measured by skeletal muscle T1-times on cardiac magnetic resonance (CMR) imaging, and adverse outcome. METHODS We measured skeletal muscle T1-times of the back muscles on standard CMR images in a prospective cohort of HFpEF patients. Cox regression models were used to test the association of skeletal muscle T1-times and adverse outcome defined as hospitalization for HF and/or cardiovascular death. RESULTS We included 101 patients (mean age 72±7 years, 71 % female) in our study. The median skeletal muscle T1-times were 842 ms (IQR 806-881 ms). In univariate analysis high muscle T1-time was associated with adverse outcome (HR=1.96 [95 % CI, 1.31-2.94] per every 100 ms increase; p=.001). After adjustment for age, sex, body mass index, left- and right ventricular ejection fraction, N-terminal pro-brain natriuretic peptide and myocardial native T1-times, native skeletal muscle T1-time remained an independent predictor for adverse outcome (HR=1.94 [95 % CI, 1.24-3.03] per every 100 ms increase; p=.004). CONCLUSION In patients with HFpEF, high skeletal muscle T1-times on standard CMR scans are associated with higher rates of HF hospitalizations and cardiovascular death. CONDENSED ABSTRACT Skeletal muscle abnormalities are common in patients with heart failure with preserved ejection fraction (HFpEF). The present study evaluates skeletal muscle composition, as quantified by native skeletal muscle T1-times of the back muscles on standard cardiac magnetic resonance imaging, and assessed the association with adverse outcome, defined as hospitalization for heart failure and/or cardiovascular death. In a prospective cohort of 101 patients with HFpEF, we found that high native skeletal muscle T1-times are associated with an increased risk for adverse outcome. These findings suggest that native skeletal muscle T1-time may serve as marker for improved risk prediction.
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Affiliation(s)
- Christina Kronberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Robin Willixhofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder-Rodriguez
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poledniczek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Nikita Ermolaev
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jutta Bergler-Klein
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas A Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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10
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Han C, Xu H, Gao H, Liu F, Wu J, Liu Y, Cheng Y, Deng W, Yue X, Wu Z, Yu Y, Zhao R, Han Y, Li X. Effect of spin-lock frequency on quantitative myocardial T1ρ mapping. Insights Imaging 2024; 15:176. [PMID: 38992330 PMCID: PMC11239636 DOI: 10.1186/s13244-024-01762-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES To use T1ρ mapping to assess myocardial fibrosis and to provide a reference for future clinical application, it is necessary to understand the factors influencing T1ρ values. This study explored the influence of different spin-locking frequencies on T1ρ values under a 3.0-T MR system. METHODS Fifty-seven healthy subjects were prospectively and consecutively included in this study, and T1ρ mapping was performed on them in 3 short-axis slices with three spin-lock frequencies at the amplitude of 300 Hz, 400 Hz, and 500 Hz, then nine T1ρ images were acquired per subject. Four T1ρ-weighted images were acquired using a spin-lock preparation pulse with varying durations (0 msec, 13.3 msec, 26.6 msec, 40 msec). T1ρ relaxation times were quantified for each slice and each myocardial segment. The results were analyzed using Student's t-test and one-way analysis of variance (ANOVA) methods. RESULTS Mean T1ρ relaxation times were 43.5 ± 2.8 msec at 300 Hz, 44.9 ± 3.6 msec at 400 Hz, and 46.2 ± 3.1 msec at 500 Hz, showing a significant progressive increase from low to high spin-lock frequency (300 Hz vs. 400 Hz, p = 0.046; 300 Hz vs. 500 Hz, p < 0.001; 400 Hz vs. 500 Hz, p = 0.043). In addition, The T1ρ values of females were significantly higher than those of males (300 Hz, p = 0.049; 400 Hz, p = 0.01; 500 Hz, p = 0.002). CONCLUSION In this prospective study, myocardial T1ρ values for the specific CMR setting are provided, and we found that gender and spin-lock frequency can affect the T1ρ values. CRITICAL RELEVANCE STATEMENT T1ρ mapping could supersede late gadolinium enhancement for detection of myocardial fibrosis. Establishing reference mean values that take key technical elements into account will facilitate interpretation of data in disease states. KEY POINTS This study established myocardial T1ρ reference values for different spin-lock frequencies. T1ρ values increased with spin-lock frequency, but numerical differences were minimal. Females had higher T1ρ values than males at all frequencies.
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Affiliation(s)
- Caiyun Han
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Huimin Xu
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Hui Gao
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Fang Liu
- Department of Cardiology, the First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, 230022, Hefei, China
| | - Jian Wu
- Department of Cardiology, the First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, 230022, Hefei, China
| | - Yan Liu
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Yong Cheng
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | - Wei Deng
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China
| | | | | | - Yongqiang Yu
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China.
| | - Ren Zhao
- Department of Cardiology, the First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, 230022, Hefei, China.
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, College of Medicine, the Ohio State University Medical Center, Columbus, Ohio, USA
| | - Xiaohu Li
- Department of Radiology, the First Affiliated Hospital of Anhui Medical University; Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Hefei, 230032, Anhui Province, China.
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11
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Fitian AI, Shieh MC, Gimnich OA, Belousova T, Taylor AA, Ballantyne CM, Bismuth J, Shah DJ, Brunner G. Contrast-Enhanced Magnetic Resonance Imaging Based T1 Mapping and Extracellular Volume Fractions Are Associated with Peripheral Artery Disease. J Cardiovasc Dev Dis 2024; 11:181. [PMID: 38921681 PMCID: PMC11203653 DOI: 10.3390/jcdd11060181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/28/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Extracellular volume fraction (ECV), measured with contrast-enhanced magnetic resonance imaging (CE-MRI), has been utilized to study myocardial fibrosis, but its role in peripheral artery disease (PAD) remains unknown. We hypothesized that T1 mapping and ECV differ between PAD patients and matched controls. METHODS AND RESULTS A total of 37 individuals (18 PAD patients and 19 matched controls) underwent 3.0T CE-MRI. Skeletal calf muscle T1 mapping was performed before and after gadolinium contrast with a motion-corrected modified look-locker inversion recovery (MOLLI) pulse sequence. T1 values were calculated with a three-parameter Levenberg-Marquardt curve fitting algorithm. ECV and T1 maps were quantified in five calf muscle compartments (anterior [AM], lateral [LM], and deep posterior [DM] muscle groups; soleus [SM] and gastrocnemius [GM] muscles). Averaged peak blood pool T1 values were obtained from the posterior and anterior tibialis and peroneal arteries. T1 values and ECV are heterogeneous across calf muscle compartments. Native peak T1 values of the AM, LM, and DM were significantly higher in PAD patients compared to controls (all p < 0.028). ECVs of the AM and SM were significantly higher in PAD patients compared to controls (AM: 26.4% (21.2, 31.6) vs. 17.3% (10.2, 25.1), p = 0.046; SM: 22.7% (19.5, 27.8) vs. 13.8% (10.2, 19.1), p = 0.020). CONCLUSIONS Native peak T1 values across all five calf muscle compartments, and ECV fractions of the anterior muscle group and the soleus muscle were significantly elevated in PAD patients compared with matched controls. Non-invasive T1 mapping and ECV quantification may be of interest for the study of PAD.
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Affiliation(s)
- Asem I. Fitian
- Penn State Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Michael C. Shieh
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Olga A. Gimnich
- Penn State Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Addison A. Taylor
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Michael E DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Christie M. Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jean Bismuth
- Division of Vascular Surgery, University of South Florida Health Morsani School of Medicine, Tampa, FL 33620, USA
| | - Dipan J. Shah
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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12
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Wang DD, Naumova AV, Isquith D, Sapp J, Huynh KA, Tucker I, Balu N, Voronyuk A, Chu B, Ordovas K, Maynard C, Tian R, Zhao XQ, Kim F. Dapagliflozin reduces systemic inflammation in patients with type 2 diabetes without known heart failure. Cardiovasc Diabetol 2024; 23:197. [PMID: 38849829 PMCID: PMC11161924 DOI: 10.1186/s12933-024-02294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE Sodium glucose cotransporter 2 (SGLT2) inhibitors significantly improve cardiovascular outcomes in diabetic patients; however, the mechanism is unclear. We hypothesized that dapagliflozin improves cardiac outcomes via beneficial effects on systemic and cardiac inflammation and cardiac fibrosis. RESEARCH AND DESIGN METHODS This randomized placebo-controlled clinical trial enrolled 62 adult patients (mean age 62, 17% female) with type 2 diabetes (T2D) without known heart failure. Subjects were randomized to 12 months of daily 10 mg dapagliflozin or placebo. For all patients, blood/plasma samples and cardiac magnetic resonance imaging (CMRI) were obtained at time of randomization and at the end of 12 months. Systemic inflammation was assessed by plasma IL-1B, TNFα, IL-6 and ketone levels and PBMC mitochondrial respiration, an emerging marker of sterile inflammation. Global myocardial strain was assessed by feature tracking; cardiac fibrosis was assessed by T1 mapping to calculate extracellular volume fraction (ECV); and cardiac tissue inflammation was assessed by T2 mapping. RESULTS Between the baseline and 12-month time point, plasma IL-1B was reduced (- 1.8 pg/mL, P = 0.003) while ketones were increased (0.26 mM, P = 0.0001) in patients randomized to dapagliflozin. PBMC maximal oxygen consumption rate (OCR) decreased over the 12-month period in the placebo group but did not change in patients receiving dapagliflozin (- 158.9 pmole/min/106 cells, P = 0.0497 vs. - 5.2 pmole/min/106 cells, P = 0.41), a finding consistent with an anti-inflammatory effect of SGLT2i. Global myocardial strain, ECV and T2 relaxation time did not change in both study groups. CLINICAL TRIAL GOV REGISTRATION NCT03782259.
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Affiliation(s)
- Dennis D Wang
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Anna V Naumova
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Daniel Isquith
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jamie Sapp
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kim A Huynh
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Isabella Tucker
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Anna Voronyuk
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Karen Ordovas
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Charles Maynard
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Rong Tian
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Francis Kim
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
- University of Washington, 850 Republican St, Box 358055, Seattle, WA, 98104, USA.
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13
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Lucas JT, Abramson ZR, Epstein K, Morin CE, Jaju A, Lee JW, Lee CL, Sitaram R, Voss SD, Hudson MM, Constine LS, Hua CH. Imaging Assessment of Radiation Therapy-Related Normal Tissue Injury in Children: A PENTEC Visionary Statement. Int J Radiat Oncol Biol Phys 2024; 119:669-680. [PMID: 38760116 DOI: 10.1016/j.ijrobp.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 05/19/2024]
Abstract
The Pediatric Normal Tissue Effects in the Clinic (PENTEC) consortium has made significant contributions to understanding and mitigating the adverse effects of childhood cancer therapy. This review addresses the role of diagnostic imaging in detecting, screening, and comprehending radiation therapy-related late effects in children, drawing insights from individual organ-specific PENTEC reports. We further explore how the development of imaging biomarkers for key organ systems, alongside technical advancements and translational imaging approaches, may enhance the systematic application of imaging evaluations in childhood cancer survivors. Moreover, the review critically examines knowledge gaps and identifies technical and practical limitations of existing imaging modalities in the pediatric population. Addressing these challenges may expand access to, minimize the risk of, and optimize the real-world application of, new imaging techniques. The PENTEC team envisions this document as a roadmap for the future development of imaging strategies in childhood cancer survivors, with the overarching goal of improving long-term health outcomes and quality of life for this vulnerable population.
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Affiliation(s)
| | - Zachary R Abramson
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Katherine Epstein
- Division of Radiology and Medical Imaging, UC Department of Radiology, Cincinnati, Ohio
| | - Cara E Morin
- Division of Radiology and Medical Imaging, UC Department of Radiology, Cincinnati, Ohio
| | - Alok Jaju
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Chang-Lung Lee
- Department of Radiation Oncology and; Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Ranganatha Sitaram
- Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephan D Voss
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Louis S Constine
- Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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14
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Bergamaschi L, Landi A, Maurizi N, Pizzi C, Leo LA, Arangalage D, Iglesias JF, Eeckhout E, Schwitter J, Valgimigli M, Pavon AG. Acute Response of the Noninfarcted Myocardium and Surrounding Tissue Assessed by T2 Mapping After STEMI. JACC Cardiovasc Imaging 2024; 17:610-621. [PMID: 38276932 DOI: 10.1016/j.jcmg.2023.11.014] [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: 05/16/2023] [Revised: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is associated with a systemic and local inflammatory response with edema. However, their role at the tissue level is poorly characterized. OBJECTIVES This study aims to characterize T2 values of the noninfarcted myocardium (NIM) and surrounding tissue and to investigate prognostic relevance of higher NIM T2 values after STEMI. METHODS A total of 171 consecutive patients with STEMI without prior cardiovascular events who underwent cardiac magnetic resonance after primary percutaneous coronary intervention were analyzed in terms of standard infarct characteristics. Edema of the NIM, liver, spleen, and pectoralis muscle was assessed based on T2 mapping. Follow-up was available for 130 patients. The primary endpoint was major adverse cardiac events (MACE), defined as cardiovascular death, myocardial infarction, unplanned coronary revascularization or rehospitalization for heart failure. The median time from primary percutaneous coronary intervention to cardiac magnetic resonance was 3 days (IQR: 2-5 days). RESULTS Higher (above the median value of 45 ms) T2 values in the NIM area were associated with larger infarct size, microvascular obstruction, and left ventricular dysfunction and did not correlate with C-reactive protein, white blood cells, or T2 values of the pectoralis muscle, liver, and spleen. At a median follow-up of 17 months, patients with higher (>45 ms) NIM T2 values had increased risk of MACE (P < 0.001) compared with subjects with NIM T2 values ≤45 ms, mainly caused by a higher rate of myocardial reinfarction (26.3% vs 1.4%; P < 0.001). At multivariable analysis, higher NIM T2 values independently predicted MACE (HR: 2.824 [95% CI: 1.254-6.361]; P = 0.012). CONCLUSIONS Higher NIM T2 values after STEMI are independently associated with worse cardiovascular outcomes, mainly because of higher risk of myocardial infarction.
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Affiliation(s)
- Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Niccolò Maurizi
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Dimitri Arangalage
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (Unil), Lausanne, Switzerland
| | - Juerg Schwitter
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland; University of Lausanne (Unil), Lausanne, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland.
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15
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Edin C, Ekstedt M, Karlsson M, Wegmann B, Warntjes M, Swahn E, Östgren CJ, Ebbers T, Lundberg P, Carlhäll CJ. Liver fibrosis is associated with left ventricular remodeling: insight into the liver-heart axis. Eur Radiol 2024:10.1007/s00330-024-10798-1. [PMID: 38795131 DOI: 10.1007/s00330-024-10798-1] [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: 11/01/2023] [Revised: 03/21/2024] [Accepted: 04/04/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE In nonalcoholic fatty liver disease (NAFLD), liver fibrosis is the strongest predictor of adverse outcomes. We sought to investigate the relationship between liver fibrosis and cardiac remodeling in participants from the general population using magnetic resonance imaging (MRI), as well as explore potential mechanistic pathways by analyzing circulating cardiovascular biomarkers. METHODS In this cross-sectional study, we prospectively included participants with type 2 diabetes and individually matched controls from the SCAPIS (Swedish CArdioPulmonary bioImage Study) cohort in Linköping, Sweden. Between November 2017 and July 2018, participants underwent MRI at 1.5 Tesla for quantification of liver proton density fat fraction (spectroscopy), liver fibrosis (stiffness from elastography), left ventricular (LV) structure and function, as well as myocardial native T1 mapping. We analyzed 278 circulating cardiovascular biomarkers using a Bayesian statistical approach. RESULTS In total, 92 participants were enrolled (mean age 59.5 ± 4.6 years, 32 women). The mean liver stiffness was 2.1 ± 0.4 kPa. 53 participants displayed hepatic steatosis. LV concentricity increased across quartiles of liver stiffness. Neither liver fat nor liver stiffness displayed any relationships to myocardial tissue characteristics (native T1). In a regression analysis, liver stiffness was related to increased LV concentricity. This association was independent of diabetes and liver fat (Beta = 0.26, p = 0.0053), but was attenuated (Beta = 0.17, p = 0.077) when also adjusting for circulating levels of interleukin-1 receptor type 2. CONCLUSION MRI reveals that liver fibrosis is associated to structural LV remodeling, in terms of increased concentricity, in participants from the general population. This relationship could involve the interleukin-1 signaling. CLINICAL RELEVANCE STATEMENT Liver fibrosis may be considered a cardiovascular risk factor in patients without cirrhosis. Further research on the mechanisms that link liver fibrosis to left ventricular concentricity may reveal potential therapeutic targets in patients with non-alcoholic fatty liver disease (NAFLD). KEY POINTS Previously, studies on liver fibrosis and cardiac remodeling have focused on advanced stages of liver fibrosis. Liver fibrosis is associated with left ventricular (LV) concentricity and may relate to interleukin-1 receptor type 2. Interleukin-1 signaling is a potential mechanistic interlink between early liver fibrosis and LV remodeling.
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Affiliation(s)
- Carl Edin
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mattias Ekstedt
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Markus Karlsson
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Bertil Wegmann
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Marcel Warntjes
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Eva Swahn
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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16
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Spaapen TOM, Bohte AE, Slieker MG, Grotenhuis HB. Cardiac MRI in diagnosis, prognosis, and follow-up of hypertrophic cardiomyopathy in children: current perspectives. Br J Radiol 2024; 97:875-881. [PMID: 38331407 PMCID: PMC11075988 DOI: 10.1093/bjr/tqae033] [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: 04/06/2022] [Revised: 09/15/2023] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is an inherited myocardial disease characterised by left ventricular hypertrophy, which carries an increased risk of life-threatening arrhythmias and sudden cardiac death. The age of presentation and the underlying aetiology have a significant impact on the prognosis and quality of life of children with HCM, as childhood-onset HCM is associated with high mortality risk and poor long-term outcomes. Accurate cardiac assessment and identification of the HCM phenotype are therefore crucial to determine the diagnosis, prognostic stratification, and follow-up. Cardiac magnetic resonance (CMR) is a comprehensive evaluation tool capable of providing information on cardiac morphology and function, flow, perfusion, and tissue characterisation. CMR allows to detect subtle abnormalities in the myocardial composition and characterise the heterogeneous phenotypic expression of HCM. In particular, the detection of the degree and extent of myocardial fibrosis, using late-gadolinium enhanced sequences or parametric mapping, is unique for CMR and is of additional value in the clinical assessment and prognostic stratification of paediatric HCM patients. Additionally, childhood HCM can be progressive over time. The rate, timing, and degree of disease progression vary from one patient to the other, so close cardiac monitoring and serial follow-up throughout the life of the diagnosed patients is of paramount importance. In this review, an update of the use of CMR in childhood HCM is provided, focussing on its clinical role in diagnosis, prognosis, and serial follow-up.
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Affiliation(s)
- Tessa O M Spaapen
- Department of Paediatric Cardiology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Anneloes E Bohte
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Martijn G Slieker
- Department of Paediatric Cardiology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Paediatric Cardiology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Vaitiekiene A, Kulboke M, Bieseviciene M, Jankauskas A, Bartnykaite A, Rinkuniene D, Strazdiene I, Lidziute E, Jankauskaite D, Gaidamavicius I, Bucius P, Lapinskas T, Gerbutavicius R, Juozaityte E, Vaskelyte JJ, Vaitiekus D, Sakalyte G. T1 Mapping in Cardiovascular Magnetic Resonance-A Marker of Diffuse Myocardial Fibrosis in Patients Undergoing Hematopoietic Stem Cell Transplantation. J Pers Med 2024; 14:412. [PMID: 38673039 PMCID: PMC11051481 DOI: 10.3390/jpm14040412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of cardiovascular diseases. In our study, we aimed to find subclinical changes in myocardial tissue after HSCT with the help of cardiovascular magnetic resonance (CMR) tissue imaging techniques. Methods: The data of 44 patients undergoing autologous and allogeneic HSCT in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from October 2021 to February 2023 were analyzed. Bioethics approval for the prospective study was obtained (No BE-2-96). CMR was performed two times: before enrolling for the HSCT procedure (before starting mobilization chemotherapy for autologous HSCT and before starting the conditioning regimen for allogeneic HSCT) and 12 ± 1 months after HSCT. LV end-diastolic volume, LV end-systolic volume, LV mass and values indexed to body surface area (BSA), and LV ejection fraction were calculated. T1 and T2 mapping values were measured. Results: There was a statistically significant change in T1 mapping values. Before HSCT, mean T1 mapping was 1226.13 ± 39.74 ms, and after HSCT, it was 1248.70 ± 41.07 ms (p = 0.01). The other parameters did not differ significantly. Conclusions: Increases in T1 mapping values following HSCT can show the progress of diffuse myocardial fibrosis and may reflect subclinical injury. T2 mapping values remain the same and do not show edema and active inflammation processes at 12 months after HSCT.
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Affiliation(s)
- Audrone Vaitiekiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Migle Kulboke
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Oncology Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Monika Bieseviciene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Antanas Jankauskas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Agne Bartnykaite
- Oncology Research Laboratory, Oncology Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Diana Rinkuniene
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Igne Strazdiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Emilija Lidziute
- Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Darija Jankauskaite
- Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Ignas Gaidamavicius
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Oncology Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Paulius Bucius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rolandas Gerbutavicius
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Oncology Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Elona Juozaityte
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Oncology Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Jolanta Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Domas Vaitiekus
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Oncology Institute, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Gintare Sakalyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Malmberg MA, Odéen H, Hofstetter LW, Hadley JR, Parker DL. Validation of single reference variable flip angle (SR-VFA) dynamic T 1 mapping with T 2 * correction using a novel rotating phantom. Magn Reson Med 2024; 91:1419-1433. [PMID: 38115639 PMCID: PMC10872756 DOI: 10.1002/mrm.29944] [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: 06/27/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To validate single reference variable flip angle (SR-VFA) dynamic T1 mapping with and without T2 * correction against inversion recovery (IR) T1 measurements. METHODS A custom cylindrical phantom with three concentric compartments was filled with variably doped agar to produce a smooth spatial gradient of the T1 relaxation rate as a function of angle across each compartment. IR T1 , VFA T1 , and B1 + measurements were made on the phantom before rotation, and multi-echo stack-of-radial dynamic images were acquired during rotation via an MRI-compatible motor. B1 + -corrected SR-VFA and SR-VFA-T2 * T1 maps were computed from the sliding window reconstructed images and compared against rotationally registered IR and VFA T1 maps to determine the percentage error. RESULTS Both VFA and SR-VFA-T2 * T1 maps fell within 10% of IR T1 measurements for a low rotational speed, with a mean accuracy of 2.3% ± 2.6% and 2.8% ± 2.6%, respectively. Increasing rotational speed was found to decrease the accuracy due to increasing temporal smoothing over ranges where the T1 change had a nonconstant slope. SR-VFA T1 mapping was found to have similar accuracy as the SR-VFA-T2 * and VFA methods at low TEs (˜<2 ms), whereas accuracy degraded strongly with later TEs. T2 * correction of the SR-VFA T1 maps was found to consistently improve accuracy and precision, especially at later TEs. CONCLUSION SR-VFA-T2 * dynamic T1 mapping was found to be accurate against reference IR T1 measurements within 10% in an agar phantom. Further validation is needed in mixed fat-water phantoms and in vivo.
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Affiliation(s)
- Michael A. Malmberg
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Henrik Odéen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - J. Rock Hadley
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Dennis L. Parker
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Wang D, Naumova A, Isquith D, Sapp J, Huynh KA, Tucker I, Balu N, Voronyuk A, Chu B, Ordovas K, Maynard C, Tian R, Zhao XQ, Kim F. Dapagliflozin Reduces Systemic Inflammation in Patients with Type 2 Diabetes Without Known Heart Failure. RESEARCH SQUARE 2024:rs.3.rs-4132581. [PMID: 38585865 PMCID: PMC10996801 DOI: 10.21203/rs.3.rs-4132581/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Objective Sodium glucose cotransporter 2 (SGLT2) inhibitors significantly improve cardiovascular outcomes in diabetic patients; however, the mechanism is unclear. We hypothesized that dapagliflozin improves cardiac outcomes via beneficial effects on systemic and cardiac inflammation and cardiac fibrosis. Research and Design Methods This randomized placebo-controlled clinical trial enrolled 62 adult patients (mean age 62, 17% female) with type 2 diabetes (T2D) without known heart failure. Subjects were randomized to 12 months of daily 10 mg dapagliflozin or placebo. For all patients, blood/plasma samples and cardiac magnetic resonance imaging (CMRI) were obtained at time of randomization and at the end of 12 months. Systemic inflammation was assessed by plasma IL-1B, TNFα, IL-6 and ketone levels and PBMC mitochondrial respiration, an emerging marker of sterile inflammation. Cardiac fibrosis was assessed by T1 mapping to calculate extracellular volume fraction (ECV); cardiac tissue inflammation was assessed by T2 mapping. Results Between the baseline and 12-month time point, plasma IL-1B was reduced (-1.8 pg/mL, P=0.003) while ketones were increased (0.26 mM, P=0.0001) in patients randomized to dapagliflozin. PBMC maximal oxygen consumption rate (OCR) decreased over the 12-month period in the placebo group but did not change in patients receiving dapagliflozin (-158.9 pmole/min/106cells, P=0.0497 vs -45.2 pmole/min/106cells, P=0.41), a finding consistent with an anti-inflammatory effect of SGLT2i. ECV and T2 relaxation time did not change in both study groups. Conclusion This study demonstrates that 12 months of dapagliflozin reduces IL-1B mediated systemic inflammation but affect cardiac fibrosis in T2D. Clinical Trialgov Registration NCT03782259.
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20
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Qi Y, Wang F, Kong J, Cao JJ, Li YY. SwinUNet: a multiscale feature learning approach to cardiovascular magnetic resonance parametric mapping for myocardial tissue characterization. Physiol Meas 2024; 45:035007. [PMID: 38387052 DOI: 10.1088/1361-6579/ad2c15] [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: 11/14/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
Objective.Cardiovascular magnetic resonance (CMR) can measure T1 and T2 relaxation times for myocardial tissue characterization. However, the CMR procedure for T1/T2 parametric mapping is time-consuming, making it challenging to scan heart patients routinely in clinical practice. This study aims to accelerate CMR parametric mapping with deep learning.Approach. A deep-learning model, SwinUNet, was developed to accelerate T1/T2 mapping. SwinUNet used a convolutional UNet and a Swin transformer to form a hierarchical 3D computation structure, allowing for analyzing CMR images spatially and temporally with multiscale feature learning. A comparative study was conducted between SwinUNet and an existing deep-learning model, MyoMapNet, which only used temporal analysis for parametric mapping. The T1/T2 mapping performance was evaluated globally using mean absolute error (MAE) and structural similarity index measure (SSIM). The clinical T1/T2 indices for characterizing the left-ventricle myocardial walls were also calculated and evaluated using correlation and Bland-Altman analysis.Main results. We performed accelerated T1 mapping with ≤4 heartbeats and T2 mapping with 2 heartbeats in reference to the clinical standard, which required 11 heartbeats for T1 mapping and 3 heartbeats for T2 mapping. SwinUNet performed well in all the experiments (MAE < 50 ms, SSIM > 0.8, correlation > 0.75, and Bland-Altman agreement limits < 100 ms for T1 mapping; MAE < 1 ms, SSIM > 0.9, correlation > 0.95, and Bland-Altman agreement limits < 1.5 ms for T2 mapping). When the maximal acceleration was used (2 heartbeats), SwinUNet outperformed MyoMapNet and gave measurement accuracy similar to the clinical standard.Significance. SwinUNet offers an optimal solution to CMR parametric mapping for assessing myocardial diseases quantitatively in clinical cardiology.
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Affiliation(s)
- Yifan Qi
- Department of Computer Science, Stony Brook University, Stony Brook, NY 11790, United States of America
| | - Fusheng Wang
- Department of Computer Science, Stony Brook University, Stony Brook, NY 11790, United States of America
| | - Jun Kong
- Department of Mathematics and Statistics, Georgia State University, Atlanta, GA 30303, United States of America
| | - J Jane Cao
- DeMatteis Centre for Research and Education, St. Francis Hospital, Roslyn, NY 11576, United States of America
- Clinical medicine, Stony Brook University, Stony Brook, NY 11790, United States of America
| | - Yu Y Li
- DeMatteis Centre for Research and Education, St. Francis Hospital, Roslyn, NY 11576, United States of America
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11790, United States of America
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Petersen A, Nagel SN, Hamm B, Elgeti T, Schaafs LA. The influence of left bundle branch block on myocardial T1 mapping. Sci Rep 2024; 14:5379. [PMID: 38438510 PMCID: PMC10912434 DOI: 10.1038/s41598-024-55821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
Tissue characterisation using T1 mapping has become an established magnetic resonance imaging (MRI) technique to detect myocardial diseases. This retrospective study aimed to determine the influence of left bundle branch block (LBBB) on T1 mapping at 1.5 T. Datasets of 36 patients with LBBB and 27 healthy controls with T1 mapping (Modified Look-Locker inversion-recovery (MOLLI), 5(3)3 sampling) were included. T1 relaxation times were determined on mid-cavity short-axis images. R2 maps were generated as a pixel-wise indicator for the goodness of the fit of T1 maps. R2 values were significantly lower in patients with LBBB than in healthy controls (whole myocardium/septum, 0.997, IQR, 0.00 vs. 0.998, IQR, 0.00; p = 0.008/0.998, IQR, 0.00 vs. 0.999, IQR, 0.00; p = 0.027). Manual correction of semi-automated evaluation tended to improve R2 values but not significantly. Strain analysis was performed and the systolic dyssynchrony index (SDIglobal) was calculated as a measure for left ventricular dyssynchrony. While MRI is generally prone to artefacts, lower goodness of the fit in LBBB may be mainly attributable to asynchronous contraction. Therefore, careful checking of the source data and, if necessary, manual post-processing is important. New techniques might improve the goodness of the fit of T1 mapping by reducing sampling in the motion prone diastole of LBBB patients.
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Affiliation(s)
- Antonia Petersen
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Sebastian Niko Nagel
- Academic Department of Diagnostic and Interventional Radiology and Paediatric Radiology, Protestant Hospital of the Bethel Foundation, Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Burgsteig 13, 33617, Bielefeld, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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Rottmann M, Yoo S, Pfenniger A, Mikhailov A, Benefield B, Johnson DA, Zhang W, Ghosh AK, Kim D, Passman R, Knight BP, Lee DC, Arora R. Use of Atrial Fibrillation Electrograms and T1/T2 Magnetic Resonance Imaging to Define the Progressive Nature of Molecular and Structural Remodeling: A New Paradigm Underlying the Emergence of Persistent Atrial Fibrillation. J Am Heart Assoc 2024; 13:e032514. [PMID: 37930082 PMCID: PMC10944076 DOI: 10.1161/jaha.123.032514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The temporal progression states of the molecular and structural substrate in atrial fibrillation (AF) are not well understood. We hypothesized that these can be detected by AF electrograms and magnetic resonance imaging parametric mapping. METHODS AND RESULTS AF was induced in 43 dogs (25-35 kg, ≥1 year) by rapid atrial pacing (RAP) (3-33 weeks, 600 beats/min), and 4 controls were used. We performed high-resolution epicardial mapping (UnEmap, 6 atrial regions, both atria, 130 electrodes, distance 2.5 mm) and analyzed electrogram cycle length, dominant frequency, organization index, and peak-to-peak bipolar voltage. Implantable telemetry recordings were used to quantify parasympathetic nerve activity over RAP time. Magnetic resonance imaging native T1, postcontrast T1, T2 mapping, and extracellular volume fraction were assessed (1.5T, Siemens) at baseline and AF. In explanted atrial tissue, DNA oxidative damage (8-hydroxy-2'-deoxyguanosine staining) and percentage of fibrofatty tissue were quantified. Cycle length and organization index decreased (R=0.5, P<0.05; and R=0.5, P<0.05; respectively), and dominant frequency increased (R=0.3, P n.s.) until 80 days of RAP but not thereafter. In contrast, voltage continued to decrease throughout the duration of RAP (R=0.6, P<0.05). Parasympathetic nerve activity increased following RAP and plateaued at 80 days. Magnetic resonance imaging native T1 and T2 times increased with RAP days (R=0.5, P<0.05; R=0.6, P<0.05) in the posterior left atrium throughout RAP. Increased RAP days correlated with increasing 8-hydroxy-2'-deoxyguanosine levels and with fibrosis percentage (R=0.5, P<0.05 for both). CONCLUSIONS A combination of AF electrogram characteristics and T1/T2 magnetic resonance imaging can detect early-stage AF remodeling (autonomic remodeling, oxidative stress) and advanced AF remodeling due to oxidative stress and fibrosis.
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Affiliation(s)
- Markus Rottmann
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Shin Yoo
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Anna Pfenniger
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Aleksei Mikhailov
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Brandon Benefield
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - David A. Johnson
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Wenwei Zhang
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Asish K. Ghosh
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Daniel Kim
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Rod Passman
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Bradley P. Knight
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Daniel C. Lee
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Rishi Arora
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University Feinberg School of MedicineChicagoILUSA
- Division of CardiologyNorthwestern University Feinberg School of MedicineChicagoILUSA
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Steen H, Montenbruck M, Kallifatidis A, André F, Frey N, Kelle S, Korosoglou G. Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy. Clin Res Cardiol 2024; 113:469-480. [PMID: 38095711 DOI: 10.1007/s00392-023-02348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 02/22/2024]
Abstract
AIM To evaluate the ability of fast strain-encoded (SENC) cardiac magnetic resonance (CMR) derived myocardial strain and native T1 mapping to discriminate between hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis. METHODS Ninety nine patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis) were systematically analysed. LV-ejection fraction, LV-mass index, septal wall thickness and native T1 mapping values were assessed. In addition, global circumferential and longitudinal strain and segmental circumferential and longitudinal strain in basal, mid-ventricular, and apical segments were calculated. A ratio was built by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio). RESULTS Myocardial strain was equally distributed in apical and basal segments in HCM patients, whereas an apical sparing with less impaired apical strain was noticed in cardiac amyloidosis (apical-to-basal-ratio of 1.01 ± 0.23 versus 1.20 ± 0.28, p < 0.001). T1 values were significantly higher in amyloidosis compared to HCM patients (1170.7 ± 66.4 ms versus 1078.3 ± 57.4ms, p < 0.001). The T1-to-basal segmental strain ratio exhibited high accuracy for the differentiation between the two clinical entities (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.81-0.95, p < 0.001). Multivariable analysis showed that age and the T1-to-basal-strain-ratio were the most robust factors for the differentiation between HCM and cardiac amyloidosis. CONCLUSION The T1-to-basal-segmental strain ratio, combining information from segmental circumferential and longitudinal strain and native T1 mapping aids the differentiation between HCM and cardiac amyloidosis with high accuracy and within a fast CMR protocol, obviating the need for contrast agent administration.
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Affiliation(s)
- Henning Steen
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | | | | | - Florian André
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
- Weinheim Imaging Center, GRN Hospital Weinheim, Hector Foundation, Weinheim, Germany.
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Paciorek AM, von Schacky CE, Foreman SC, Gassert FG, Gassert FT, Kirschke JS, Laugwitz KL, Geith T, Hadamitzky M, Nadjiri J. Automated assessment of cardiac pathologies on cardiac MRI using T1-mapping and late gadolinium phase sensitive inversion recovery sequences with deep learning. BMC Med Imaging 2024; 24:43. [PMID: 38350900 PMCID: PMC10865672 DOI: 10.1186/s12880-024-01217-4] [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: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND A deep learning (DL) model that automatically detects cardiac pathologies on cardiac MRI may help streamline the diagnostic workflow. To develop a DL model to detect cardiac pathologies on cardiac MRI T1-mapping and late gadolinium phase sensitive inversion recovery (PSIR) sequences were used. METHODS Subjects in this study were either diagnosed with cardiac pathology (n = 137) including acute and chronic myocardial infarction, myocarditis, dilated cardiomyopathy, and hypertrophic cardiomyopathy or classified as normal (n = 63). Cardiac MR imaging included T1-mapping and PSIR sequences. Subjects were split 65/15/20% for training, validation, and hold-out testing. The DL models were based on an ImageNet pretrained DenseNet-161 and implemented using PyTorch and fastai. Data augmentation with random rotation and mixup was applied. Categorical cross entropy was used as the loss function with a cyclic learning rate (1e-3). DL models for both sequences were developed separately using similar training parameters. The final model was chosen based on its performance on the validation set. Gradient-weighted class activation maps (Grad-CAMs) visualized the decision-making process of the DL model. RESULTS The DL model achieved a sensitivity, specificity, and accuracy of 100%, 38%, and 88% on PSIR images and 78%, 54%, and 70% on T1-mapping images. Grad-CAMs demonstrated that the DL model focused its attention on myocardium and cardiac pathology when evaluating MR images. CONCLUSIONS The developed DL models were able to reliably detect cardiac pathologies on cardiac MR images. The diagnostic performance of T1 mapping alone is particularly of note since it does not require a contrast agent and can be acquired quickly.
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Affiliation(s)
- Aleksandra M Paciorek
- Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Claudio E von Schacky
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sarah C Foreman
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- TUM-Neuroimaging Center, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Geith
- Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Martin Hadamitzky
- Department of Radiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Jonathan Nadjiri
- Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Eajazi A, Weinschenk C, Chhabra A. Imaging Biomarkers of Peripheral Nerves: Focus on Magnetic Resonance Neurography and Ultrasonography. Semin Musculoskelet Radiol 2024; 28:92-102. [PMID: 38330973 DOI: 10.1055/s-0043-1776427] [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: 02/10/2024]
Abstract
Peripheral neuropathy is a prevalent and debilitating condition affecting millions of individuals globally. Magnetic resonance neurography (MRN) and ultrasonography (US) are noninvasive methods offering comprehensive visualization of peripheral nerves, using anatomical and functional imaging biomarkers to ensure accurate evaluation. For optimized MRN, superior and high-resolution two-dimensional and three-dimensional imaging protocols are essential. The anatomical MRN and US imaging markers include quantitative measures of nerve and fascicular size and signal, and qualitative markers of course and morphology. Among them, quantitative markers of T2-signal intensity ratio are sensitive to nerve edema-like signal changes, and the T1-mapping technique reveals nerve and muscle tissue fatty and fibrous compositional alterations.The functional markers are derived from physiologic properties of nerves, such as diffusion characteristics or blood flow. They include apparent diffusion coefficient from diffusion-weighted imaging and fractional anisotropy and tractography from diffusion tensor imaging to delve into peripheral nerve microstructure and integrity. Peripheral nerve perfusion using dynamic contrast-enhanced magnetic resonance imaging estimates perfusion parameters, offering insights into nerve health and neuropathies involving edema, inflammation, demyelination, and microvascular alterations in conditions like type 2 diabetes, linking nerve conduction pathophysiology to vascular permeability alterations.Imaging biomarkers thus play a pivotal role in the diagnosis, prognosis, and monitoring of nerve pathologies, thereby ensuring comprehensive assessment and elevating patient care. These biomarkers provide valuable insights into nerve structure, function, and pathophysiology, contributing to the accurate diagnosis and management planning for peripheral neuropathy.
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Affiliation(s)
- Alireza Eajazi
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Cindy Weinschenk
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
- Department of Radiology & Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
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Shumliakivska M, Luxán G, Hemmerling I, Scheller M, Li X, Müller-Tidow C, Schuhmacher B, Sun Z, Dendorfer A, Debes A, Glaser SF, Muhly-Reinholz M, Kirschbaum K, Hoffmann J, Nagel E, Puntmann VO, Cremer S, Leuschner F, Abplanalp WT, John D, Zeiher AM, Dimmeler S. DNMT3A clonal hematopoiesis-driver mutations induce cardiac fibrosis by paracrine activation of fibroblasts. Nat Commun 2024; 15:606. [PMID: 38242884 PMCID: PMC10799021 DOI: 10.1038/s41467-023-43003-w] [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: 12/23/2022] [Accepted: 10/27/2023] [Indexed: 01/21/2024] Open
Abstract
Hematopoietic mutations in epigenetic regulators like DNA methyltransferase 3 alpha (DNMT3A), play a pivotal role in driving clonal hematopoiesis of indeterminate potential (CHIP), and are associated with unfavorable outcomes in patients suffering from heart failure (HF). However, the precise interactions between CHIP-mutated cells and other cardiac cell types remain unknown. Here, we identify fibroblasts as potential partners in interactions with CHIP-mutated monocytes. We used combined transcriptomic data derived from peripheral blood mononuclear cells of HF patients, both with and without CHIP, and cardiac tissue. We demonstrate that inactivation of DNMT3A in macrophages intensifies interactions with cardiac fibroblasts and increases cardiac fibrosis. DNMT3A inactivation amplifies the release of heparin-binding epidermal growth factor-like growth factor, thereby facilitating activation of cardiac fibroblasts. These findings identify a potential pathway of DNMT3A CHIP-driver mutations to the initiation and progression of HF and may also provide a compelling basis for the development of innovative anti-fibrotic strategies.
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Affiliation(s)
- Mariana Shumliakivska
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
| | - Guillermo Luxán
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
| | - Inga Hemmerling
- Department of Internal Medicine III, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120, Heidelberg, Germany
| | - Marina Scheller
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Xue Li
- Department of Internal Medicine III, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Bianca Schuhmacher
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Zhengwu Sun
- Walter-Brendel-Centre of Experimental Medicine, Hospital of the Ludwig-Maximilians-University Munich, Marchioninistraße 68, 81377, München, Germany
| | - Andreas Dendorfer
- Walter-Brendel-Centre of Experimental Medicine, Hospital of the Ludwig-Maximilians-University Munich, Marchioninistraße 68, 81377, München, Germany
| | - Alisa Debes
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Simone-Franziska Glaser
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
| | - Marion Muhly-Reinholz
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Klara Kirschbaum
- Department of Medicine, Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Jedrzej Hoffmann
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Institute of Experimental and Translational Cardiovascular Imaging, Centre for Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Eike Nagel
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Institute of Experimental and Translational Cardiovascular Imaging, Centre for Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Institute of Experimental and Translational Cardiovascular Imaging, Centre for Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Cremer
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
- Department of Medicine, Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Florian Leuschner
- Department of Internal Medicine III, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120, Heidelberg, Germany
| | - Wesley Tyler Abplanalp
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
| | - David John
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
| | - Andreas M Zeiher
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
- German Center of Cardiovascular Research (DZHK), Partner Site Rhine/Main, 60439, Frankfurt am Main, Germany.
- Cardiopulmonary Institute (CPI), 60590, Frankfurt, Germany.
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Yang G, Xia J, Dai X, Zhao H, Gao W, Ding W, Tao X, Zhu L. A Targeted Multi-Crystalline Manganese Oxide as a Tumor-Selective Nano-Sized MRI Contrast Agent for Early and Accurate Diagnosis of Tumors. Int J Nanomedicine 2024; 19:527-540. [PMID: 38260241 PMCID: PMC10802178 DOI: 10.2147/ijn.s444061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Introduction Magnetic resonance imaging (MRI) is an important tool for the accurate diagnosis of malignant tumors in clinical settings. However, the lack of tumor-specific MRI contrast agents limits diagnostic accuracy. Methods Herein, we developed αv integrin receptor-targeting multi-crystalline manganese oxide (MCMO) as a novel MRI contrast agent for accurate diagnosis of tumors by coupling iRGD cyclopeptide PEGylation polymer onto the surface of MCMO (iRGD-pMCMO). Results The MCMO consisted of numerous small crystals and exhibited an oval structure of 200 nm in size. The iRGD-pMCMO actively recognizes tumor cells and effectively accumulates at the tumor site, consequently releasing abundant Mn2+ ions in a weakly acidic and high-GSH-expressing tumor microenvironment. Subsequently, Mn2+ ions interact with cellular GSH to form Mn-GSH chelates, enabling efficient T1-weighted MR contrast imaging. In vivo experiments indicated that iRGD-pMCMO significantly improved T1-weighted images, achieving an accurate diagnosis of subcutaneous and orthotopic tumors. The results verified that the T1 contrast effect of iRGD-pMCMO was closely associated with the expression of GSH in tumor cells. Conclusion Altogether, the novel tumor-targeting, highly sensitive MRI contrast agent developed in this study can improve the accuracy of MRI for tumor diagnosis.
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Affiliation(s)
- Gongxin Yang
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
| | - Jikai Xia
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, 264100, People’s Republic of China
| | - Xiaoqing Dai
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
| | - Hongbo Zhao
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
| | - Weiqing Gao
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
| | - Weilong Ding
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
| | - Ling Zhu
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People’s Republic of China
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Vitouš J, Jiřík R, Stračina T, Hendrych M, Nádeníček J, Macíček O, Tian Y, Krátká L, Dražanová E, Nováková M, Babula P, Panovský R, DiBella E, Starčuk Z. T1 mapping of myocardium in rats using self-gated golden-angle acquisition. Magn Reson Med 2024; 91:368-380. [PMID: 37811699 DOI: 10.1002/mrm.29846] [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: 03/14/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE The aim of this study is to design a method of myocardial T1 quantification in small laboratory animals and to investigate the effects of spatiotemporal regularization and the needed acquisition duration. METHODS We propose a compressed-sensing approach to T1 quantification based on self-gated inversion-recovery radial two/three-dimensional (2D/3D) golden-angle stack-of-stars acquisition with image reconstruction performed using total-variation spatiotemporal regularization. The method was tested on a phantom and on a healthy rat, as well as on rats in a small myocardium-remodeling study. RESULTS The results showed a good match of the T1 estimates with the results obtained using the ground-truth method on a phantom and with the literature values for rats myocardium. The proposed 2D and 3D methods showed significant differences between normal and remodeling myocardium groups for acquisition lengths down to approximately 5 and 15 min, respectively. CONCLUSIONS A new 2D and 3D method for quantification of myocardial T1 in rats was proposed. We have shown the capability of both techniques to distinguish between normal and remodeling myocardial tissue. We have shown the effects of image-reconstruction regularization weights and acquisition length on the T1 estimates.
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Affiliation(s)
- Jiří Vitouš
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czechia
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
| | - Radovan Jiřík
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czechia
| | - Tibor Stračina
- Department of Physiology, Masaryk University, Faculty of Medicine, Brno, Czechia
| | - Michal Hendrych
- First Department of Pathology, St. Anne's University Hospital and Faculty of Medicine Masaryk University, Brno, Czechia
| | - Jaroslav Nádeníček
- Department of Physiology, Masaryk University, Faculty of Medicine, Brno, Czechia
| | - Ondřej Macíček
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czechia
| | - Ye Tian
- Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Lucie Krátká
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czechia
| | - Eva Dražanová
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czechia
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Marie Nováková
- Department of Physiology, Masaryk University, Faculty of Medicine, Brno, Czechia
| | - Petr Babula
- Department of Physiology, Masaryk University, Faculty of Medicine, Brno, Czechia
| | - Roman Panovský
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czechia
- 1st Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Edward DiBella
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Zenon Starčuk
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czechia
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Amyar A, Fahmy AS, Guo R, Nakata K, Sai E, Rodriguez J, Cirillo J, Pareek K, Kim J, Judd RM, Ruberg FL, Weinsaft JW, Nezafat R. Scanner-Independent MyoMapNet for Accelerated Cardiac MRI T 1 Mapping Across Vendors and Field Strengths. J Magn Reson Imaging 2024; 59:179-189. [PMID: 37052580 PMCID: PMC11218141 DOI: 10.1002/jmri.28739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND In cardiac T1 mapping, a series of T1 -weighted (T1 w) images are collected and numerically fitted to a two or three-parameter model of the signal recovery to estimate voxel-wise T1 values. To reduce the scan time, one can collect fewer T1 w images, albeit at the cost of precision or/and accuracy. Recently, the feasibility of using a neural network instead of conventional two- or three-parameter fit modeling has been demonstrated. However, prior studies used data from a single vendor and field strength; therefore, the generalizability of the models has not been established. PURPOSE To develop and evaluate an accelerated cardiac T1 mapping approach based on MyoMapNet, a convolution neural network T1 estimator that can be used across different vendors and field strengths by incorporating the relevant scanner information as additional inputs to the model. STUDY TYPE Retrospective, multicenter. POPULATION A total of 1423 patients with known or suspected cardiac disease (808 male, 57 ± 16 years), from three centers, two vendors (Siemens, Philips), and two field strengths (1.5 T, 3 T). The data were randomly split into 60% training, 20% validation, and 20% testing. FIELD STRENGTH/SEQUENCE A 1.5 T and 3 T, Modified Look-Locker inversion recovery (MOLLI) for native and postcontrast T1 . ASSESSMENT Scanner-independent MyoMapNet (SI-MyoMapNet) was developed by altering the deep learning (DL) architecture of MyoMapNet to incorporate scanner vendor and field strength as inputs. Epicardial and endocardial contours and blood pool (by manually drawing a large region of interest in the blood pool) of the left ventricle were manually delineated by three readers, with 2, 8, and 9 years of experience, and SI-MyoMapNet myocardial and blood pool T1 values (calculated from four T1 w images) were compared with conventional MOLLI T1 values (calculated from 8 to 11 T1 w images). STATISTICAL TESTS Equivalency test with 95% confidence interval (CI), linear regression slope, Pearson correlation coefficient (r), Bland-Altman analysis. RESULTS The proposed SI-MyoMapNet successfully created T1 maps. Native and postcontrast T1 values measured from SI-MyoMapNet were strongly correlated with MOLLI, despite using only four T1 w images, at both field-strengths and vendors (all r > 0.86). For native T1 , SI-MyoMapNet and MOLLI were in good agreement for myocardial and blood T1 values in institution 1 (myocardium: 5 msec, 95% CI [3, 8]; blood: -10 msec, 95%CI [-16, -4]), in institution 2 (myocardium: 6 msec, 95% CI [0, 11]; blood: 0 msec, [-18, 17]), and in institution 3 (myocardium: 7 msec, 95% CI [-8, 22]; blood: 8 msec, [-14, 30]). Similar results were observed for postcontrast T1 . DATA CONCLUSION Inclusion of field strength and vendor as additional inputs to the DL architecture allows generalizability of MyoMapNet across different vendors or field strength. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Amine Amyar
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ahmed S. Fahmy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Rui Guo
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kei Nakata
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Eiryu Sai
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Julia Cirillo
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Karishma Pareek
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | - Robert M. Judd
- Department of Medicine (Cardiology Division), Duke University, Durham, NC, USA
| | - Frederick L. Ruberg
- Department of Medicine (Section of Cardiovascular Medicine and Amyloidosis Center), Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | | | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Zheng Y, Liu H, Zhao L, Guan S, Huo H, Li H, Guo J, Peng X, Hao Y, Jin S, Hou Y, Dai X, Liu T, Zhang X. Serial Cardiac MRI for Quantification of the Dynamics of Anthracycline-Induced Subclinical Myocardial Injury. J Magn Reson Imaging 2023; 58:1533-1541. [PMID: 36912379 DOI: 10.1002/jmri.28667] [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: 12/02/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Anthracyclines are known to be associated with chemotherapy-induced cardiotoxicity. Limited data focus on dynamic myocardial injury during the course of chemotherapy in patients with breast cancer. PURPOSE To investigate the variation of tissue characterization and myocardial deformation derived by cardiac MRI during anthracycline chemotherapy. STUDY TYPE Prospective. POPULATION Fifty-eight female breast cancer patients (mean age: 52.82 ± 2.61 years) were enrolled. FIELD STRENGTH/SEQUENCE A 3.0-T, cardiac MRI including cine balanced steady-state free precession, a modified Looker-Locker inversion recovery (MOLLI), and a fast spin echo (FSE) T2-weighted sequences were performed. ASSESSMENT Cardiac MRI was performed baseline and after two, four, and six cycles of chemotherapy. Assessment of global longitudinal strain (GLS), global circumstance strain (GCS), global radial strain (GRS), and strain rate (GLS-s, GCS-s, GRS-s) and T1, T2 and T2* were accomplished by CVI42. The anthracycline dose and risk factors were also collected before each cardiac MRI. STATISTICAL TESTS Analysis of variance (ANOVA) for repeated measures was used to compare the changes in LVEF cardiac function, strain and T1/T2/T2* parameters over time. Pearson correlation analyses were performed to estimate the potential associations between differences in myocardial characteristics (∆) and the chemotherapy cycle. A P value <0.05 was considered statistically significant. RESULTS LVEF was not significantly different from pretreatment MRI regarding each cycle of chemotherapy (P = 0.54). Compared with baseline, patients had significantly lower GLS (-15.85% ± 0.83%, -14.50% ± 0.88%, -12.34% ± 1.01% vs. -18.82% ± 0.92%) and GLS-s (-0.71% ± 0.07%, -0.65% ± 0.05%, -0.64% ± 0.04% vs. -0.95 ± 0.06%) and increased T2 values (57.21 ± 4.27 msec, 58.60 ± 3.93 msec, 58.10 ± 3.17 msec vs. 43.88 ± 3.28 msec) at two, four and six cycles of chemotherapy treatment. ∆GLS and ∆GLS-s were significantly associated with the chemotherapy cycle (correlation coefficients for GLS = 0.75, GLS-s = 0.75). DATA CONCLUSION Cardiac MRI can precisely detect the dynamic changes of anthracycline-induced subclinical myocardial injury that is represented as a gradually decrease in GLS and GLS-s. These parameters may provide new insight for monitoring risk and therapy in patients with breast cancer. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Yue Zheng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Hui Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Shu Guan
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Huaibi Huo
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Jie Guo
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xin Peng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yuetong Hao
- Department of Breast Surgery, Cancer Hospital of China Medical University, Shenyang, China
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Shiqi Jin
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Dai
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
- Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Ting Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xinfeng Zhang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Shenyang, China
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
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Guo R, Si D, Fan Y, Qian X, Zhang H, Ding H, Tang X. DeepFittingNet: A deep neural network-based approach for simplifying cardiac T 1 and T 2 estimation with improved robustness. Magn Reson Med 2023; 90:1979-1989. [PMID: 37415445 DOI: 10.1002/mrm.29782] [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: 11/27/2022] [Revised: 05/12/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To develop and evaluate a deep neural network (DeepFittingNet) for T1 /T2 estimation of the most commonly used cardiovascular MR mapping sequences to simplify data processing and improve robustness. THEORY AND METHODS DeepFittingNet is a 1D neural network composed of a recurrent neural network (RNN) and a fully connected (FCNN) neural network, in which RNN adapts to the different number of input signals from various sequences and FCNN subsequently predicts A, B, and Tx of a three-parameter model. DeepFittingNet was trained using Bloch-equation simulations of MOLLI and saturation-recovery single-shot acquisition (SASHA) T1 mapping sequences, and T2 -prepared balanced SSFP (T2 -prep bSSFP) T2 mapping sequence, with reference values from the curve-fitting method. Several imaging confounders were simulated to improve robustness. The trained DeepFittingNet was tested using phantom and in-vivo signals, and compared to the curve-fitting algorithm. RESULTS In testing, DeepFittingNet performed T1 /T2 estimation of four sequences with improved robustness in inversion-recovery T1 estimation. The mean bias in phantom T1 and T2 between the curve-fitting and DeepFittingNet was smaller than 30 and 1 ms, respectively. Excellent agreements between both methods was found in the left ventricle and septum T1 /T2 with a mean bias <6 ms. There was no significant difference in the SD of both the left ventricle and septum T1 /T2 between the two methods. CONCLUSION DeepFittingNet trained with simulations of MOLLI, SASHA, and T2 -prep bSSFP performed T1 /T2 estimation tasks for all these most used sequences. Compared with the curve-fitting algorithm, DeepFittingNet improved the robustness for inversion-recovery T1 estimation and had comparable performance in terms of accuracy and precision.
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Affiliation(s)
- Rui Guo
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Dongyue Si
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Xiaofeng Qian
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Haina Zhang
- Center for Community Health Service, Peking University Health Science Center, Beijing, China
| | - Haiyan Ding
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoying Tang
- School of Life Science, Beijing Institute of Technology, Beijing, China
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Puntmann VO, Shchendrygina A, Bolanos CR, Madjiguène Ka M, Valbuena S, Rolf A, Escher F, Nagel E. Cardiac Involvement Due to COVID-19: Insights from Imaging and Histopathology. Eur Cardiol 2023; 18:e58. [PMID: 37942208 PMCID: PMC10628999 DOI: 10.15420/ecr.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/04/2023] [Indexed: 11/10/2023] Open
Abstract
Lingering cardiac symptoms are increasingly recognised complications of severe acute respiratory syndrome coronavirus 2 infection, now referred to as post-acute cardiovascular sequelae of COVID-19 (PASC). In the acute phase, cardiac injury is driven by cytokine release and stems from ischaemic and thrombotic complications, resulting in myocardial necrosis. Patients with pre-existing cardiac conditions are particularly vulnerable. Myocarditis due to a direct viral infection is rare. Chronic symptoms relate to either worsening of pre-existing heart disease (PASC - cardiovascular disease) or delayed chronic inflammatory condition due to heterogenous immune dysregulation (PASC - cardiovascular syndrome), the latter affecting a broad segment of previously well people. Both PASC presentations are associated with increased cardiovascular risk, long-term disability and reduced quality of life. The recognition and management of PASC in clinical settings remains a considerable challenge. Sensitive diagnostic methods are needed to detect subtler inflammatory changes that underlie the persistent symptoms in PASC - cardiovascular syndrome, alongside considerable clinical experience in inflammatory cardiac conditions.
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Affiliation(s)
- Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Anastasia Shchendrygina
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Carlos Rodriguez Bolanos
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Mame Madjiguène Ka
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Silvia Valbuena
- Department of Cardiology, University Hospital La Paz Madrid, Spain
| | - Andreas Rolf
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen Bad Nauheim, Germany
| | - Felicitas Escher
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH Berlin, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt Frankfurt am Main, Germany
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Ravassa S, López B, Treibel TA, San José G, Losada-Fuentenebro B, Tapia L, Bayés-Genís A, Díez J, González A. Cardiac Fibrosis in heart failure: Focus on non-invasive diagnosis and emerging therapeutic strategies. Mol Aspects Med 2023; 93:101194. [PMID: 37384998 DOI: 10.1016/j.mam.2023.101194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
Heart failure is a leading cause of mortality and hospitalization worldwide. Cardiac fibrosis, resulting from the excessive deposition of collagen fibers, is a common feature across the spectrum of conditions converging in heart failure. Eventually, either reparative or reactive in nature, in the long-term cardiac fibrosis contributes to heart failure development and progression and is associated with poor clinical outcomes. Despite this, specific cardiac antifibrotic therapies are lacking, making cardiac fibrosis an urgent unmet medical need. In this context, a better patient phenotyping is needed to characterize the heterogenous features of cardiac fibrosis to advance toward its personalized management. In this review, we will describe the different phenotypes associated with cardiac fibrosis in heart failure and we will focus on the potential usefulness of imaging techniques and circulating biomarkers for the non-invasive characterization and phenotyping of this condition and for tracking its clinical impact. We will also recapitulate the cardiac antifibrotic effects of existing heart failure and non-heart failure drugs and we will discuss potential strategies under preclinical development targeting the activation of cardiac fibroblasts at different levels, as well as targeting additional extracardiac processes.
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Affiliation(s)
- Susana Ravassa
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Begoña López
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, UK; Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Gorka San José
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Blanca Losada-Fuentenebro
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Leire Tapia
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Antoni Bayés-Genís
- CIBERCV, Carlos III Institute of Health, Madrid, Spain; Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain.
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain.
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Luo S, Dou WQ, Schoepf UJ, Varga-Szemes A, Pridgen WT, Zhang LJ. Cardiovascular magnetic resonance imaging in myocardial involvement of systemic lupus erythematosus. Trends Cardiovasc Med 2023; 33:346-354. [PMID: 35150849 DOI: 10.1016/j.tcm.2022.02.002] [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: 10/12/2021] [Revised: 01/18/2022] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that primarily affects young women. Myocardial involvement in SLE frequently occurs and it is rather challenging to make the diagnosis in current clinical settings, mainly due to the extensive clinical presentation of signs and symptoms. As a noninvasive imaging reference in diagnosing cardiomyopathy and myocarditis, cardiovascular magnetic resonance (CMR) imaging can provide new insight into myocardial abnormalities including inflammation, fibrosis, and microcirculation. Therefore, the main aim of this work was to systematically review the pathology, clinical features, and diagnosis, while illustrating the clinical role of CMR on myocardial involvement of SLE.
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Affiliation(s)
- Song Luo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Wanya T Pridgen
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, SC 29425, USA
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
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Silva TQAC, Pezel T, Jerosch-Herold M, Coelho-Filho OR. The Role and Advantages of Cardiac Magnetic Resonance in the Diagnosis of Myocardial Ischemia. J Thorac Imaging 2023; 38:235-246. [PMID: 36917509 DOI: 10.1097/rti.0000000000000701] [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
Ischemic heart disease continues to be the leading cause of death and disability worldwide. For the diagnosis of ischemic heart disease, some form of cardiac stress test involving exercise or pharmacological stimulation continues to play an important role, despite advances within modalities like computer tomography for the noninvasive detection and characterization of epicardial coronary lesions. Among noninvasive stress imaging tests, cardiac magnetic resonance (CMR) combines several capabilities that are highly relevant for the diagnosis of ischemic heart disease: assessment of wall motion abnormalities, myocardial perfusion imaging, and depiction of replacement and interstitial fibrosis markers by late gadolinium enhancement techniques and T1 mapping. On top of these qualities, CMR is also well tolerated and safe in most clinical scenarios, including in the presence of cardiovascular implantable devices, while in the presence of renal disease, gadolinium-based contrast should only be used according to guidelines. CMR also offers outstanding viability assessment and prognostication of cardiovascular events. The last 2019 European Society of Cardiology guidelines for chronic coronary syndromes has positioned stress CMR as a class I noninvasive imaging technique for the diagnosis of coronary artery disease in symptomatic patients. In the present review, we present the current state-of-the-art assessment of myocardial ischemia by stress perfusion CMR, highlighting its advantages and current shortcomings. We discuss the safety, clinical, and cost-effectiveness aspects of gadolinium-based CMR-perfusion imaging for ischemic heart disease assessment.
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Affiliation(s)
- Thiago Quinaglia A C Silva
- Discipline of Cardiology, Faculty of Medical Science-State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Théo Pezel
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Cardiology, University of Paris, CHU Lariboisière, Inserm, UMRS 942, Paris, France
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program and Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Otávio R Coelho-Filho
- Discipline of Cardiology, Faculty of Medical Science-State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil
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Yu C, Pathan S, Jeyaprakash P, Kritharides L, Pathan F, Negishi K. Cardiac magnetic relaxometry versus ejection fraction in anthracycline-related cardiac changes: a systematic review and meta-analysis. Open Heart 2023; 10:e002344. [PMID: 37507150 PMCID: PMC10387664 DOI: 10.1136/openhrt-2023-002344] [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: 04/16/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE The purpose of this meta-analysis is to compare the magnitude of the changes in left ventricular ejection fraction (LVEF) and cardiac magnetic resonance (CMR) relaxometry techniques soon after the completion of anthracycline therapy. Anthracyclines are associated with myocardial functional and morphological changes. LVEF is currently used to identify the functional changes. Anthracyclines can also cause myocardial inflammation and oedema. This can be assessed using CMR relaxometry techniques; T1 and T2 mapping and extracellular volume (ECV) fraction. METHODS Three databases were systematically searched for studies evaluating CMR relaxometry parameter at baseline and 1±1 months after anthracycline completion (the last search date 17 March 2023). CMR parameters pre and post anthracycline-based chemotherapy were abstracted. A random effects model was used to pool mean difference (MD) in LVEF and ECV. Standardised mean difference (SMD) was also calculated for T1 and T2 mapping due to the variations in techniques, normal ranges and for the comparison among the parameters. RESULTS A total of 296 patients were included from 10 studies. 84% were female with a mean age of 54.9 years. Statistically significant alterations were observed in LVEF (MD -3.38% (95% CI -5.13%, -1.62%)) and ECV (1.92% (1.30%, 2.53%)). The pooled SMDs were also significant in LVEF, T1, T2 and ECV with -0.61 (-0.91, -0.30), 0.53 (0.16, 0.90), 0.59 (0.22, 0.96) and 0.74 (0.41, 1.06), respectively. CONCLUSIONS Our meta-analysis demonstrated small but significant alterations in CMR relaxometry parameters soon after anthracycline therapy, where ECV was superior to LVEF and T1 or T2 mapping. However, these short-term MDs were below the minimal detectable differences. PROSPERO REGISTRATION NUMBER CRD42020196296.
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Affiliation(s)
- Christopher Yu
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
| | - Shahab Pathan
- Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
- Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Prajith Jeyaprakash
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
| | - Leonard Kritharides
- Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Faraz Pathan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
| | - Kazuaki Negishi
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
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Diekmann J, Neuser J, Röhrich M, Derlin T, Zwadlo C, Koenig T, Weiberg D, Jäckle F, Kempf T, Ross TL, Tillmanns J, Thackeray JT, Widder J, Haberkorn U, Bauersachs J, Bengel FM. Molecular Imaging of Myocardial Fibroblast Activation in Patients with Advanced Aortic Stenosis Before Transcatheter Aortic Valve Replacement: A Pilot Study. J Nucl Med 2023:jnumed.122.265147. [PMID: 37290793 DOI: 10.2967/jnumed.122.265147] [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: 11/07/2022] [Revised: 04/10/2023] [Indexed: 06/10/2023] Open
Abstract
Using multimodal imaging, we investigated the extent and functional correlates of myocardial fibroblast activation in patients with aortic stenosis (AS) scheduled for transcatheter aortic valve replacement (TAVR). AS may cause myocardial fibrosis, which is associated with disease progression and may limit response to TAVR. Novel radiopharmaceuticals identify upregulation of fibroblast activation protein (FAP) as a cellular substrate of cardiac profibrotic activity. Methods: Twenty-three AS patients underwent 68Ga-FAP inhibitor 46 (68Ga-FAPI) PET, cardiac MRI, and echocardiography within 1-3 d before TAVR. Imaging parameters were correlated and then were integrated with clinical and blood biomarkers. Control cohorts of subjects without a history of cardiac disease and with (n = 5) and without (n = 9) arterial hypertension were compared with matched AS subgroups. Results: Myocardial FAP volume varied significantly among AS subjects (range, 1.54-138 cm3, mean ± SD, 42.2 ± 35.6 cm3) and was significantly higher than in controls with (7.42 ± 8.56 cm3, P = 0.007) and without (2.90 ± 6.67 cm3; P < 0.001) hypertension. FAP volume correlated with N-terminal prohormone of brain natriuretic peptide (r = 0.58, P = 0.005), left ventricular ejection fraction (r = -0.58, P = 0.02), mass (r = 0.47, P = 0.03), and global longitudinal strain (r = 0.55, P = 0.01) but not with cardiac MRI T1 (spin-lattice relaxation time) and extracellular volume (P = not statistically significant). In-hospital improvement in left ventricular ejection fraction after TAVR correlated with pre-TAVR FAP volume (r = 0.440, P = 0.035), N-terminal prohormone of brain natriuretic peptide, and strain but not with other imaging parameters. Conclusion: FAP-targeted PET identifies varying degrees of left ventricular fibroblast activation in TAVR candidates with advanced AS. 68Ga-FAPI signal does not match other imaging parameters, generating the hypothesis that it may become useful as a tool for personalized selection of optimal TAVR candidates.
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Affiliation(s)
- Johanna Diekmann
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany;
| | - Jonas Neuser
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Carolin Zwadlo
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Tobias Koenig
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Desiree Weiberg
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Felix Jäckle
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Tobias L Ross
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Jochen Tillmanns
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - James T Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Julian Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany; and
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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38
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Emrich T. Kommentar zu HERZ THORAX – Parametrische Kardio-MRT bewährt sich in Real-World-Szenario. ROFO-FORTSCHR RONTG 2023; 195:476-477. [PMID: 37224824 DOI: 10.1055/a-2038-2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Tilman Emrich
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
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Hameed A, Condliffe R, Swift AJ, Alabed S, Kiely DG, Charalampopoulos A. Assessment of Right Ventricular Function-a State of the Art. Curr Heart Fail Rep 2023; 20:194-207. [PMID: 37271771 PMCID: PMC10256637 DOI: 10.1007/s11897-023-00600-6] [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] [Accepted: 04/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) has a complex geometry and physiology which is distinct from the left. RV dysfunction and failure can be the aftermath of volume- and/or pressure-loading conditions, as well as myocardial and pericardial diseases. RECENT FINDINGS Echocardiography, magnetic resonance imaging and right heart catheterisation can assess RV function by using several qualitative and quantitative parameters. In pulmonary hypertension (PH) in particular, RV function can be impaired and is related to survival. An accurate assessment of RV function is crucial for the early diagnosis and management of these patients. This review focuses on the different modalities and indices used for the evaluation of RV function with an emphasis on PH.
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Affiliation(s)
- Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield, UK
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
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Nauffal V, Di Achille P, Klarqvist MDR, Cunningham JW, Hill MC, Pirruccello JP, Weng LC, Morrill VN, Choi SH, Khurshid S, Friedman SF, Nekoui M, Roselli C, Ng K, Philippakis AA, Batra P, Ellinor PT, Lubitz SA. Genetics of myocardial interstitial fibrosis in the human heart and association with disease. Nat Genet 2023; 55:777-786. [PMID: 37081215 PMCID: PMC11107861 DOI: 10.1038/s41588-023-01371-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/13/2023] [Indexed: 04/22/2023]
Abstract
Myocardial interstitial fibrosis is associated with cardiovascular disease and adverse prognosis. Here, to investigate the biological pathways that underlie fibrosis in the human heart, we developed a machine learning model to measure native myocardial T1 time, a marker of myocardial fibrosis, in 41,505 UK Biobank participants who underwent cardiac magnetic resonance imaging. Greater T1 time was associated with diabetes mellitus, renal disease, aortic stenosis, cardiomyopathy, heart failure, atrial fibrillation, conduction disease and rheumatoid arthritis. Genome-wide association analysis identified 11 independent loci associated with T1 time. The identified loci implicated genes involved in glucose transport (SLC2A12), iron homeostasis (HFE, TMPRSS6), tissue repair (ADAMTSL1, VEGFC), oxidative stress (SOD2), cardiac hypertrophy (MYH7B) and calcium signaling (CAMK2D). Using a transforming growth factor β1-mediated cardiac fibroblast activation assay, we found that 9 of the 11 loci consisted of genes that exhibited temporal changes in expression or open chromatin conformation supporting their biological relevance to myofibroblast cell state acquisition. By harnessing machine learning to perform large-scale quantification of myocardial interstitial fibrosis using cardiac imaging, we validate associations between cardiac fibrosis and disease, and identify new biologically relevant pathways underlying fibrosis.
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Affiliation(s)
- Victor Nauffal
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Paolo Di Achille
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jonathan W Cunningham
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Matthew C Hill
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - James P Pirruccello
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Valerie N Morrill
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Shaan Khurshid
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel F Friedman
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, MA, USA
| | - Anthony A Philippakis
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Eric and Wendy Schmidt Center, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
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41
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Segre CAW, de Lemos JA, Assunção Junior AN, Nomura CH, Favarato D, Strunz CMC, Villa AV, Parga Filho JR, Rezende PC, Hueb W, Ramires JAF, Kalil Filho R, Serrano Junior CV. Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease. Medicine (Baltimore) 2023; 102:e33548. [PMID: 37083772 PMCID: PMC10118361 DOI: 10.1097/md.0000000000033548] [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: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. METHODS We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. RESULTS A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means ± standard deviations) increased across tertiles: nativeT1 (1006 ± 27 ms vs 1016 ± 27 ms vs 1034 ± 37 ms, ptrend = 0.006) and ECV (22 ± 3% vs 23 ± 1.9% vs 25 ± 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. CONCLUSION In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
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Affiliation(s)
| | - James A. de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Cesar Higa Nomura
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Desiderio Favarato
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | | | | | - Paulo Cury Rezende
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Whady Hueb
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | - Roberto Kalil Filho
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
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Dong Z, Yin G, Yang K, Jiang K, Wu Z, Chen X, Song Y, Yu S, Wang J, Yang S, Ma X, Xu Y, Zhao K, Lu M, Xu X, Zhao S. Endogenous assessment of late gadolinium enhancement grey zone in patients with non-ischaemic cardiomyopathy with T1ρ and native T1 mapping. Eur Heart J Cardiovasc Imaging 2023; 24:492-502. [PMID: 35793269 DOI: 10.1093/ehjci/jeac128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/22/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS This study aims to validate and compare the feasibility of T1ρ and native longitudinal relaxation time (T1) mapping in detection of myocardial fibrosis in patients with non-ischaemic cardiomyopathy, focusing on the performance of both methods in identifying late gadolinium enhancement (LGE) grey zone. METHODS AND RESULTS Twenty-seven hypertrophic cardiomyopathy (HCM) patients, 16 idiopathic dilated cardiomyopathy (DCM) patients, and 18 healthy controls were prospectively enrolled for native T1 and T1ρ mapping imaging and then all the patients underwent enhancement scan for LGE extent and extracellular volume (ECV) values. In LGE positive patients, the LGE areas were divided into LGE core (6 SDs above remote myocardium) and grey zone (2-6 SDs above remote myocardium) according to the signal intensity of LGE. Both HCM and DCM patients showed significantly higher native T1 values and T1ρ values than controls no matter the presence of LGE (all P < 0.01). There were significant differences in native T1 and T1ρ values among four different types of myocardia (LGE core, grey zone, remote area and control, P < 0.0001). However, the T1ρ values of grey zone were significantly higher than control (P < 0.01), while the native T1 values were not (P = 0.089). T1ρ values were significantly associated with both native T1 values (r = 0.54, P < 0.001) and ECV values (r = 0.54, P < 0.001). CONCLUSION T1ρ mapping is a feasible method to detect myocardial fibrosis in patients with non-ischaemic cardiomyopathy no matter the presence of LGE. Compared with native T1, T1ρ may serve as a better discriminator in the identification of LGE grey zone.
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Affiliation(s)
- Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Gang Yin
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Ke Jiang
- Philips Healthcare, Tianze Road No.16, Chaoyang District, Beijing 100020, China
| | - Zhigang Wu
- Philips Healthcare, Tianze Road No.16, Chaoyang District, Beijing 100020, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Yanyan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Shiqing Yu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Jiaxin Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Yangfei Xu
- Department of Cardiology, Chizhou People's Hospital, Baiya Middle Road No.3, Guichi District, Anhui 247099, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen 518055, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
| | - Xiaodong Xu
- Department of Cardiology, Chizhou People's Hospital, Baiya Middle Road No.3, Guichi District, Anhui 247099, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China
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Chen BH, An DA, Wu CW, Yue T, Bautista M, Ouchi E, Xu JR, Hu J, Zhou Y, Pu J, Wu LM. Prognostic significance of non-infarcted myocardium correlated with microvascular impairment evaluated dynamically by native T1 mapping. Insights Imaging 2023; 14:50. [PMID: 36941401 PMCID: PMC10027971 DOI: 10.1186/s13244-022-01360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 03/22/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the influence of microvascular impairment on myocardial characteristic alterations in remote myocardium at multiple time points, and its prognostic significance after acute ST-segment elevation myocardial infarction (STEMI). METHODS Patients were enrolled prospectively and performed CMR at baseline, 30 days, and 6 months. The primary endpoint was major adverse cardiac events (MACE): death, myocardial reinfarction, malignant arrhythmia, and hospitalization for heart failure. Cox proportional hazards regression modeling was analyzed to estimate the correlation between T1 mapping of remote myocardium and MACE in patients with and without microvascular obstruction (MVO). RESULTS A total of 135 patients (mean age 60.72 years; 12.70% female, median follow-up 510 days) were included, of whom 86 (63.70%) had MVO and 26 (19.26%) with MACE occurred in patients. Native T1 values of remote myocardium changed dynamically. At 1 week and 30 days, T1 values of remote myocardium in the group with MVO were higher than those without MVO (p = 0.030 and p = 0.001, respectively). In multivariable cox regression analysis of 135 patients, native1w T1 (HR 1.03, 95%CI 1.01-1.04, p = 0.002), native30D T1 (HR 1.05, 95%CI 1.03-1.07, p < 0.001) and LGE (HR 1.10, 95%CI 1.05-1.15, p < 0.001) were joint independent predictors of MACE. In multivariable cox regression analysis of 86 patients with MVO, native30D T1 (HR 1.05, 95%CI 1.04-1.07, p < 0.001) and LGE (HR 1.10, 95%CI 1.05-1.15, p < 0.001) were joint independent predictors of MACE. CONCLUSIONS The evolution of native T1 in remote myocardium was associated with the extent of microvascular impairment after reperfusion injury. In patients with MVO, native30D T1 and LGE were joint independent predictors of MACE.
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Affiliation(s)
- Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China
| | - Chong-Wen Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China
| | - Ting Yue
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China
| | - Matthew Bautista
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Erika Ouchi
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Jian-Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China.
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China.
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, P. R. China.
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Varghese J, Jin N, Giese D, Chen C, Liu Y, Pan Y, Nair N, Shalaan MT, Khan M, Tong MS, Ahmad R, Han Y, Simonetti OP. Building a comprehensive cardiovascular magnetic resonance exam on a commercial 0.55 T system: A pictorial essay on potential applications. Front Cardiovasc Med 2023; 10:1120982. [PMID: 36937932 PMCID: PMC10014600 DOI: 10.3389/fcvm.2023.1120982] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Background Contemporary advances in low-field magnetic resonance imaging systems can potentially widen access to cardiovascular magnetic resonance (CMR) imaging. We present our initial experience in building a comprehensive CMR protocol on a commercial 0.55 T system with a gradient performance of 26 mT/m amplitude and 45 T/m/s slew rate. To achieve sufficient image quality, we adapted standard imaging techniques when possible, and implemented compressed-sensing (CS) based techniques when needed in an effort to compensate for the inherently low signal-to-noise ratio at lower field strength. Methods A prototype CMR exam was built on an 80 cm, ultra-wide bore commercial 0.55 T MR system. Implementation of all components aimed to overcome the inherently lower signal of low-field and the relatively longer echo and repetition times owing to the slower gradients. CS-based breath-held and real-time cine imaging was built utilizing high acceleration rates to meet nominal spatial and temporal resolution recommendations. Similarly, CS 2D phase-contrast cine was implemented for flow. Dark-blood turbo spin echo sequences with deep learning based denoising were implemented for morphology assessment. Magnetization-prepared single-shot myocardial mapping techniques incorporated additional source images. CS-based dynamic contrast-enhanced imaging was implemented for myocardial perfusion and 3D MR angiography. Non-contrast 3D MR angiography was built with electrocardiogram-triggered, navigator-gated magnetization-prepared methods. Late gadolinium enhanced (LGE) tissue characterization methods included breath-held segmented and free-breathing single-shot imaging with motion correction and averaging using an increased number of source images. Proof-of-concept was demonstrated through porcine infarct model, healthy volunteer, and patient scans. Results Reasonable image quality was demonstrated for cardiovascular structure, function, flow, and LGE assessment. Low-field afforded utilization of higher flip angles for cine and MR angiography. CS-based techniques were able to overcome gradient speed limitations and meet spatial and temporal resolution recommendations with imaging times comparable to higher performance scanners. Tissue mapping and perfusion imaging require further development. Conclusion We implemented cardiac applications demonstrating the potential for comprehensive CMR on a novel commercial 0.55 T system. Further development and validation studies are needed before this technology can be applied clinically.
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Affiliation(s)
- Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Malvern, PA, United States
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare, Erlangen, Germany
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Chong Chen
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Yingmin Liu
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
| | - Yue Pan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Nikita Nair
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
| | - Mahmoud T. Shalaan
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
| | - Mahmood Khan
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Matthew S. Tong
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Rizwan Ahmad
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Yuchi Han
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Orlando P. Simonetti
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
- Department of Radiology, The Ohio State University, Columbus, OH, United States
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Gama FF, Patel K, Bennett J, Aziminia N, Pugliese F, Treibel T. Myocardial Evaluation in Patients with Aortic Stenosis by Cardiac Computed Tomography. ROFO-FORTSCHR RONTG 2023; 195:506-513. [PMID: 36854383 DOI: 10.1055/a-1999-7271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Aortic valve stenosis (AVS) is one of the most prevalent pathologies affecting the heart that can curtail expected survival and quality of life if not managed appropriately. CURRENT STATUS Cardiac computed tomography (CT) has long played a central role in this subset, mostly for severity assessment and for procedural planning. Although not as widely accepted as other imaging modalities for functional myocardial assessment [i. e., transthoracic echocardiogram (TTE), cardiac magnetic resonance (CMR)], this technique has recently increased its clinical application in this regard. FUTURE OUTLOOK The ability to provide morphological, functional, tissue, and preprocedural information highlights the potential of the "all-in-one" concept of cardiac CT as a potential reality for the near future for AVS assessment. In this review article, we sought to analyze the current applications of cardiac CT that allow a full comprehensive evaluation of aortic valve disease. KEY POINTS · Noninvasive myocardial tissue characterization stopped being an exclusive feature of cardiac magnetic resonance.. · Emerging acquisition methods make cardiac CT an accurate and widely accessible imaging modality.. · Cardiac CT has the potential to become a "one-stop" exam for comprehensive aortic stenosis assessment.. CITATION FORMAT · Gama FF, Patel K, Bennett J et al. Myocardial Evaluation in Patients with Aortic Stenosis by Cardiac Computed Tomography. Fortschr Röntgenstr 2023; DOI: 10.1055/a-1999-7271.
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Affiliation(s)
- Francisco F Gama
- Cardiology, Hospital Centre of West Lisbon Campus Hospital of Santa Cruz, Lisboa, Portugal.,Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Kush Patel
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Bennett
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikoo Aziminia
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Francesca Pugliese
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Treibel
- Cardiac Imaging, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
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Bentatou Z, Troalen T, Bernard M, Guye M, Pini L, Bartoli A, Jacquier A, Kober F, Rapacchi S. Simultaneous multi-slice T1 mapping using MOLLI with blipped CAIPIRINHA bSSFP. Magn Reson Imaging 2023; 95:90-102. [PMID: 32304799 DOI: 10.1016/j.mri.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/02/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study evaluates the possibility for replacing conventional 3 slices, 3 breath-holds MOLLI cardiac T1 mapping with single breath-hold 3 simultaneous multi-slice (SMS3) T1 mapping using blipped-CAIPIRINHA SMS-bSSFP MOLLI sequence. As a major drawback, SMS-bSSFP presents unique artefacts arising from side-lobe slice excitations that are explained by imperfect RF modulation rendering and bSSFP low flip angle enhancement. Amplitude-only RF modulation (AM) is proposed to reduce these artefacts in SMS-MOLLI compared to conventional Wong multi-band RF modulation (WM). MATERIALS AND METHODS Phantoms and ten healthy volunteers were imaged at 1.5 T using a modified blipped-CAIPIRINHA SMS-bSSFP MOLLI sequence with 3 simultaneous slices. WM-SMS3 and AM-SMS3 were compared to conventional single-slice (SMS1) MOLLI. First, SNR degradation and T1 accuracy were measured in phantoms. Second, artefacts from side-lobe excitations were evaluated in a phantom designed to reproduce fat presence near the heart. Third, the occurrence of these artefacts was observed in volunteers, and their impact on T1 quantification was compared between WM-SMS3 and AM-SMS3 with conventional MOLLI as a reference. RESULTS In the phantom, larger slice gaps and slice thicknesses yielded higher SNR. There was no significant difference of T1 values between conventional MOLLI and SMS3-MOLLI (both WM and AM). Positive banding artefacts were identified from fat neighbouring the targeted FOV due to side-lobe excitations from WM and the unique bSSFP signal profile. AM RF pulses reduced these artefacts by 38%. In healthy volunteers, AM-SMS3-MOLLI showed similar artefact reduction compared to WM-SMS3-MOLLI (3 ± 2 vs 5 ± 3 corrupted LV segments out of 16). In-vivo native T1 values obtained from conventional MOLLI and AM-SMS3-MOLLI were equivalent in LV myocardium (SMS1-T1 = 935.5 ± 36.1 ms; AM-SMS3-T1 = 933.8 ± 50.2 ms; P = 0.436) and LV blood pool (SMS1-T1 = 1475.4 ± 35.9 ms; AM-SMS3-T1 = 1452.5 ± 70.3 ms; P = 0.515). Identically, no differences were found between SMS1 and SMS3 postcontrast T1 values in the myocardium (SMS1-T1 = 556.0 ± 19.7 ms; SMS3-T1 = 521.3 ± 28.1 ms; P = 0.626) and the blood (SMS1-T1 = 478 ± 65.1 ms; AM-SMS3-T1 = 447.8 ± 81.5; P = 0.085). CONCLUSIONS Compared to WM RF modulation, AM SMS-bSSFP MOLLI was able to reduce side-lobe artefacts considerably, providing promising results to image the three levels of the heart in a single breath hold. However, few artefacts remained even using AM-SMS-bSSFP due to residual RF imperfections. The proposed blipped-CAIPIRINHA MOLLI T1 mapping sequence provides accurate in vivo T1 quantification in line with those obtained with a single slice acquisition.
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Affiliation(s)
- Zakarya Bentatou
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France; Siemens Healthcare SAS, Saint-Denis, France.
| | | | | | - Maxime Guye
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France.
| | - Lauriane Pini
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France.
| | - Axel Bartoli
- APHM, Hôpital Universitaire Timone, Service de Radiologie, Marseille, France.
| | - Alexis Jacquier
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hôpital Universitaire Timone, Service de Radiologie, Marseille, France.
| | - Frank Kober
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.
| | - Stanislas Rapacchi
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France.
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Miao F, Tang C, Ren G, Guo J, Zhao L, Xu W, Zhou X, Zhang L, Huang X. The prognostic value of multiparametric cardiac magnetic resonance in patients with systemic light chain amyloidosis. Front Oncol 2023; 13:1069788. [PMID: 37207148 PMCID: PMC10189062 DOI: 10.3389/fonc.2023.1069788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) is a classic imaging modality derived from cardiac magnetic resonance (CMR), which is commonly used to describe cardiac tissue characterization. T1 mapping with extracellular volume (ECV) and native T1 are novel quantitative parameters. The prognostic value of multiparametric CMR in patients with light chain (AL) amyloidosis remains to be thoroughly investigated. Methods A total of 89 subjects with AL amyloidosis were enrolled from April 2016 to January 2021, and all of them underwent CMR on a 3.0 T scanner. The clinical outcome and therapeutic effect were observed. Cox regression was used to investigate the effect of multiple CMR parameters on outcomes in this population. Results LGE extent, native T1 and ECV correlated well with cardiac biomarkers. During a median follow-up of 40 months, 21 patients died. ECV (hazard ratio [HR]: 2.087 for per 10% increase, 95% confidence interval [CI]: 1.379-3.157, P < 0.001) and native T1 (HR: 2.443 for per 100 ms increase, 95% CI: 1.381-4.321, P=0.002) were independently predictive of mortality. A novel prognostic staging system based on median native T1 (1344 ms) and ECV (40%) was similar to Mayo 2004 Stage, and the 5-year estimated overall survival rates in Stage I, II, and III were 95%, 80%, and 53%, respectively. In patients with ECV > 40%, receiving autologous stem cell transplantation had higher cardiac and renal response rates than conventional chemotherapy. Conclusion Both native T1 and ECV independently predict mortality in patients with AL amyloidosis. Receiving autologous stem cell transplantation is effective and significantly improves the clinical outcomes in patients with ECV > 40%.
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Affiliation(s)
- Fujia Miao
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chunxiang Tang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guisheng Ren
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinzhou Guo
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Liang Zhao
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiwei Xu
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiyang Zhou
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Longjiang Zhang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Longjiang Zhang, ; Xianghua Huang,
| | - Xianghua Huang
- National Clinical Research Center of Kidney Diseases, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- *Correspondence: Longjiang Zhang, ; Xianghua Huang,
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Ferrer-Sistach E, Teis A, Bayés-Genís A, Delgado V. Multimodality imaging in aortic stenosis: new diagnostic and therapeutic frontiers. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:40-46. [PMID: 35716910 DOI: 10.1016/j.rec.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 12/24/2022]
Abstract
The advent of transcatheter aortic valve implantation has revolutionized the treatment of calcific aortic valve stenosis. Elderly patients who were previously considered inoperable have currently an efficacious and safe therapy that provides better survival. In addition, current practice guidelines tend to recommend earlier intervention to avoid the irreversible consequences of long-lasting pressure overload caused by the stenotic aortic valve. Appropriate timing of the intervention relies significantly on imaging techniques that provide information on the severity of the aortic stenosis as well as on the hemodynamic consequences and cardiac remodeling. While left ventricular ejection fraction remains one of the main functional parameters for risk stratification in patients with severe aortic stenosis, advances in imaging techniques have provided new structural and functional parameters that allow the identification of patients who will benefit from intervention before the occurrence of symptoms or irreversible cardiac damage. Furthermore, ongoing research aiming to identify the medical therapies that can effectively halt the progression of aortic stenosis relies heavily on imaging endpoints, and new imaging techniques that characterize the metabolic activity of calcific aortic stenosis have been proposed to monitor the effects of these therapies. The present review provides an up-to-date overview of the imaging advances that characterizes the pathophysiology and that have changed the management paradigm of aortic stenosis.
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Affiliation(s)
| | - Albert Teis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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T1 mapping of the myocardium and liver in the single ventricle population. Pediatr Radiol 2022; 53:1092-1099. [PMID: 36539566 DOI: 10.1007/s00247-022-05560-y] [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: 09/01/2022] [Revised: 11/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fontan associated liver disease (FALD) is an increasingly recognized complication of the single ventricle circulation characterized by hepatic venous congestion leading to hepatic fibrosis. Within the Fontan myocardium, fibrotic myocardial remodeling may occur and lead to ventricular dysfunction. Magnetic resonance imaging (MRI) T1 mapping can characterize both myocardial and liver properties. OBJECTIVE The aim of this study was to compare myocardial and liver T1 between single ventricle patients with and without a Fontan and biventricular controls. MATERIALS AND METHODS A retrospective study of 3 groups of patients: 16 single ventricle patients before Fontan (SVpre 2 newborns, 9 pre-Glenn, 5 pre-Fontan, 31% single right ventricle [SRV]), 16 Fontans (56% SRV) and 10 repaired d-transposition of the great arteries (TGA). Native modified Look-Locker inversion T1 times were measured in the myocardium and liver. Cardiac MRI parameters, myocardial and liver T1 values were compared in the three groups. Correlations were assessed between liver T1 and cardiac parameters. RESULTS Myocardial T1 was higher in SVpre (1,056 ± 48 ms) and Fontans (1,047 ± 41 ms) compared to TGA (1,012 ± 48 ms, P < 0.05). Increased liver T1 was found in both SVpre (683 ± 82 ms) and Fontan (727 ± 49 ms) patients compared to TGA patients (587 ± 58 ms, P < 0.001). There was no difference between single left ventricle (SLV) versus SRV myocardial or liver T1. Liver T1 showed moderate correlations with myocardial T1 (r = 0.48, confidence interval [CI] 0.26-0.72) and ejection fraction (r = -0.36, CI -0.66-0.95) but not with other volumetric parameters. CONCLUSION Increased liver T1 at both pre- and post-Fontan stages suggests there are intrinsic liver abnormalities early in the course of single ventricle palliation. Increased myocardial T1 and its relationship to liver T1 suggest a combination of edema from passive venous congestion and/or myocardial fibrosis occurring in this population. Liver T1 may provide an earlier marker of liver disease warranting further study.
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Mikail N, Rossi A, Bengs S, Haider A, Stähli BE, Portmann A, Imperiale A, Treyer V, Meisel A, Pazhenkottil AP, Messerli M, Regitz-Zagrosek V, Kaufmann PA, Buechel RR, Gebhard C. Imaging of heart disease in women: review and case presentation. Eur J Nucl Med Mol Imaging 2022; 50:130-159. [PMID: 35974185 PMCID: PMC9668806 DOI: 10.1007/s00259-022-05914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging - Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, Strasbourg, France
- Molecular Imaging - DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin, Berlin, Berlin, Germany
- University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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