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Gissler MC, Antiochos P, Ge Y, Heydari B, Gräni C, Kwong RY. Cardiac Magnetic Resonance Evaluation of LV Remodeling Post-Myocardial Infarction: Prognosis, Monitoring and Trial Endpoints. JACC Cardiovasc Imaging 2024:S1936-878X(24)00127-X. [PMID: 38819335 DOI: 10.1016/j.jcmg.2024.03.012] [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: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 06/01/2024]
Abstract
Adverse left ventricular remodeling (ALVR) and subsequent heart failure after myocardial infarction (MI) remain a major cause of patient morbidity and mortality worldwide. Overt inflammation has been identified as the common pathway underlying myocardial fibrosis and development of ALVR post-MI. With its ability to simultaneously provide information about cardiac structure, function, perfusion, and tissue characteristics, cardiac magnetic resonance (CMR) is well poised to inform prognosis and guide early surveillance and therapeutics in high-risk cohorts. Further, established and evolving CMR-derived biomarkers may serve as clinical endpoints in prospective trials evaluating the efficacy of novel anti-inflammatory and antifibrotic therapies. This review provides an overview of post-MI ALVR and illustrates how CMR may help clinical adoption of novel therapies via mechanistic or prognostic imaging markers.
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Affiliation(s)
- Mark Colin Gissler
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Panagiotis Antiochos
- Cardiology and Cardiac MR Centre, University Hospital Lausanne, Lausanne, Switzerland
| | - Yin Ge
- Division of Cardiology, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Bobak Heydari
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Wang J, Meng Y, Han S, Hu C, Lu Y, Wu P, Han L, Xu Y, Xu K. Predictive value of total ischaemic time and T1 mapping after emergency percutaneous coronary intervention in acute ST-segment elevation myocardial infarction. Clin Radiol 2023; 78:e724-e731. [PMID: 37460337 DOI: 10.1016/j.crad.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 04/05/2023] [Accepted: 06/12/2023] [Indexed: 09/03/2023]
Abstract
AIM To investigate the predictive value of ischaemic time and cardiac magnetic resonance imaging (CMRI) T1 mapping in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS A total of 127 patients with STEMI treated by primary PCI were studied. All patients underwent CMRI with native T1 and extracellular volume (ECV) measurement, 61 of whom also had 4-month follow-up data. The total ischaemic (symptom onset to balloon, S2B) time expressed in minutes was recorded. CMRI cine, T1 mapping, and late gadolinium enhancement (LGE) images were analysed to evaluate left ventricular (LV) function, T1 value, ECV, and myocardial infract (MI) scar characteristics, respectively. The correlation between S2B time and T1 mapping was evaluated. The predictive values of S2B time and T1 mapping for large final infarct size were estimated. RESULTS The incidence of microvascular obstruction (MVO) increased with the prolongation of ischaemia time. Regardless of MVO or not, ECV in myocardial infarction (ECVMI) was significantly correlated with S2B time (r=0.61, p<0.001), while native T1 in MI (T1MI) was not (r=-0.19, p=0.029). In the 4-month follow-up, native T1MI was improved (1385.1 ± 90.4 versus 1288.6 ± 74 ms, p<0.001). Furthermore, ECVMI was independently associated with final larger infarct size (AUC = 0.89, 95% confidence interval [CI] = 0.81-0.98, p<0.001) in multivariable regression analysis. CONCLUSION ECVMI was correlated with total ischaemic time and was an independent predictor of final larger infarct size.
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Affiliation(s)
- J Wang
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Y Meng
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - S Han
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - C Hu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Y Lu
- Department of Cardiac Care Unit, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - P Wu
- Philips Healthcare, Shanghai, China
| | - L Han
- Philips Healthcare, Shanghai, China
| | - Y Xu
- Philips Healthcare, Guangzhou, China
| | - K Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Jahnke C, Sinn M, Hot A, Cavus E, Erley J, Schneider J, Chevalier C, Bohnen S, Radunski U, Meyer M, Lund G, Adam G, Kirchhof P, Blankenberg S, Muellerleile K, Tahir E. Differentiation of acute non-ST elevation myocardial infarction and acute infarct-like myocarditis by visual pattern analysis: a head-to-head comparison of different cardiac MR techniques. Eur Radiol 2023; 33:6258-6266. [PMID: 37438640 PMCID: PMC10415415 DOI: 10.1007/s00330-023-09905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/19/2023] [Accepted: 05/28/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Parametric cardiac magnetic resonance (CMR) techniques have improved the diagnosis of pathologies. However, the primary tool for differentiating non-ST elevation myocardial infarction (NSTEMI) from myocarditis is still a visual assessment of conventional signal-intensity-based images. This study aimed at analyzing the ability of parametric compared to conventional techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns. METHODS Twenty NSTEMI patients, twenty infarct-like myocarditis patients, and twenty controls were examined using cine, T2-weighted CMR (T2w) and late gadolinium enhancement (LGE) imaging and T1/T2 mapping on a 1.5 T scanner. CMR images were presented in random order to two experienced fully blinded observers, who had to assign them to three categories by a visual analysis: NSTEMI, myocarditis, or healthy. RESULTS The conventional approach (cine, T2w and LGE combined) had the best diagnostic accuracy with 92% (95%CI: 81-97) for NSTEMI and 86% (95%CI: 71-94) for myocarditis. The diagnostic accuracies using T1 maps were 88% (95%CI: 74-95) and 80% (95%CI: 62-91), 84% (95%CI: 67-93) and 74% (95%CI: 54-87) for LGE, and 83% (95%CI: 66-92) and 73% (95%CI: 53-87) for T2w. The accuracies for cine (72% (95%CI: 52-86) and 60% (95%CI: 38-78)) and T2 maps (62% (95%CI: 40-79) and 47% (95%CI: 28-68)) were significantly lower compared to the conventional approach (p < 0.001 and p < 0.0001). CONCLUSIONS The conventional approach provided a reliable visual discrimination between NSTEMI, myocarditis, and controls. The diagnostic accuracy of a visual pattern analysis of T1 maps was not significantly inferior, whereas the diagnostic accuracy of T2 maps was not sufficient in this context. CLINICAL RELEVANCE STATEMENT The ability of parametric compared to conventional CMR techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns can avoid potentially unnecessary invasive coronary angiography and help to shorten CMR protocols and to reduce the need of gadolinium contrast agents. KEY POINTS • A visual differentiation of ischemic from non-ischemic patterns of myocardial injury is reliably achieved by a combination of conventional CMR techniques (cine, T2-weighted and LGE imaging). • There is no significant difference in accuracies between visual pattern analysis on native T1 maps without providing quantitative values and a conventional combined approach for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls. • T2 maps do not provide a sufficient diagnostic accuracy for visual pattern analysis for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls.
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Affiliation(s)
- Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amra Hot
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Ulf Radunski
- Department of Cardiology, Regio Clinics, Pinneberg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Daniel G, Meirav G, Noam O, Tamar BK, Dvir R, Ricardo O, Noam BE. Fast and accurate T 2 mapping using Bloch simulations and low-rank plus sparse matrix decomposition. Magn Reson Imaging 2023; 98:66-75. [PMID: 36649808 DOI: 10.1016/j.mri.2023.01.007] [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: 11/21/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE MRI's T2 relaxation time is one of the key contrast mechanisms for clinical diagnosis and prognosis of pathologies. Mapping this relaxation time, however, involves extensive scan times, which are needed to collect quantitative data, thereby impeding its integration into clinical routine. This study employs a low-rank plus sparse (L + S) signal decomposition approach in order to reconstruct accurate T2-maps from highly undersampled multi-echo spin-echo (MESE) MRI data. METHODS Two new algorithms are presented: the first uses standard L + S approach, where both L and S are iteratively updated. The second technique, dubbed SPArse and fixed RanK (SPARK), uses a fixed-rank L, under the assumption that most MESE information is found in the L component and that this rank can be pre-calculated. The utility of these new techniques is demonstrated on in vivo brain and calf data at x2 to x6 acceleration factors. RESULTS Accelerated T2 maps showed improved accuracy compared to fully sampled ground truth maps, when using L + S and SPARK techniques vis-à-vis standard GRAPPA acceleration. CONCLUSION SPARK provides accurate T2 maps with increased robustness to the selection of reconstruction parameters making it suitable to a wide range of applications and facilitating the use of quantitative T2 information in clinical settings.
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Affiliation(s)
- Grzeda Daniel
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Galun Meirav
- Department of Computer Science and Applied Mathematics, Weitzman Institute of Science, Rehovot, Israel
| | - Omer Noam
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | | | - Radunsky Dvir
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Otazo Ricardo
- Departments of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10016, USA
| | - Ben-Eliezer Noam
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel; Center for Advanced Imaging Innovation and Research (CAI2R), New-York University Langone Medical Center, New York, NY 10016, USA.
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5
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Jiji GW. Biomarker for detecting myocardial ischemia using multi class particle swarm optimization. THE IMAGING SCIENCE JOURNAL 2023. [DOI: 10.1080/13682199.2022.2161152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- G. Wiselin Jiji
- Department of Computer Science & Engineering, Dr. Sivanthi Aditanar College of Engineering, Tiruchendur, Tamil Nadu, India
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6
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Fanti S, Stephenson E, Rocha-Vieira E, Protonotarios A, Kanoni S, Shahaj E, Longhi MP, Vyas VS, Dyer C, Pontarini E, Asimaki A, Bueno-Beti C, De Gaspari M, Rizzo S, Basso C, Bombardieri M, Coe D, Wang G, Harding D, Gallagher I, Solito E, Elliott P, Heymans S, Sikking M, Savvatis K, Mohiddin SA, Marelli-Berg FM. Circulating c-Met-Expressing Memory T Cells Define Cardiac Autoimmunity. Circulation 2022; 146:1930-1945. [PMID: 36417924 PMCID: PMC9770129 DOI: 10.1161/circulationaha.121.055610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Autoimmunity is increasingly recognized as a key contributing factor in heart muscle diseases. The functional features of cardiac autoimmunity in humans remain undefined because of the challenge of studying immune responses in situ. We previously described a subset of c-mesenchymal epithelial transition factor (c-Met)-expressing (c-Met+) memory T lymphocytes that preferentially migrate to cardiac tissue in mice and humans. METHODS In-depth phenotyping of peripheral blood T cells, including c-Met+ T cells, was undertaken in groups of patients with inflammatory and noninflammatory cardiomyopathies, patients with noncardiac autoimmunity, and healthy controls. Validation studies were carried out using human cardiac tissue and in an experimental model of cardiac inflammation. RESULTS We show that c-Met+ T cells are selectively increased in the circulation and in the myocardium of patients with inflammatory cardiomyopathies. The phenotype and function of c-Met+ T cells are distinct from those of c-Met-negative (c-Met-) T cells, including preferential proliferation to cardiac myosin and coproduction of multiple cytokines (interleukin-4, interleukin-17, and interleukin-22). Furthermore, circulating c-Met+ T cell subpopulations in different heart muscle diseases identify distinct and overlapping mechanisms of heart inflammation. In experimental autoimmune myocarditis, elevations in autoantigen-specific c-Met+ T cells in peripheral blood mark the loss of immune tolerance to the heart. Disease development can be halted by pharmacologic c-Met inhibition, indicating a causative role for c-Met+ T cells. CONCLUSIONS Our study demonstrates that the detection of circulating c-Met+ T cells may have use in the diagnosis and monitoring of adaptive cardiac inflammation and definition of new targets for therapeutic intervention when cardiac autoimmunity causes or contributes to progressive cardiac injury.
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Affiliation(s)
- Silvia Fanti
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Edward Stephenson
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
| | - Etel Rocha-Vieira
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Federal University of Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil (E.R.-V.)
| | - Alexandros Protonotarios
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
- Institute of Cardiovascular Science, University College London, UK (A.P., P.E.)
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Eriomina Shahaj
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - M. Paula Longhi
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Vishal S. Vyas
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
| | - Carlene Dyer
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Elena Pontarini
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Angeliki Asimaki
- Molecular and Clinical Science Institute, St George’s, University of London, UK (A.A., C.B.-B.)
| | - Carlos Bueno-Beti
- Molecular and Clinical Science Institute, St George’s, University of London, UK (A.A., C.B.-B.)
| | - Monica De Gaspari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (M.D.G., S.R., C.B.)
| | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (M.D.G., S.R., C.B.)
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (M.D.G., S.R., C.B.)
| | - Michele Bombardieri
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - David Coe
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Guosu Wang
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
| | - Daniel Harding
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
| | - Iain Gallagher
- Faculty of Health Sciences & Sport, University of Stirling, UK (I.G.)
| | - Egle Solito
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Department of Medicina Molecolare e Biotecnologie Mediche, University of Naples “Federico II,” Italy (E. Solito)
| | - Perry Elliott
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
- Institute of Cardiovascular Science, University College London, UK (A.P., P.E.)
| | - Stephane Heymans
- Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, the Netherlands (S.H., M.S.)
- Department of Cardiovascular Sciences, Centre for Vascular and Molecular Biology, KU Leuven, Belgium (S.H.)
| | - Maurits Sikking
- Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, the Netherlands (S.H., M.S.)
| | - Konstantinos Savvatis
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
| | - Saidi A. Mohiddin
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Barts Heart Centre, Barts Health NHS Trust, St Bartholomew’s Hospital, West Smithfield, London (E. Stephenson, A.P., V.S.V., D.H., P.E., K.S., S.A.M.)
| | - Federica M. Marelli-Berg
- William Harvey Research Institute, Barts and The London Faculty of Medicine and Dentistry (S.F., E. Stephenson, E.R.-V., S.K., E. Shahaj, M.P.L., V.S.V., C.D., E.P., M.B., D.C., G.W., D.H., E. Solito, K.S., S.A.M., F.M.M.-B.), Queen Mary University of London, UK
- Centre for Inflammation and Therapeutic Innovation (F.M.M.-B.), Queen Mary University of London, UK
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Addae-Mensah K, Revels J, Febbo J. Pitfalls and pearls in the imaging of cardiac ischemia. Semin Ultrasound CT MR 2022; 43:184-193. [PMID: 35688530 DOI: 10.1053/j.sult.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease is the most common cause of cardiac ischemia and a leading cause of death globally. There are multiple imaging modalities which can assess cardiac ischemia, in particular coronary CT calcium score, coronary CT angiography, and cardiac MRI. Each of these modalities offers insight into the overall patient picture. However, coronary CT and cardiac MRI are not free from limitations. This article will review the roles of CT and MRI in cardiac imaging, mimics, technical limitations, and potential pitfalls that may be encountered.
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Affiliation(s)
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, Albuquerque, NM..
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Terenicheva MA, Stukalova OV, Shakhnovich RM, Ternovoy SK. The role of cardiac magnetic resonance imaging in defining the prognosis of patients with acute <i>ST</i>-segment elevation myocardial infarction. Part 2. Assessment of the disease prognosis. TERAPEVT ARKH 2022; 94:552-557. [DOI: 10.26442/00403660.2022.04.201458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
Currently the incidence of congestive heart failure after ST-segment elevation myocardial infarction (STEMI) tends to increase. Reperfusion therapy is still the only effective method to reduce an infarct size. Therefore, there is a high unmet need of novel cardioprotective treatments that would improve outcomes in such patients. Recent advances in cardiovascular magnetic resonance (CMR) methods enabled the identification of certain new infarct characteristics associated with the development of heart failure and sudden cardiac death. These characteristics can help identify new groups of high risk patients and used as a targets for novel cardioprotective treatments. This part of the review summarizes novel CMR-based characteristics of myocardial infarction and their role in the prognostic stratification of STEMI patients.
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Blazak PL, Holland DJ, Basso T, Martin J. Spontaneous coronary artery dissection, fibromuscular dysplasia, and biventricular stress cardiomyopathy: a case report. Eur Heart J Case Rep 2022; 6:ytac125. [PMID: 35652086 PMCID: PMC9149788 DOI: 10.1093/ehjcr/ytac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/30/2021] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is an important cause of acute
coronary syndrome and is associated with fibromuscular dysplasia (FMD). The
diagnosis of stress cardiomyopathy in patients with SCAD and FMD is
uncommon, though an important consideration given the shared risk profile.
Complications of severe left ventricular (LV) dysfunction associated with
stress cardiomyopathy, such as LV thrombus, complicate the management of
SCAD where anticoagulation is controversial in the context of
SCAD-associated intramural haematoma. Case summary A 65-year-old female presented with non-ST elevation myocardial infarction
with a recent diagnosis of hypertension but no other traditional
cardiovascular risk factors. There was, however, a family history of early
cardiac death from myocardial infarction affecting her mother.
Echocardiography demonstrated severe biventricular dysfunction with
circumferential akinesis of the mid to apical segments. Coronary angiography
demonstrated type 2A SCAD involving the first diagonal artery. Cardiac
magnetic resonance imaging (MRI) confirmed a diagnosis of stress
cardiomyopathy with biventricular involvement, complicated by LV apical
thrombus and a focal region of myocardial infarction. Vascular imaging
confirmed the presence of FMD. Guideline-directed heart failure therapy in
addition to clopidogrel and rivaroxaban was prescribed. Follow-up contrast
echocardiography at six-weeks confirmed resolution of LV dysfunction and
resolution of the LV thrombus with no adverse events. Discussion The dual diagnosis of SCAD and stress cardiomyopathy is uncommon. Cardiac MRI
was useful for confirming the diagnosis of stress cardiomyopathy and the
presence of LV thrombus, where anticoagulation may complicate the management
of intramural haematoma in patients with concomitant SCAD and FMD.
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Affiliation(s)
- Penni L Blazak
- Cardiology Department, Sunshine Coast University Hospital, Birtinya, Qld 4575, Australia
| | - David J Holland
- Cardiology Department, Sunshine Coast University Hospital, Birtinya, Qld 4575, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia
- School of Medicine, Griffith University, Birtinya 4757, Australia
| | - Thomas Basso
- Cardiology Department, Sunshine Coast University Hospital, Birtinya, Qld 4575, Australia
- Cardiology Department, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - Josh Martin
- Cardiology Department, Sunshine Coast University Hospital, Birtinya, Qld 4575, Australia
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10
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van Cauteren YJM, Smulders MW, Theunissen RALJ, Gerretsen SC, Adriaans BP, Bijvoet GP, Mingels AMA, van Kuijk SMJ, Schalla S, Crijns HJGM, Kim RJ, Wildberger JE, Heijman J, Bekkers SCAM. Cardiovascular magnetic resonance accurately detects obstructive coronary artery disease in suspected non-ST elevation myocardial infarction: a sub-analysis of the CARMENTA Trial. J Cardiovasc Magn Reson 2021; 23:40. [PMID: 33752696 PMCID: PMC7983380 DOI: 10.1186/s12968-021-00723-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Invasive coronary angiography (ICA) is still the reference test in suspected non-ST elevation myocardial infarction (NSTEMI), although a substantial number of patients do not have obstructive coronary artery disease (CAD). Early cardiovascular magnetic resonance (CMR) may be a useful gatekeeper for ICA in this setting. The main objective was to investigate the accuracy of CMR to detect obstructive CAD in NSTEMI. METHODS This study is a sub-analysis of a randomized controlled trial investigating whether a non-invasive imaging-first strategy safely reduced the number of ICA compared to routine clinical care in suspected NSTEMI (acute chest pain, non-diagnostic electrocardiogram, high sensitivity troponin T > 14 ng/L), and included 51 patients who underwent CMR prior to ICA. A stepwise approach was used to assess the diagnostic accuracy of CMR to detect (1) obstructive CAD (diameter stenosis ≥ 70% by ICA) and (2) an adjudicated final diagnosis of acute coronary syndrome (ACS). First, in all patients the combination of cine, T2-weighted and late gadolinium enhancement (LGE) imaging was evaluated for the presence of abnormalities consistent with a coronary etiology in any sequence. Hereafter and only when the scan was normal or equivocal, adenosine stress-perfusion CMR was added. RESULTS Of 51 patients included (63 ± 10 years, 51% male), 34 (67%) had obstructive CAD by ICA. The sensitivity, specificity and overall accuracy of the first step to diagnose obstructive CAD were 79%, 71% and 77%, respectively. Additional vasodilator stress-perfusion CMR was performed in 19 patients and combined with step one resulted in an overall sensitivity of 97%, specificity of 65% and accuracy of 86%. Of the remaining 17 patients with non-obstructive CAD, 4 (24%) had evidence for a myocardial infarction on LGE, explaining the modest specificity. The sensitivity, specificity and overall accuracy to diagnose ACS (n = 43) were 88%, 88% and 88%, respectively. CONCLUSION CMR accurately detects obstructive CAD and ACS in suspected NSTEMI. Non-obstructive CAD is common with CMR still identifying an infarction in almost one-quarter of patients. CMR should be considered as an early diagnostic approach in suspected NSTEMI. TRIAL REGISTRATION The CARMENTA trial has been registered at ClinicalTrials.gov with identifier NCT01559467.
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Affiliation(s)
- Yvonne J M van Cauteren
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Martijn W Smulders
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Suzanne C Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | | | - Alma M A Mingels
- Department of Clinical Chemistry, Maastricht UMC+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment (KEMTA), Maastricht UMC+, Maastricht, The Netherlands
| | - Simon Schalla
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jordi Heijman
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Cardiology, Maastricht UMC+, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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11
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Broncano J, Bhalla S, Caro P, Hidalgo A, Vargas D, Williamson E, Gutiérrez F, Luna A. Cardiac MRI in Patients with Acute Chest Pain. Radiographics 2020; 41:8-31. [PMID: 33337967 DOI: 10.1148/rg.2021200084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute chest pain is a common reason for visits to the emergency department. It is important to distinguish among the various causes of acute chest pain, because treatment and prognosis are substantially different among the various conditions. It is critical to exclude acute coronary syndrome (ACS), which is a major cause of hospitalization, death, and health care costs worldwide. Myocardial ischemia is defined as potential myocyte death secondary to an imbalance between oxygen supply and demand due to obstruction of an epicardial coronary artery. Unobstructed coronary artery disease can have cardiac causes (eg, myocarditis, myocardial infarction with nonobstructed coronary arteries, and Takotsubo cardiomyopathy), and noncardiac diseases can manifest with acute chest pain and increased serum cardiac biomarker levels. In the emergency department, cardiac MRI may aid in the identification of patients with non-ST-segment elevation myocardial infarction or unstable angina or ACS with unobstructed coronary artery disease, if the patient's clinical history is known to be atypical. Also, cardiac MRI is excellent for risk stratification of patients for adverse left ventricular remodeling or major adverse cardiac events. Cardiac MRI should be performed early in the course of the disease (<2 weeks after onset of symptoms). Steady-state free-precession T2-weighted MRI with late gadolinium enhancement is the mainstay of the cardiac MRI protocol. Further sequences can be used to analyze the different pathophysiologic subjacent mechanisms of the disease, such as microvascular obstruction or intramyocardial hemorrhage. Finally, cardiac MRI may provide several prognostic biomarkers that help in follow-up of these patients. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Pilar Caro
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Alberto Hidalgo
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Eric Williamson
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Fernando Gutiérrez
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESSALTA, HT Médica, Avenida el Brillante, number 36, 14012, Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.G.); Department of Radiology, HT-DADISA, HT Médica, Cádiz, Spain (P.C.); Radiology Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain (A.H.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.W.); and MRI Section, Department of Radiology, Clínica las Nieves, HT-SERCOSA, HT Médica, Jaén, Spain (A.L.)
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12
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Hassan S, Barrett CJ, Crossman DJ. Imaging tools for assessment of myocardial fibrosis in humans: the need for greater detail. Biophys Rev 2020; 12:969-987. [PMID: 32705483 PMCID: PMC7429810 DOI: 10.1007/s12551-020-00738-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Myocardial fibrosis is recognized as a key pathological process in the development of cardiac disease and a target for future therapeutics. Despite this recognition, the assessment of fibrosis is not a part of routine clinical practice. This is primarily due to the difficulties in obtaining an accurate assessment of fibrosis non-invasively. Moreover, there is a clear discrepancy between the understandings of myocardial fibrosis clinically where fibrosis is predominately studied with comparatively low-resolution medical imaging technologies like MRI compared with the basic science laboratories where fibrosis can be visualized invasively with high resolution using molecularly specific fluorescence microscopes at the microscopic and nanoscopic scales. In this article, we will first review current medical imaging technologies for assessing fibrosis including echo and MRI. We will then highlight the need for greater microscopic and nanoscopic analysis of human tissue and how this can be addressed through greater utilization of human tissue available through endomyocardial biopsies and cardiac surgeries. We will then describe the relatively new field of molecular imaging that promises to translate research findings to the clinical practice by non-invasively monitoring the molecular signature of fibrosis in patients.
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Affiliation(s)
- Summer Hassan
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Carolyn J Barrett
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - David J Crossman
- Department of Physiology, University of Auckland, Auckland, New Zealand.
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13
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Wiesmueller M, Wuest W, Heiss R, Treutlein C, Uder M, May MS. Cardiac T2 mapping: robustness and homogeneity of standardized in-line analysis. J Cardiovasc Magn Reson 2020; 22:39. [PMID: 32460852 PMCID: PMC7254724 DOI: 10.1186/s12968-020-00619-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Interpretation of T2 values remains difficult due to limited comparability across hardware and software systems and the lack of validated measurement recommendations for the number and orientation of mandatory slices. Our aims were to provide a standardized comparison of intra- and inter-individual T2 values in the short and long axes and to investigate inter-scanner reproducibility. METHOD AND MATERIALS Ninety cardiovascular magnetic resonance (CMR) studies in 30 healthy subjects were performed with three identical 1.5 T CMR scanners (same hardware and software) using a balanced steady-state free precession (bSSFP) gradient echo sequence in three short axis (SAx) and three long axis (LAx) views. A commercially available T2 mapping software package of the latest generation with automatic in-line motion correction was used for acquisition. Regions of interest were manually drawn in each of the 16 myocardial segments according to the American Heart Association (AHA) model in three SAx and three LAx acquisitions. Analysis of inter-scanner, inter-segmental, intra-segmental, inter-regional and inter-level differences was performed. RESULTS Inter-scanner reproducibility was high and the mean myocardial T2 value for all evaluated segments was 45.7 ± 3.4 ms. Significant inter-segmental variations of mean T2 values were found. Mean intra-segmental T2 values were comparable between LAx and SAx acquisitions in 72%. Significantly higher T2 values were found in apical segments and a significant disparity among different regions was found for SAx and LAx orientations. CONCLUSION Standardized cardiac T2 mapping is highly reproducible on identical CMR systems. T2 values vary significantly between single heart segments, regions, levels, and axes in young, healthy subjects.
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Affiliation(s)
- Marco Wiesmueller
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany.
| | - Wolfgang Wuest
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Christoph Treutlein
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Matthias Stefan May
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
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14
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Initial Imaging-Guided Strategy Versus Routine Care in Patients With Non-ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2020; 74:2466-2477. [PMID: 31727284 DOI: 10.1016/j.jacc.2019.09.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with non-ST-segment elevation myocardial infarction and elevated high-sensitivity cardiac troponin levels often routinely undergo invasive coronary angiography (ICA), but many do not have obstructive coronary artery disease. OBJECTIVES This study investigated whether cardiovascular magnetic resonance imaging (CMR) or computed tomographic angiography (CTA) may serve as a safe gatekeeper for ICA. METHODS This randomized controlled trial (NCT01559467) in 207 patients (age 64 years; 62% male patients) with acute chest pain, elevated high-sensitivity cardiac troponin T levels (>14 ng/l), and inconclusive electrocardiogram compared a CMR- or CTA-first strategy with a control strategy of routine clinical care. Follow-up ICA was recommended when initial CMR or CTA suggested myocardial ischemia, infarction, or obstructive coronary artery disease (≥70% stenosis). Primary efficacy and secondary safety endpoints were referral to ICA during hospitalization and 1-year outcomes (major adverse cardiac events and complications), respectively. RESULTS The CMR- and CTA-first strategies reduced ICA compared with routine clinical care (87% [p = 0.001], 66% [p < 0.001], and 100%, respectively), with similar outcome (hazard ratio: CMR vs. routine, 0.78 [95% confidence interval: 0.37 to 1.61]; CTA vs. routine, 0.66 [95% confidence interval: 0.31 to 1.42]; and CMR vs. CTA, 1.19 [95% confidence interval: 0.53 to 2.66]). Obstructive coronary artery disease after ICA was found in 61% of patients in the routine clinical care arm, in 69% in the CMR-first arm (p = 0.308 vs. routine), and in 85% in the CTA-first arm (p = 0.006 vs. routine). In the non-CMR and non-CTA arms, follow-up CMR and CTA were performed in 67% and 13% of patients and led to a new diagnosis in 33% and 3%, respectively (p < 0.001). CONCLUSIONS A novel strategy of implementing CMR or CTA first in the diagnostic process in non-ST-segment elevation myocardial infarction is a safe gatekeeper for ICA.
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15
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Batlle JC, Kirsch J, Bolen MA, Bandettini WP, Brown RKJ, Francois CJ, Galizia MS, Hanneman K, Inacio JR, Johnson TV, Khosa F, Krishnamurthy R, Rajiah P, Singh SP, Tomaszewski CA, Villines TC, Wann S, Young PM, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome. J Am Coll Radiol 2020; 17:S55-S69. [PMID: 32370978 DOI: 10.1016/j.jacr.2020.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/17/2022]
Abstract
Chest pain is a frequent cause for emergency department visits and inpatient evaluation, with particular concern for acute coronary syndrome as an etiology, since cardiovascular disease is the leading cause of death in the United States. Although history-based, electrocardiographic, and laboratory evaluations have shown promise in identifying coronary artery disease, early accurate diagnosis is paramount and there is an important role for imaging examinations to determine the presence and extent of anatomic coronary abnormality and ischemic physiology, to guide management with regard to optimal medical therapy or revascularization, and ultimately to thereby improve patient outcomes. A summary of the various methods for initial imaging evaluation of suspected acute coronary syndrome is outlined in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Juan C Batlle
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida.
| | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | | | - W Patricia Bandettini
- National Institutes of Health, Bethesda, Maryland; Society for Cardiovascular Magnetic Resonance
| | | | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joao R Inacio
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Thomas V Johnson
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; Cardiology Expert
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Ascension Healthcare Wisconsin, Milwaukee, Wisconsin; Nuclear Cardiology Expert
| | | | | | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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16
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Ge Y, Leong-Poi H. Ischemic Memory Imaging: The Quest for the Holy Grail Continues. J Am Soc Echocardiogr 2019; 32:1487-1490. [PMID: 31679582 DOI: 10.1016/j.echo.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yin Ge
- Division of Cardiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Howard Leong-Poi
- Division of Cardiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
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Ibanez B, Aletras AH, Arai AE, Arheden H, Bax J, Berry C, Bucciarelli-Ducci C, Croisille P, Dall'Armellina E, Dharmakumar R, Eitel I, Fernández-Jiménez R, Friedrich MG, García-Dorado D, Hausenloy DJ, Kim RJ, Kozerke S, Kramer CM, Salerno M, Sánchez-González J, Sanz J, Fuster V. Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 74:238-256. [PMID: 31296297 PMCID: PMC7363031 DOI: 10.1016/j.jacc.2019.05.024] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.
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Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, IIS Fundación Jiménez Díaz Hospital, Madrid, Spain.
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hakan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Jeroen Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, and Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol NIHR Cardiovascular Research Centre, University of Bristol and University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Pierre Croisille
- University Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, Department of Biomedical Imaging Sciences, University of Leeds, Leeds, United Kingdom
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Division of Cardiology, Department of Medicine, University of California, Los Angeles, California
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBERCV, Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthias G Friedrich
- Departments of Medicine & Diagnostic Radiology, McGill University, Montreal, Quebec, Canada; Department of Medicine, Heidelberg University, Heidelberg, Germany
| | - David García-Dorado
- CIBERCV, Madrid, Spain; Vall d'Hebron University Hospital and Research Institute, Universtat Autònoma de Barcelona, Barcelona, Spain
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, National Heart Research Institute Singapore, National Heart Centre, Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, and The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London, United Kingdom; Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, and Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Christopher M Kramer
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | | | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
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Future perspectives of nanoparticle-based contrast agents for cardiac magnetic resonance in myocardial infarction. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 17:329-341. [PMID: 30802547 DOI: 10.1016/j.nano.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/11/2019] [Accepted: 02/02/2019] [Indexed: 12/23/2022]
Abstract
Cardiac Magnetic Resonance (CMR), thanks to high spatial resolution and absence of ionizing radiation, has been widely used in myocardial infarction (MI) assessment to evaluate cardiac structure, function, perfusion and viability. Nevertheless, it suffers from limitations in tissue and assessment of myocardial pathophysiological changes subsequent to MI. In this issue, nanoparticle-based contrast agents offer the possibility to track biological processes at cellular and molecular level underlying the various phases of MI, infarct healing and tissue repair. In this paper, first we examine the conventional CMR protocol and its findings in MI patients. Next, we looked at how nanoparticles can help in the imaging of MI and give an overview of the major approaches currently explored. Based on the presentation of successful nanoparticle applications as contrast agents (CAs) in preclinical and clinical models, we discuss promises and outstanding challenges facing the field of CMR in MI, their translational potential and clinical application.
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Puntmann VO, Valbuena S, Hinojar R, Petersen SE, Greenwood JP, Kramer CM, Kwong RY, McCann GP, Berry C, Nagel E. Society for Cardiovascular Magnetic Resonance (SCMR) expert consensus for CMR imaging endpoints in clinical research: part I - analytical validation and clinical qualification. J Cardiovasc Magn Reson 2018; 20:67. [PMID: 30231886 PMCID: PMC6147157 DOI: 10.1186/s12968-018-0484-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/05/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality globally. Changing natural history of the disease due to improved care of acute conditions and ageing population necessitates new strategies to tackle conditions which have more chronic and indolent course. These include an increased deployment of safe screening methods, life-long surveillance, and monitoring of both disease activity and tailored-treatment, by way of increasingly personalized medical care. Cardiovascular magnetic resonance (CMR) is a non-invasive, ionising radiation-free method, which can support a significant number of clinically relevant measurements and offers new opportunities to advance the state of art of diagnosis, prognosis and treatment. The objective of the SCMR Clinical Trial Taskforce was to summarizes the evidence to emphasize where currently CMR-guided clinical care can indeed translate into meaningful use and efficient deployment of resources results in meaningful and efficient use. The objective of the present initiative was to provide an appraisal of evidence on analytical validation, including the accuracy and precision, and clinical qualification of parameters in disease context, clarifying the strengths and weaknesses of the state of art, as well as the gaps in the current evidence This paper is complementary to the existing position papers on standardized acquisition and post-processing ensuring robustness and transferability for widespread use. Themed imaging-endpoint guidance on trial design to support drug-discovery or change in clinical practice (part II), will be presented in a follow-up paper in due course. As CMR continues to undergo rapid development, regular updates of the present recommendations are foreseen.
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Affiliation(s)
- Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Silvia Valbuena
- Department of Cardiology, University Hospital La Paz, Madrid, Germany
| | - Rocio Hinojar
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of London, Barts and the London NIHR Biomedical Research Centre at Barts, London, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher M Kramer
- Department of Medicine (Cardiology) and Radiology, Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Womens' Hospital, Boston, Massachusetts, USA
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- the NIHR Leicester Cardiovascular Biomedical Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt, Germany.
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20
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Ziegler CE, Painter DM, Borawski JB, Kim RJ, Kim HW, Limkakeng AT. Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome. Crit Pathw Cardiol 2018; 17:167-171. [PMID: 30044259 DOI: 10.1097/hpc.0000000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of alternative diagnoses (diagnoses other than ACS that could explain symptoms) and incidental findings in patients presenting to the ED for potential ACS. METHODS We prospectively enrolled adult patients who presented to an academic ED from 2011 to 2015 for possible ACS and subsequently had an adenosine stress perfusion CMR as part of their diagnostic evaluation. All medical charts were reviewed to verify accurate prospective data collection and to collect follow-up data. RESULTS A total of 391 patients were included. On stress CMR, abnormalities attributable to coronary artery disease (CAD) were found in 106 (27.1%) of patients. Previously undiagnosed moderate to severe valvular disease was the most common non-CAD cardiac finding, occurring in 20 (5.1%) cases. Other alternative diagnoses were rare with 7 cases of cardiomyopathy, 1 case of aortic aneurysm, 1 case of aortic dissection, 1 case of acute myocarditis, 3 cases of pericarditis, and 2 cases of moderate pleural effusion. Cardiac incidental findings were rare. Extracardiac incidental findings were found in 79 patients (20.2%). Only 18.6% of the patients recommended for follow-up imaging had this completed within 1 year after CMR. CONCLUSIONS This experience suggests that stress CMR is useful in not only diagnosing symptomatic CAD but also potentially important non-CAD-related disease. These factors may impact their use in ED-based ACS workups.
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Affiliation(s)
| | - David M Painter
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Joseph B Borawski
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Raymond J Kim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Han W Kim
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Alexander T Limkakeng
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC
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21
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Lebrun S, Bond RM. Spontaneous coronary artery dissection (SCAD): The underdiagnosed cardiac condition that plagues women. Trends Cardiovasc Med 2018; 28:340-345. [DOI: 10.1016/j.tcm.2017.12.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
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Garg P, Saunders LC, Swift AJ, Wild JM, Plein S. Role of cardiac T1 mapping and extracellular volume in the assessment of myocardial infarction. Anatol J Cardiol 2018; 19:404-411. [PMID: 29638222 PMCID: PMC5998858 DOI: 10.14744/anatoljcardiol.2018.39586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although late gadolinium enhancement on cardiac magnetic resonance imaging remains the reference standard for scar assessment, it does not provide quantitative information about the extent of pathophysiological changes within the scar tissue. T1 mapping and extracellular volume (ECV) mapping are steadily becoming diagnostic and prognostically useful tests for in vivo myocardial histology, influencing clinical decision-making. Quantitative native T1 maps (acquired without a contrast agent) represent the longitudinal relaxation time within the myocardium and changes with myocardial extracellular water (edema, focal, or diffuse fibrosis), fat, iron, and amyloid protein content. Post-contrast ECV maps estimate the size of the extracellular space and have sensitivity in the identification of interstitial disease. Both pre- and post-contrast T1 mapping are emerging as comprehensive tools for the assessment of numerous conditions including ischemic scarring that occurs post myocardial infarction (MI). This review outlines the current evidence and potential future role of T1 mapping in MI. We conclude by highlighting some of the remaining challenges such as quality control, standardization of image acquisition for clinical practice, and automated methods for quantifying infarct size, area at risk, and myocardial salvage post MI.
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Affiliation(s)
- Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield; Sheffield-United Kingdom.
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23
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Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins! Heart Fail Rev 2018; 22:385-399. [PMID: 28432605 DOI: 10.1007/s10741-017-9609-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.
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Affiliation(s)
- Ahmed Aljizeeri
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulbaset Sulaiman
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Naji Alhulaimi
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, AB, Canada
| | - Ahmed Alsaileek
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Stillman AE, Oudkerk M, Bluemke DA, de Boer MJ, Bremerich J, Garcia EV, Gutberlet M, van der Harst P, Hundley WG, Jerosch-Herold M, Kuijpers D, Kwong RY, Nagel E, Lerakis S, Oshinski J, Paul JF, Slart RHJA, Thourani V, Vliegenthart R, Wintersperger BJ. Imaging the myocardial ischemic cascade. Int J Cardiovasc Imaging 2018; 34:1249-1263. [PMID: 29556943 DOI: 10.1007/s10554-018-1330-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/05/2018] [Indexed: 01/25/2023]
Abstract
Non-invasive imaging plays a growing role in the diagnosis and management of ischemic heart disease from its earliest manifestations of endothelial dysfunction to myocardial infarction along the myocardial ischemic cascade. Experts representing the North American Society for Cardiovascular Imaging and the European Society of Cardiac Radiology have worked together to organize the role of non-invasive imaging along the framework of the ischemic cascade. The current status of non-invasive imaging for ischemic heart disease is reviewed along with the role of imaging for guiding surgical planning. The issue of cost effectiveness is also considered. Preclinical disease is primarily assessed through the coronary artery calcium score and used for risk assessment. Once the patient becomes symptomatic, other imaging tests including echocardiography, CCTA, SPECT, PET and CMR may be useful. CCTA appears to be a cost-effective gatekeeper. Post infarction CMR and PET are the preferred modalities. Imaging is increasingly used for surgical planning of patients who may require coronary artery bypass.
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Affiliation(s)
- Arthur E Stillman
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Matthijs Oudkerk
- Center of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - David A Bluemke
- Department of Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Menko Jan de Boer
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Jens Bremerich
- Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Pim van der Harst
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - W Gregory Hundley
- Departments of Internal Medicine & Radiology, Wake Forest University, Winston-Salem, NC, USA
| | | | - Dirkjan Kuijpers
- Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Raymond Y Kwong
- Department of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital, Frankfurt/Main, Germany
| | | | - John Oshinski
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Rd NE, Atlanta, GA, 30322, USA
| | | | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vinod Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
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Abstract
PURPOSE OF REVIEW The purpose of the present paper is to analytically review the diagnostic and prognostic role of CMR in ST-segment elevation myocardial infarction (STEMI) survivors. Percutaneous coronary intervention (PCI) is the treatment of choice in patients STEMI. However, risk of future events remains substantial. Assessment of the extent of myocardial infarction (MI), cardiac function and ventricular remodelling has become the focus of recent studies. Electrocardiography, angiography and echocardiography parameters, as well as risk scores, lack sensitivity and reproducibility in predicting future cardiovascular events. A major advantage of cardiac magnetic resonance imaging (CMR) is that it provides myocardial tissue characterization. RECENT FINDINGS CMR is able to quantify both reversible and irreversible myocardial injury and correlates with future events. This review will illustrate how microvascular function indices (myocardial salvage index, presence and amount of microvascular obstruction and intramyocardial haemorrhage) detectable by CMR add prognostic information and could impact on future strategies to improve outcomes in revascularized patients.
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Aquaro GD, Di Bella G, Castelletti S, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Pontone G. Clinical recommendations of cardiac magnetic resonance, Part I: ischemic and valvular heart disease: a position paper of the working group 'Applicazioni della Risonanza Magnetica' of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2017; 18:197-208. [PMID: 28072628 DOI: 10.2459/jcm.0000000000000498] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as a reliable and accurate diagnostic tool for the evaluation of patients with cardiac disease in several clinical settings and with proven additional diagnostic and prognostic value compared with other imaging modalities. This document has been developed by the working group on the 'application of CMR' of the Italian Society of Cardiology to provide a perspective on the current state of technical advances and clinical applications of CMR and to inform cardiologists on how to implement their clinical and diagnostic pathways with the inclusion of this technique in clinical practice. The writing committee consisted of members of the working group of the Italian Society of Cardiology and two external peer reviewers with acknowledged experience in the field of CMR.
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Affiliation(s)
- Giovanni Donato Aquaro
- aU.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa bUO Cardiologia, Università di Messina, Messina cIstituto Auxologico Italiano, Milano dDepartment of Cardiovascular, Respiratory, Geriatric, Anesthesiologic and Nephrologic Sciences, Sapienza University of Rome, Rome, Italy eCentre for Cardiac MR, Cardiology Unit, University Hospital Lausanne, Lausanne, Switzerland fU.O. Radiologia Diagnostica, Humanitas Hospital, Milan gDivision of Cardiology, Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piemont University, Novara hU.O. Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università di Padova, Padua iUnità Operativa di Cardiologia Universitaria Dipartimento di Emergenze e Trapianti di Organi (D.E.T.O.) Azienda Ospedaliera Policlinico Consorziale di Bari, Bari jLaboratorio di RM Cardiovascolare Divisione di Cardiologia Clinica Villa dei Fiori, Acerra kU.O. Cardiologia, Centro Cardiologico Monzino, Milano, Italy
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Katragadda S, Alagesan M, Rathakrishnan S, Kaliyaperumal D, Mambatta AK. Correlation of Reciprocal Changes and QRS Amplitude in ECG to Left Ventricular Dysfunction, Wall Motion Score and Clinical Outcome in First Time ST Elevation Myocardial Infarction. J Clin Diagn Res 2017; 11:OC04-OC08. [PMID: 28892952 PMCID: PMC5583838 DOI: 10.7860/jcdr/2017/26021.10155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/25/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Electrocardiogram (ECG) is the simplest tool for diagnosing ST Elevation Myocardial Infarction (STEMI). We can use a12 lead ECG for prognostication purposes also. AIM The aim of the study was to find out the role of ECG as a prognostic marker in terms of clinical outcome and wall motion abnormality. MATERIALS AND METHODS It was a prospective study done in PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, from January 2014 to September 2014. Patients aged above 18 years admitted with first episode of ST EMI as per the inclusion and exclusion criteria were recruited for the study. Presence of reciprocal changes and QRS amplitude was measured from ECG. Presence of Left Ventricular Dysfunction (LVD) and wall motion score were calculated from ECG along with clinical outcome during first follow up visit. Statistical analysis was done using SPSS software. Probability was calculated using chi-square test, independent t-test and ANOVA analysis. RESULTS A total of 120 patients were recruited for the study of which six were excluded based on the exclusion criteria. Among 114 patients analysed, 55 had reciprocal changes; 38 of them developed LVD which was statistically significant (p=0.002). Of the 78 patients with Anterior Wall Myocardial Infarction (AWMI), 35 had reciprocal changes; 15 (42.9%) of them had NYHA Class 1 symptoms, 14 (40%) had Class II and 4 (11%) had class III symptoms at follow up. The association was statistically significant (p=0.001). Similar statistically significant association was found in patients with Inferior Wall Myocardial Infarction (IWMI) who had reciprocal changes and NYHA symptoms at follow up (p=0.004). The mean wall motion score in patients with AWMI and reciprocal changes was 24.83 ± 4.1; whereas, without reciprocal changes was 23.98 ± 3.6; the association was not statistically significant. The mean QRS amplitude of all patients with LVD was 33.25 ±16.34. The association between QRS amplitude and LVD was not statistically significant. The overall mean wall motion score was 24.86 ± 3.91. The association between QRS amplitude and wall motion score was statistically significant (r value = 0.210). The association between QRS amplitude and wall motion score was statistically significant when we analysed AWMI (r= -0.147, p=0.199) and IWMI (r= -0.359, p=0.031) separately. CONCLUSION ECG can be used as a tool for prognostication in acute STEMI. The presence of reciprocal changes in the ECG can signify poorer outcome on follow up. Lower QRS amplitude can be used as a predictor of larger infarct.
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Affiliation(s)
- Silpita Katragadda
- Registrar, Department of Infectious Diseases, Apollo Health City Campus, Jubilee Hills, Hyderabad, Telangana, India
| | - Murali Alagesan
- Professor, Department of General Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shanmugasundaram Rathakrishnan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Deepalakshmi Kaliyaperumal
- Associate Professor, Department of Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Anith Kumar Mambatta
- Associate Professor, Department of General Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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28
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Saremi F. Cardiac MR Imaging in Acute Coronary Syndrome: Application and Image Interpretation. Radiology 2017; 282:17-32. [PMID: 28005512 DOI: 10.1148/radiol.2016152849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute coronary syndrome (ACS) is a frequent cause of hospitalization and coronary interventions. Cardiac magnetic resonance (MR) imaging is an increasingly used technique for initial work-up of chest pain and early post-reperfusion and follow-up evaluation of ACS to identify patients at high risk of further cardiac events. Cardiac MR imaging can evaluate with accuracy a variety of prognostic indicators of myocardial damage, including regional myocardial dysfunction, infarct distribution, infarct size, myocardium at risk, microvascular obstruction, and intramyocardial hemorrhage in both acute setting and later follow-up examinations. In addition, MR imaging is useful to rule out other causes of acute chest pain in patients admitted to the emergency department. In this article, a brief explanation of the pathophysiology, classification, and treatment options for patients with ACS will be introduced. Indications of cardiac MR imaging in ACS patients will be reviewed and specific cardiac MR protocol, image interpretation, and potential diagnostic pitfalls will be discussed. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Farhood Saremi
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles CA 90033
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Schmidt EJ, Watkins RD, Zviman MM, Guttman MA, Wang W, Halperin HA. A Magnetic Resonance Imaging-Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005091. [PMID: 27729363 DOI: 10.1161/circimaging.116.005091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Subjects undergoing cardiac arrest within a magnetic resonance imaging (MRI) scanner are currently removed from the bore and then from the MRI suite, before the delivery of cardiopulmonary resuscitation and defibrillation, potentially increasing the risk of mortality. This precludes many higher-risk (acute ischemic and acute stroke) patients from undergoing MRI and MRI-guided intervention. An MRI-conditional cardiac defibrillator should enable scanning with defibrillation pads attached and the generator ON, enabling application of defibrillation within the seconds of MRI after a cardiac event. An MRI-conditional external defibrillator may improve patient acceptance for MRI procedures. METHODS AND RESULTS A commercial external defibrillator was rendered 1.5 Tesla MRI-conditional by the addition of novel radiofrequency filters between the generator and commercial disposable surface pads. The radiofrequency filters reduced emission into the MRI scanner and prevented cable/surface pad heating during imaging, while preserving all the defibrillator monitoring and delivery functions. Human volunteers were imaged using high specific absorption rate sequences to validate MRI image quality and lack of heating. Swine were electrically fibrillated (n=4) and thereafter defibrillated both outside and inside the MRI bore. MRI image quality was reduced by 0.8 or 1.6 dB, with the generator in monitoring mode and operating on battery or AC power, respectively. Commercial surface pads did not create artifacts deeper than 6 mm below the skin surface. Radiofrequency heating was within US Food and Drug Administration guidelines. Defibrillation was completely successful inside and outside the MRI bore. CONCLUSIONS A prototype MRI-conditional defibrillation system successfully defibrillated in the MRI without degrading the image quality or increasing the time needed for defibrillation. It can increase patient acceptance for MRI procedures.
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Affiliation(s)
- Ehud J Schmidt
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.).
| | - Ronald D Watkins
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Menekhem M Zviman
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Michael A Guttman
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Wei Wang
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Henry A Halperin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
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30
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Layland J, Rauhalammi S, Lee MMY, Ahmed N, Carberry J, Teng Yue May V, Watkins S, McComb C, Mangion K, McClure JD, Carrick D, O'Donnell A, Sood A, McEntegart M, Oldroyd KG, Radjenovic A, Berry C. Diagnostic Accuracy of 3.0-T Magnetic Resonance T1 and T2 Mapping and T2-Weighted Dark-Blood Imaging for the Infarct-Related Coronary Artery in Non-ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.116.004759. [PMID: 28364045 PMCID: PMC5532996 DOI: 10.1161/jaha.116.004759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with recent non-ST-segment elevation myocardial infarction commonly have heterogeneous characteristics that may be challenging to assess clinically. METHODS AND RESULTS We prospectively studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1 established (T2-weighted short tau inversion recovery [T2W-STIR]) magnetic resonance imaging methods for imaging the ischemic area at risk and myocardial salvage in 73 patients with non-ST-segment elevation myocardial infarction (mean age 57±10 years, 78% male) at 3.0-T magnetic resonance imaging within 6.5±3.5 days of invasive management. The infarct-related territory was identified independently using a combination of angiographic, ECG, and clinical findings. The presence and extent of infarction was assessed with late gadolinium enhancement imaging (gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was independently assessed with native T1, T2, and T2W-STIR methods. The mean infarct size was 5.9±8.0% of left ventricular mass. The infarct zone T1 and T2 times were 1323±68 and 57±5 ms, respectively. The diagnostic accuracies of T1 and T2 mapping for identification of the infarct-related artery were similar (P=0.125), and both were superior to T2W-STIR (P<0.001). The extent of myocardial injury (percentage of left ventricular volume) estimated with T1 (15.8±10.6%) and T2 maps (16.0±11.8%) was similar (P=0.838) and moderately well correlated (r=0.82, P<0.001). Mean extent of acute injury estimated with T2W-STIR (7.8±11.6%) was lower than that estimated with T1 (P<0.001) or T2 maps (P<0.001). CONCLUSIONS In patients with non-ST-segment elevation myocardial infarction, T1 and T2 magnetic resonance imaging mapping have higher diagnostic performance than T2W-STIR for identifying the infarct-related artery. Compared with conventional STIR, T1 and T2 maps have superior value to inform diagnosis and revascularization planning in non-ST-segment elevation myocardial infarction. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.
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Affiliation(s)
- Jamie Layland
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Samuli Rauhalammi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Matthew M Y Lee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Nadeem Ahmed
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Jaclyn Carberry
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Vannesa Teng Yue May
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Christie McComb
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Kenneth Mangion
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - John D McClure
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - David Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Anna O'Donnell
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Arvind Sood
- Hairmyres Hospital, East Kilbride, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Aleksandra Radjenovic
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom .,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
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Azarisman SM, Teo KS, Worthley MI, Worthley SG. Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome. J Int Med Res 2017; 45:1680-1692. [PMID: 29239257 PMCID: PMC5805198 DOI: 10.1177/0300060517698265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chest pain is an important presenting symptom. However, few cases of chest pain
are diagnosed as acute coronary syndrome (ACS) in the acute setting. This
results in frequent inappropriate discharge and major delay in treatment for
patients with underlying ACS. The conventional methods of assessing ACS, which
include electrocardiography and serological markers of infarct, can take time to
manifest. Recent studies have investigated more sensitive and specific imaging
modalities that can be used. Diastolic dysfunction occurs early following
coronary artery occlusion and its detection is useful in confirming the
diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic
resonance provides a single imaging modality for comprehensive evaluation of
chest pain in the acute setting. In particular, cardiac magnetic resonance has
many imaging techniques that assess diastolic dysfunction post-coronary artery
occlusion. Techniques such as measurement of left atrial size, mitral inflow,
and mitral annular and pulmonary vein flow velocities with phase-contrast
imaging enable general assessment of ventricular diastolic function. More novel
imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and
myocardial tagging, allow early determination of regional diastolic dysfunction
and oedema. These findings may correspond to specific infarcted arteries that
may be used to tailor eventual percutaneous coronary artery intervention.
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Affiliation(s)
- Shah M. Azarisman
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
- Department of Internal Medicine,
International Islamic University Malaysia, Pahang, Malaysia
- Shah M Azarisman, Professor of Medicine,
International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar
InderaMahkota, 25200 Kuantan, Pahang, Malaysia.
| | - Karen S Teo
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal
Adelaide Hospital, Adelaide, South Australia
- Department of Medicine, University of
Adelaide, Adelaide, South Australia
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Mavrogeni S, Markousis-Mavrogenis G, Koutsogeorgopoulou L, Dimitroulas T, Bratis K, Kitas GD, Sfikakis P, Tektonidou M, Karabela G, Stavropoulos E, Katsifis G, Boki KA, Kitsiou A, Filaditaki V, Gialafos E, Plastiras S, Vartela V, Kolovou G. Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases. Int J Cardiol 2017; 236:151-156. [PMID: 28185705 DOI: 10.1016/j.ijcard.2017.01.104] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND-AIM Cardiac involvement at diagnosis of connective tissue disease (CTD) has been described by echocardiography. We hypothesized that cardio-vascular magnetic resonance (CMR) detects occult lesions at CTD diagnosis. PATIENTS-METHODS CMR was performed early after diagnosis in 78 treatment-naïve CTDs (aged 43±11, 59F/19M) without cardiac involvement [5 Takayasu arteritis (TA), 4 Churg Strauss syndrome (CSS), 5 Wegener granulomatosis (WG), 16 systemic lupus erythematosus (SLE), 12 rheumatoid arthritis (RA), 8 mixed connective tissue diseases (MCTD), 12 ankylosing spondylitis (AS), 3 polymyalgia rheumatica (PMR), 8 systemic sclerosis (SSc) and 5 dermatomyositis (DM)]. Acute and chronic lesions were assessed by T2>2 with positive LGE and T2<2 with positive LGE, respectively. RESULTS In 3/5 TA, 3/4 CSS, 4/5 WG, 10/16 SLE, 9/12 RA, 6/8 MCTD, 4/12 AS, 1/3 PMR, 2/8 SSc and 2/5 DM, the T2 ratio was higher compared to normal (2.78±0.25 vs 1.5±0.2, p<0.01). Myocarditis was identified in 1 TA, 1 SLE, 1 RA, 1 SSc and 2 DM patients; diffuse, subendocardial fibrosis in 1 CSS and 1 RA patient, while subendocardial myocardial infarction in 3 SLE, 1 MCTD, 1 PMR and 2 RA patients. CMR re-evaluation after 6 and 12months of rheumatic and cardiac treatment, available in 28/52 CTDs with increased T2 ratio, showed significant improvement in T2 ratio (p<0.001), non-significant change in LGE extent and normalisation of those with impaired LV function. CONCLUSIONS Occult CMR lesions, including oedema, myocarditis, diffuse subendocardial fibrosis and myocardial infarction are not unusual in treatment naïve CTDs and may be reversed with appropriate treatment.
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Affiliation(s)
| | | | | | - Theodoros Dimitroulas
- Department of Rheumatology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George D Kitas
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
| | - Petros Sfikakis
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | - Maria Tektonidou
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | | | | | | | | | | | | | - Elias Gialafos
- Joint Academic Rheumatology Program, National and Kapodistrian University of Athens Medical School, Greece
| | - Sotiris Plastiras
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
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Tweet MS, Gulati R, Williamson EE, Vrtiska TJ, Hayes SN. Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women. JACC Cardiovasc Imaging 2017; 9:436-50. [PMID: 27056163 DOI: 10.1016/j.jcmg.2016.01.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/12/2016] [Accepted: 01/28/2016] [Indexed: 12/15/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) has gained attention as a key cause of acute coronary syndrome and sudden cardiac death among women. Recent advancements in cardiac imaging have improved identification and accelerated awareness of SCAD. Accurate diagnosis of SCAD through use of imaging is critical, as emerging evidence suggests that the optimal short- and long-term management strategies for women with SCAD differs substantially from that of women with atherosclerotic coronary disease. This review summarizes the application of both invasive and noninvasive imaging for the diagnosis, assessment, surveillance, and treatment of women affected by SCAD.
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Affiliation(s)
- Marysia S Tweet
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Eric E Williamson
- Division of Cardiovascular Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Terri J Vrtiska
- Division of Abdominal Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Sharonne N Hayes
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
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Jeserich M, Merkely B, Schlosser P, Kimmel S, Pavlik G, Achenbach S. Assessment of edema using STIR+ via 3D cardiovascular magnetic resonance imaging in patients with suspected myocarditis. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 30:309-316. [DOI: 10.1007/s10334-016-0603-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/04/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
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35
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Wong C, Chen S, Iyngkaran P. Cardiac Imaging in Heart Failure with Comorbidities. Curr Cardiol Rev 2017; 13:63-75. [PMID: 27492227 PMCID: PMC5324322 DOI: 10.2174/1573403x12666160803100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.
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Affiliation(s)
- Chiew Wong
- Flinders University, NT Medical School, Darwin Australia
| | - Sylvia Chen
- Flinders University, NT Medical School, Darwin Australia
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36
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Lee WW. Recent Advances in Nuclear Cardiology. Nucl Med Mol Imaging 2016; 50:196-206. [PMID: 27540423 DOI: 10.1007/s13139-016-0433-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022] Open
Abstract
Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine.
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Affiliation(s)
- Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
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Verbrugge FH, Bertrand PB, Willems E, Gielen E, Mullens W, Giri S, Tang WW, Raman SV, Verhaert D. Global myocardial oedema in advanced decompensated heart failure. Eur Heart J Cardiovasc Imaging 2016; 18:787-794. [DOI: 10.1093/ehjci/jew131] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/29/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Frederik H. Verbrugge
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Philippe B. Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Endry Willems
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ellen Gielen
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium
| | | | - W.H. Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - David Verhaert
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium
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Smulders MW, Kietselaer BL, Schalla S, Bucerius J, Jaarsma C, van Dieijen-Visser MP, Mingels AM, Rocca HPBL, Post M, Das M, Crijns HJ, Wildberger JE, Bekkers SC. Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging? Am Heart J 2016; 177:102-11. [PMID: 27297855 DOI: 10.1016/j.ahj.2016.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.
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Abstract
Noninvasive cardiac imaging has an important role in the assessment of patients with acute-onset chest pain. In patients with suspected acute coronary syndrome (ACS), cardiac imaging offers incremental value over routine clinical assessment, the electrocardiogram, and blood biomarkers of myocardial injury, to confirm or refute the diagnosis of coronary artery disease and to assess future cardiovascular risk. This Review covers the current guidelines and clinical use of the common noninvasive imaging techniques, including echocardiography and stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, positron emission tomography, and cardiovascular magnetic resonance imaging, in patients with suspected ACS, and provides an update on the developments in noninvasive imaging techniques in the past 5 years.
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40
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Maffei E, Seitun S, Guaricci AI, Cademartiri F. Chest pain: coronary CT in the ER. Br J Radiol 2016; 89:20150954. [PMID: 26866681 PMCID: PMC4985473 DOI: 10.1259/bjr.20150954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 01/16/2023] Open
Abstract
Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection of subclinical CAD and plaque imaging offer the opportunity to improve risk stratification. Moreover, recent advances of the latest generation CT scanners allow combining both anatomical and functional imaging by stress myocardial perfusion. The role of cardiac CT in acute settings is already important and will become progressively more important in the coming years.
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Affiliation(s)
- Erica Maffei
- Centre de Recherché/Department of Radiology, Montréal Heart Institute/Universitè de Montréal, Montréal, Quebec, Canada
| | - Sara Seitun
- Department of Radiology, IRCCS San Martino University Hospital—IST, Genoa, Italy
| | | | - Filippo Cademartiri
- Centre de Recherché/Department of Radiology, Montréal Heart Institute/Universitè de Montréal, Montréal, Quebec, Canada
- Department of Radiology, Erasmus Medical Center University, Rotterdam, Netherlands
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41
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Yeh FC, Liu L, Hitchens TK, Wu YL. Mapping immune cell infiltration using restricted diffusion MRI. Magn Reson Med 2016; 77:603-612. [PMID: 26843524 DOI: 10.1002/mrm.26143] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Diffusion MRI provides a noninvasive way to assess tissue microstructure. Based on diffusion MRI, we propose a model-free method called restricted diffusion imaging (RDI) to quantify restricted diffusion and correlate it with cellularity. THEORY AND METHODS An analytical relation between q-space signals and the density of restricted spins was derived to quantify restricted diffusion. A phantom study was conducted to investigate the performance of RDI, and RDI was applied to an animal study to assess immune cell infiltration in myocardial tissues with ischemia-reperfusion injury. RESULTS Our phantom study showed a correlation coefficient of 0.998 between cell density and the restricted diffusion quantified by RDI. The animal study also showed that the high-value regions in RDI matched well with the macrophage infiltration areas in the H&E stained slides. In comparison with diffusion tensor imaging (DTI), RDI exhibited its outperformance to detect macrophage infiltration and delineate inflammatory myocardium. CONCLUSION RDI can be used to reveal cell density and detect immune cell infiltration. RDI exhibits better specificity than the diffusivity measurement derived from DTI. Magn Reson Med 77:603-612, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Fang-Cheng Yeh
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Li Liu
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - T Kevin Hitchens
- Animal Imaging Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Neurobiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yijen L Wu
- Rangos Research Center Animal Imaging Core, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Developmental Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Radiol 2016; 13:e1-e29. [PMID: 26810814 DOI: 10.1016/j.jacr.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/02/2023]
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Rybicki FJ, Udelson JE, Peacock WF, Goldhaber SZ, Isselbacher EM, Kazerooni E, Kontos MC, Litt H, Woodard PK. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol 2016; 67:853-79. [PMID: 26809772 DOI: 10.1016/j.jacc.2015.09.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bogaert J, Eitel I. Role of cardiovascular magnetic resonance in acute coronary syndrome. Glob Cardiol Sci Pract 2016; 2015:24. [PMID: 26779508 PMCID: PMC4614331 DOI: 10.5339/gcsp.2015.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/30/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jan Bogaert
- KU Leuven - University of Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology, Angiology, Intensive care medicine), Lübeck, Germany
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Hatem SN, Redheuil A, Gandjbakhch E. Cardiac adipose tissue and atrial fibrillation: the perils of adiposity. Cardiovasc Res 2016; 109:502-9. [PMID: 26790475 DOI: 10.1093/cvr/cvw001] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/09/2015] [Indexed: 12/25/2022] Open
Abstract
The amount of adipose tissue that accumulates around the atria is associated with the risk, persistence, and severity of atrial fibrillation (AF). A strong body of clinical and experimental evidence indicates that this relationship is not an epiphenomenon but is the result of complex crosstalk between the adipose tissue and the neighbouring atrial myocardium. For instance, epicardial adipose tissue is a major source of adipokines, inflammatory cytokines, or reactive oxidative species, which can contribute to the fibrotic remodelling of the atrial myocardium. Fibro-fatty infiltrations of the subepicardium could also contribute to the functional disorganization of the atrial myocardium. The observation that obesity is associated with distinct structural and functional remodelling of the atria has opened new perspectives of treating AF substrate with aggressive risk factor management. Advances in cardiac imaging should lead to an improved ability to visualize myocardial fat depositions and to localize AF substrates.
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Affiliation(s)
- Stéphane N Hatem
- Sorbonne University, Faculté de médicine, Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière Hospital, INSERM UMR_S1166, Cardiology Department, Institute of Cardiometabolism and Nutrition-ICAN, 91, boulevard de l'hôpital, 75013 Paris, France
| | - Alban Redheuil
- Sorbonne Universités, Université Pierre et Marie Curie UPMC, Laboratoire d'imagerie biomédicale INSERM UMR_S1146, Cardiovascular Imaging Department, ICAN Imaging Core Lab, Paris, France
| | - Estelle Gandjbakhch
- Sorbonne University, Faculté de médicine, Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière Hospital, INSERM UMR_S1166, Cardiology Department, Institute of Cardiometabolism and Nutrition-ICAN, 91, boulevard de l'hôpital, 75013 Paris, France
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Dastidar AG, Rodrigues JCL, Baritussio A, Bucciarelli-Ducci C. MRI in the assessment of ischaemic heart disease. Heart 2015; 102:239-52. [DOI: 10.1136/heartjnl-2014-306963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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ACR Appropriateness Criteria Acute Nonspecific Chest Pain—Low Probability of Coronary Artery Disease. J Am Coll Radiol 2015; 12:1266-71. [DOI: 10.1016/j.jacr.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 11/24/2022]
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Guaricci AI, Brunetti ND, Marra MP, Tarantini G, di Biase M, Pontone G. Diagnosis and prognosis of ischemic heart disease. J Cardiovasc Med (Hagerstown) 2015; 16:653-62. [DOI: 10.2459/jcm.0000000000000267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Schroeder J, Hamada S, Gründlinger N, Rubeau T, Altiok E, Ulbrich K, Keszei A, Marx N, Becker M. Myocardial deformation by strain echocardiography identifies patients with acute coronary syndrome and non-diagnostic ECG presenting in a chest pain unit: a prospective study of diagnostic accuracy. Clin Res Cardiol 2015; 105:248-56. [PMID: 26349786 DOI: 10.1007/s00392-015-0916-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of patients with non-cardiac chest pain is an enormous cost factor. METHODS 2315 patients who presented in the chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS) were screened. All patients with relevant changes in ECG or myocardial enzymes were excluded. 268 consecutive patients (mean 58 ± 7 years, 88 men) were prospectively included and underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) and strain parameter and a coronary angiography (CA) within 2 ± 1 days after admission. RESULTS Anatomically obstructive coronary artery disease (CAD) (≥70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (χ (2) = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients. CONCLUSIONS In patients with suspected ACS but without ECG changes or myocardial enzyme abnormalities, myocardial deformation imaging can identify patients at risk. This approach may be applied to improve decision guidance at the CPU for fast discharge of patients with non-cardiac chest pain or prompt cardiological allocation of patients with CAD. CLINICAL TRIAL REGISTRATION NCT 02357641.
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Affiliation(s)
- Joerg Schroeder
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sandra Hamada
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nina Gründlinger
- Department of Internal Medicine, Hospital St. Brigida, Simmerath, Germany
| | - Tanja Rubeau
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Katrin Ulbrich
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andras Keszei
- Department of Medical Statistics, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Michael Becker
- Department of Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
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