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Paim LR, da Silva LM, Antunes-Correa LM, Ribeiro VC, Schreiber R, Minin EO, Bueno LC, Lopes EC, Yamaguti R, Coy-Canguçu A, Dertkigil SSJ, Sposito A, Matos-Souza JR, Quinaglia T, Neilan TG, Velloso LA, Nadruz W, Jerosch-Herold M, Coelho-Filho OR. Profile of serum microRNAs in heart failure with reduced and preserved ejection fraction: Correlation with myocardial remodeling. Heliyon 2024; 10:e27206. [PMID: 38515724 PMCID: PMC10955197 DOI: 10.1016/j.heliyon.2024.e27206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Background and aims Cardiomyocyte hypertrophy and interstitial fibrosis are key components of myocardial remodeling in Heart Failure (HF) with preserved (HFpEF) or reduced ejection fraction (HFrEF). MicroRNAs (miRNAs) are non-coding, evolutionarily conserved RNA molecules that may offer novel insights into myocardial remodeling. This study aimed to characterize miRNA expression in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%) and its association with myocardial remodeling. Methods Prospectively enrolled symptomatic HF patients (HFpEF:n = 36; HFrEF:n = 31) and controls (n = 23) underwent cardiac magnetic resonance imaging with T1-mapping and circulating miRNA expression (OpenArray system). Results 13 of 188 miRNAs were differentially expressed between HF groups (11 downregulated in HFpEF). Myocardial extracellular volume (ECV) was increased in both HF groups (HFpEF 30 ± 5%; HFrEF 30 ± 3%; controls 26 ± 2%, p < 0.001). miR-128a-3p, linked to cardiac hypertrophy, fibrosis, and dysfunction, correlated positively with ECV in HFpEF (r = 0.60, p = 0.01) and negatively in HFrEF (r = - 0.51, p = 0.04). miR-423-5p overexpression, previously associated HF mortality, was inversely associated with LVEF (r = - 0.29, p = 0.04) and intracellular water lifetime (τ ic) (r = - 0.45, p < 0.05) in both HF groups, and with NT-proBNP in HFpEF (r = - 0.63, p < 0.01). Conclusions miRNA expression profiles differed between HF phenotypes. The differential expression and association of miR-128a-3p with ECV may reflect the distinct vascular, interstitial, and cellular etiologies of HF phenotypes.
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Affiliation(s)
- Layde Rosane Paim
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Luis Miguel da Silva
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | | | - Roberto Schreiber
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Eduarda O.Z. Minin
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Larissa C.M. Bueno
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Elisangela C.P. Lopes
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Renan Yamaguti
- Faculdade de Engenharia Elétrica e de Computação – Universidade Estadual de Campinas, São Paulo, Brazil
| | - Andréa Coy-Canguçu
- Faculdade de Medicina – Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | | | - Andrei Sposito
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Thiago Quinaglia
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tomas G. Neilan
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Licio A. Velloso
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Michael Jerosch-Herold
- Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Liu J, Qu Y, Li J, He W, Chen X, Li X, Wang Y, Tang H, Yuan Y, Deng L, Chen G, Zheng T, Nie L, Zhou X, Song B, Tong N, Peng L. Myocardial tissue remodeling in early adult obesity and its association with regional adipose tissue distribution and ectopic fat deposits: a prospective study. Eur Radiol 2024; 34:970-980. [PMID: 37572193 DOI: 10.1007/s00330-023-10081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/16/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To evaluate the left ventricular (LV) myocardial tissue characteristics in early adult obesity and its association with regional adipose tissue and ectopic fat deposition. METHODS Forty-nine obese adults (mean body mass index: 29.9 ± 2.0 kg/m2) and 44 healthy controls were prospectively studied. LV native and post-contrast T1 values, extracellular volume fraction (ECV), regional adipose tissue (epicardial, visceral, and subcutaneous adipose tissue (EAT, VAT, and SAT)), and ectopic fat deposition (hepatic and pancreatic proton density fat fractions (H-PDFF and P-PDFF)) based on magnetic resonance imaging were compared. The association was assessed by multivariable linear regression. RESULTS The obese participants showed reduced global ECV compared to the healthy controls (p < 0.05), but there was no significant difference in global native or post-contrast T1 values between the two groups. Additionally, the obese individuals exhibited higher EAT, VAT, SAT, H-PDFF, and P-PDFF than the controls (p < 0.05). ECV was associated with insulin resistance, dyslipidemia, and systolic blood pressure (SBP) (p < 0.05). Multiple linear regression demonstrated that H-PDFF and SAT were independently associated with ECV in entire population (β = - 0.123 and - 0.012; p < 0.05). CONCLUSIONS Reduced myocardial ECV in patients with mild-to-moderate obesity and its relationship to SBP may indicate that cardiomyocyte hypertrophy, rather than extracellular matrix expansion, is primarily responsible for myocardial tissue remodeling in early adult obesity. Our findings further imply that H-PDFF and SAT are linked with LV myocardial tissue remodeling in this cohort beyond the growth difference and cardiovascular risk factors. CLINICAL TRIALS REGISTRATION Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476). CLINICAL RELEVANCE STATEMENT Myocardial fibrosis in severe obesity predicts poor prognosis. We showed that cardiomyocyte hypertrophy, not myocardial fibrosis, is the main myocardial tissue characteristic of early obesity. This finding raises the possibility that medical interventions, like weight loss, may prevent cardiac fibrosis. KEY POINTS • Myocardial tissue characteristics in early adult obesity are unclear. • Myocardial extracellular volume fraction (ECV) can be quantitatively evaluated using T1 mapping based on cardiac magnetic resonance imaging (MRI). • Cardiac MRI-derived ECV may noninvasively evaluate myocardial tissue remodeling in early adult obesity.
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Affiliation(s)
- Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yali Qu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Jing Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yinqiu Wang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Yuan Yuan
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Liping Deng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Guoyong Chen
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Tianying Zheng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, 200126, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
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Liu X, Du H, Pan Y, Li X. New insights into the effect of VMP1 on the treatment of pressure overload-induced pathological cardiac hypertrophy: Involving SERCA-regulated autophagic flux. Microvasc Res 2023; 150:104572. [PMID: 37353069 DOI: 10.1016/j.mvr.2023.104572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/08/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
Pathological cardiac hypertrophy is an adaptive reaction in response to pressure or volume overload. Autophagy is critical for damage caused by pathological cardiac hypertrophy. Vacuole membrane protein 1 (VMP1) is an endoplasmic reticulum (ER) transmembrane protein that is effective in activating autophagy. However, the role of VMP1 in pathological cardiac hypertrophy and its underlying mechanisms remain elusive. This study was designed to explore the potential mechanisms of VMP1 on pressure overload-induced pathological cardiac hypertrophy. In this work, abdominal aorta constriction (AAC) surgery was used to induce pathological cardiac hypertrophy in male C57BL/6 mice. H9C2 cardiomyocytes were treated with phenylephrine stimulation (PE) to induce the hypertrophic response. The in vivo results revealed that mice with AAC surgery caused pathological cardiac hypertrophy as evidenced by improved cardiac function according to multiple echocardiographic parameters. Moreover, elevated VMP1 expression was also observed in mice after AAC surgery. VMP1 knockdown aggravated changes in cardiac structure, cardiac dysfunction, and fibrosis. Meanwhile, VMP1 knockdown suppressed autophagy and endoplasmic reticulum calcium ATPase (SERCA) activity in heart tissues. H9C2 cardiomyocytes with VMP1 overexpression were used to investigate the specific mechanism of VMP1 in pathological cardiac hypertrophy, and VMP1 overexpression increased autophagic flux by upregulating SERCA activity. In conclusion, these findings revealed that VMP1 protected against pressure overload-induced pathological cardiac hypertrophy by inducing SERCA-regulated autophagic flux. Our results provide valuable insights regarding the pathophysiology of pathological cardiac hypertrophy and clues to a novel target for the treatment of pathological cardiac hypertrophy.
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Affiliation(s)
- Xue Liu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
| | - Hongjiao Du
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yilong Pan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xiaodong Li
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
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Doughan M, Chehab O, de Vasconcellos HD, Zeitoun R, Varadarajan V, Doughan B, Wu CO, Blaha MJ, Bluemke DA, Lima JAC. Periodontal Disease Associated With Interstitial Myocardial Fibrosis: The Multiethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e8146. [PMID: 36718872 PMCID: PMC9973639 DOI: 10.1161/jaha.122.027974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Periodontitis is a chronic inflammatory disease common among adults. It has been suggested that periodontal disease (PD) may be a contributing risk factor for cardiovascular disease; however, pathways underlying such a relationship require further investigation. Methods and Results A total of 665 men (mean age 68±9 years) and 611 women (mean age 67±9 years) enrolled in the MESA (Multiethnic Study of Atherosclerosis) underwent PD assessment using a 2-item questionnaire at baseline (2000-2002) and had cardiovascular magnetic resonance 10 years later. PD was defined when participants reported either a history of periodontitis or gum disease or lost teeth caused by periodontitis or gum disease. Multivariable linear regression models were constructed to assess the associations of baseline self-reported PD with cardiovascular magnetic resonance-obtained measures of interstitial myocardial fibrosis (IMF), including extracellular volume and native T1 time. Men with a self-reported history of PD had greater extracellular volume percent (ß=0.6%±0.2, P=0.01). This association was independent of age, left ventricular mass, traditional cardiovascular risk factors, and history of myocardial infarction. In a subsequent model, substituting myocardial infarction for coronary artery calcium score, the association of PD with IMF remained significant (ß=0.6%±0.3, P=0.03). In women, a self-reported history of PD was not linked to higher IMF. Importantly, a self-reported history of PD was not found to be associated with myocardial scar independent of sex (odds ratio, 1.01 [95% CI, 0.62-1.65]; P=0.9). Conclusions In a community-based setting, men but not women with a self-reported PD history at baseline were found to be associated with increased measures of IMF. These findings support a plausible link between PD, a proinflammatory condition, and subclinical IMF.
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Affiliation(s)
- Maria Doughan
- Division of Orthodontics, Department of DentistryUniversity of MarylandBaltimoreMD
| | - Omar Chehab
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | | | - Ralph Zeitoun
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Vinithra Varadarajan
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Bassel Doughan
- Faculty of Dental SurgeryCôte d’Azur UniversityNiceFrance
| | - Colin O. Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of HealthBethesdaMD
| | - Michael J Blaha
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - David A. Bluemke
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HeathMadisonWI
| | - Joao A. C. Lima
- Division of Cardiology, Department of MedicineJohns Hopkins UniversityBaltimoreMD
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Fotaki A, Velasco C, Prieto C, Botnar RM. Quantitative MRI in cardiometabolic disease: From conventional cardiac and liver tissue mapping techniques to multi-parametric approaches. Front Cardiovasc Med 2023; 9:991383. [PMID: 36756640 PMCID: PMC9899858 DOI: 10.3389/fcvm.2022.991383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Cardiometabolic disease refers to the spectrum of chronic conditions that include diabetes, hypertension, atheromatosis, non-alcoholic fatty liver disease, and their long-term impact on cardiovascular health. Histological studies have confirmed several modifications at the tissue level in cardiometabolic disease. Recently, quantitative MR methods have enabled non-invasive myocardial and liver tissue characterization. MR relaxation mapping techniques such as T1, T1ρ, T2 and T2* provide a pixel-by-pixel representation of the corresponding tissue specific relaxation times, which have been shown to correlate with fibrosis, altered tissue perfusion, oedema and iron levels. Proton density fat fraction mapping approaches allow measurement of lipid tissue in the organ of interest. Several studies have demonstrated their utility as early diagnostic biomarkers and their potential to bear prognostic implications. Conventionally, the quantification of these parameters by MRI relies on the acquisition of sequential scans, encoding and mapping only one parameter per scan. However, this methodology is time inefficient and suffers from the confounding effects of the relaxation parameters in each single map, limiting wider clinical and research applications. To address these limitations, several novel approaches have been proposed that encode multiple tissue parameters simultaneously, providing co-registered multiparametric information of the tissues of interest. This review aims to describe the multi-faceted myocardial and hepatic tissue alterations in cardiometabolic disease and to motivate the application of relaxometry and proton-density cardiac and liver tissue mapping techniques. Current approaches in myocardial and liver tissue characterization as well as latest technical developments in multiparametric quantitative MRI are included. Limitations and challenges of these novel approaches, and recommendations to facilitate clinical validation are also discussed.
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Affiliation(s)
- Anastasia Fotaki
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,*Correspondence: Anastasia Fotaki,
| | - Carlos Velasco
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile,Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
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Interpretation of pre-morbid cardiac 3T MRI findings in overweight and hypertensive young adults. PLoS One 2022; 17:e0278308. [PMID: 36454872 PMCID: PMC9714856 DOI: 10.1371/journal.pone.0278308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
In young adults, overweight and hypertension possibly already trigger cardiac remodeling as seen in mature adults, potentially overlapping non-ischemic cardiomyopathy findings. To this end, in young overweight and hypertensive adults, we aimed to investigate changes in left ventricular mass (LVM) and cardiac volumes, and the impact of different body scales for indexation. We also aimed to explore the presence of myocardial fibrosis, fat and edema, and changes in cellular mass with extracellular volume (ECV), T1 and T2 tissue characteristics. We prospectively recruited 126 asymptomatic subjects (51% male) aged 27-41 years for 3T cardiac magnetic resonance imaging: 40 controls, 40 overweight, 17 hypertensive and 29 hypertensive overweight. Myocyte mass was calculated as (100%-ECV) * height2.7-indexed LVM. Absolute LVM was significantly increased in overweight, hypertensive and hypertensive overweight groups (104 ± 23, 109 ± 27, 112 ± 26 g) versus controls (87 ± 21 g), with similar volumes. Body surface area (BSA) indexation resulted in LVM normalization in overweights (48 ± 8 g/m2) versus controls (47 ± 9 g/m2), but not in hypertensives (55 ± 9 g/m2) and hypertensive overweights (52 ± 9 g/m2). BSA-indexation overly decreased volumes in overweight versus normal-weight (LV end-diastolic volume; 80 ± 14 versus 92 ± 13 ml/m2), where height2.7-indexation did not. All risk groups had lower ECV (23 ± 2%, 23 ± 2%, 23 ± 3%) than controls (25 ± 2%) (P = 0.006, P = 0.113, P = 0.039), indicating increased myocyte mass (16.9 ± 2.7, 16.5 ± 2.3, 18.1 ± 3.5 versus 14.0 ± 2.9 g/m2.7). Native T1 values were similar. Lower T2 values in the hypertensive overweight group related to heart rate. In conclusion, BSA-indexation masks hypertrophy and causes volume overcorrection in overweight subjects compared to controls, height2.7-indexation therefore seems advisable.
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Lertlaksameewilai P, Songsangjinda T, Kaolawanich Y, Yindeengam A, Krittayaphong R. Extracellular volume and left ventricular hypertrophy by cardiac magnetic resonance are independent predictors of cardiovascular outcome in obesity. Sci Rep 2022; 12:18758. [PMID: 36335162 PMCID: PMC9637172 DOI: 10.1038/s41598-022-23672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/03/2022] [Indexed: 11/07/2022] Open
Abstract
This retrospective cohort study investigated for association between increased extracellular volume (ECV) and left ventricular hypertrophy (LVH) by cardiac magnetic resonance (CMR) and cardiovascular composite outcomes in obesity. Native T1 was measured at the ventricular septum. ECV was calculated from native and post-contrast T1 and hematocrit. Cardiovascular (CV) composite outcomes included acute myocardial infarction, unstable angina requiring hospitalization, myocardial revascularization (excluding early revascularization), heart failure, and CV death. A total of 456 patients with a mean follow-up of 2.1 ± 0.4 years were enrolled. LGE and LVH was detected in 30.5% and 9.2%. 107 patients (23.5%) had the composite outcomes. Multivariable analysis revealed that LGE, LVH, and high ECV as independent predictors for cardiovascular composite outcomes The event rate in the LVH and high ECV, the LVH alone, the high ECV alone, and the no-LVH with lower ECV group was 57.1%, 38.1%, 32.6%, and 17.7%, respectively. Assessment of incremental prognostic value by comparing global chi-square showed that high ECV had additional prognostic value on top of LGE, and LVH. LVH and high ECV are independent predictors of CV composite outcomes in obesity. This is the first study that demonstrate the prognostic value of ECV in obese population.
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Affiliation(s)
- Panuwat Lertlaksameewilai
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Thammarak Songsangjinda
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Yodying Kaolawanich
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Ahthit Yindeengam
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
| | - Rungroj Krittayaphong
- grid.10223.320000 0004 1937 0490Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand
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Zhao X, Liu S, Wang X, Chen Y, Pang P, Yang Q, Lin J, Deng S, Wu S, Fan G, Wang B. Diabetic cardiomyopathy: Clinical phenotype and practice. Front Endocrinol (Lausanne) 2022; 13:1032268. [PMID: 36568097 PMCID: PMC9767955 DOI: 10.3389/fendo.2022.1032268] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetic cardiomyopathy (DCM) is a pathophysiological condition of cardiac structure and function changes in diabetic patients without coronary artery disease, hypertension, and other types of heart diseases. DCM is not uncommon in people with diabetes, which increases the risk of heart failure. However, the treatment is scarce, and the prognosis is poor. Since 1972, one clinical study after another on DCM has been conducted. However, the complex phenotype of DCM still has not been fully revealed. This dilemma hinders the pace of understanding the essence of DCM and makes it difficult to carry out penetrating clinical or basic research. This review summarizes the literature on DCM over the last 40 years and discusses the overall perspective of DCM, phase of progression, potential clinical indicators, diagnostic and screening criteria, and related randomized controlled trials to understand DCM better.
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Affiliation(s)
- Xudong Zhao
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shengwang Liu
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Xiao Wang
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Yibing Chen
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Pai Pang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Qianjing Yang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Jingyi Lin
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shuaishuai Deng
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Shentao Wu
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Guanwei Fan
- Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
| | - Bin Wang
- Department of Endocrine and Metabolic Diseases, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing, Tianjin, China
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Tuleta I, Frangogiannis NG. Fibrosis of the diabetic heart: Clinical significance, molecular mechanisms, and therapeutic opportunities. Adv Drug Deliv Rev 2021; 176:113904. [PMID: 34331987 PMCID: PMC8444077 DOI: 10.1016/j.addr.2021.113904] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 01/02/2023]
Abstract
In patients with diabetes, myocardial fibrosis may contribute to the pathogenesis of heart failure and arrhythmogenesis, increasing ventricular stiffness and delaying conduction. Diabetic myocardial fibrosis involves effects of hyperglycemia, lipotoxicity and insulin resistance on cardiac fibroblasts, directly resulting in increased matrix secretion, and activation of paracrine signaling in cardiomyocytes, immune and vascular cells, that release fibroblast-activating mediators. Neurohumoral pathways, cytokines, growth factors, oxidative stress, advanced glycation end-products (AGEs), and matricellular proteins have been implicated in diabetic fibrosis; however, the molecular links between the metabolic perturbations and activation of a fibrogenic program remain poorly understood. Although existing therapies using glucose- and lipid-lowering agents and neurohumoral inhibition may act in part by attenuating myocardial collagen deposition, specific therapies targeting the fibrotic response are lacking. This review manuscript discusses the clinical significance, molecular mechanisms and cell biology of diabetic cardiac fibrosis and proposes therapeutic targets that may attenuate the fibrotic response, preventing heart failure progression.
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Affiliation(s)
- Izabela Tuleta
- The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology), Albert Einstein College of Medicine, Bronx NY, USA
| | - Nikolaos G Frangogiannis
- The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology), Albert Einstein College of Medicine, Bronx NY, USA.
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10
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Phipps K, van de Boomen M, Eder R, Michelhaugh SA, Spahillari A, Kim J, Parajuli S, Reese TG, Mekkaoui C, Das S, Gee D, Shah R, Sosnovik DE, Nguyen C. Accelerated in Vivo Cardiac Diffusion-Tensor MRI Using Residual Deep Learning-based Denoising in Participants with Obesity. Radiol Cardiothorac Imaging 2021; 3:e200580. [PMID: 34250491 DOI: 10.1148/ryct.2021200580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022]
Abstract
Purpose To develop and assess a residual deep learning algorithm to accelerate in vivo cardiac diffusion-tensor MRI (DT-MRI) by reducing the number of averages while preserving image quality and DT-MRI parameters. Materials and Methods In this prospective study, a denoising convolutional neural network (DnCNN) for DT-MRI was developed; a total of 26 participants, including 20 without obesity (body mass index [BMI] < 30 kg/m2; mean age, 28 years ± 3 [standard deviation]; 11 women) and six with obesity (BMI ≥ 30 kg/m2; mean age, 48 years ± 11; five women), were recruited from June 19, 2019, to July 29, 2020. DT-MRI data were constructed at four averages (4Av), two averages (2Av), and one average (1Av) without and with the application of the DnCNN (4AvDnCNN, 2AvDnCNN, 1AvDnCNN). All data were compared against the reference DT-MRI data constructed at eight averages (8Av). Image quality, characterized by using the signal-to-noise ratio (SNR) and structural similarity index (SSIM), and the DT-MRI parameters of mean diffusivity (MD), fractional anisotropy (FA), and helix angle transmurality (HAT) were quantified. Results No differences were found in image quality or DT-MRI parameters between the accelerated 4AvDnCNN DT-MRI and the reference 8Av DT-MRI data for the SNR (29.1 ± 2.7 vs 30.5 ± 2.9), SSIM (0.97 ± 0.01), MD (1.3 µm2/msec ± 0.1 vs 1.31 µm2/msec ± 0.11), FA (0.32 ± 0.05 vs 0.30 ± 0.04), or HAT (1.10°/% ± 0.13 vs 1.11°/% ± 0.09). The relationship of a higher MD and lower FA and HAT in individuals with obesity compared with individuals without obesity in reference 8Av DT-MRI measurements was retained in 4AvDnCNN and 2AvDnCNN DT-MRI measurements but was not retained in 4Av or 2Av DT-MRI measurements. Conclusion Cardiac DT-MRI can be performed at an at least twofold-accelerated rate by using DnCNN to preserve image quality and DT-MRI parameter quantification.Keywords: Adults, Cardiac, Obesity, Technology Assessment, MR-Diffusion Tensor Imaging, Heart, Tissue CharacterizationSupplemental material is available for this article.© RSNA, 2021.
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Affiliation(s)
- Kellie Phipps
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Maaike van de Boomen
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Robert Eder
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Sam Allen Michelhaugh
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Aferdita Spahillari
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Joan Kim
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Shestruma Parajuli
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Timothy G Reese
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Choukri Mekkaoui
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Saumya Das
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Denise Gee
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Ravi Shah
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - David E Sosnovik
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
| | - Christopher Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, 4.213, Charlestown, MA 02129 (K.P., M.v.d.B., R.E., J.K., S.P., S.D., R.S., D.E.S., C.N.); Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (M.v.d.B.); A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass (M.v.d.B., T.G.R., C.M., D.E.S., C.N.); Cardiology Division (S.A.M., A.S., S.D., R.S., D.E.S.) and Weight Center (D.G.), Massachusetts General Hospital, Boston, Mass; and Departments of Radiology (T.G.R., C.M.), Medicine (S.D., R.S., D.E.S., C.N.), and Surgery (D.G.), Harvard Medical School, Boston, Mass
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Philip C, Seifried R, Peterson PG, Liotta R, Steel K, Bittencourt MS, Hulten EA. Cardiac MRI for Patients with Increased Cardiometabolic Risk. Radiol Cardiothorac Imaging 2021; 3:e200575. [PMID: 33969314 DOI: 10.1148/ryct.2021200575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/11/2022]
Abstract
Cardiac MRI (CMR) has rich potential for future cardiovascular screening even though not approved clinically for routine screening for cardiovascular disease among patients with increased cardiometabolic risk. Patients with increased cardiometabolic risk include those with abnormal blood pressure, body mass, cholesterol level, or fasting glucose level, which may be related to dietary and exercise habits. However, CMR does accurately evaluate cardiac structure and function. CMR allows for effective tissue characterization with a variety of sequences that provide unique insights as to fibrosis, infiltration, inflammation, edema, presence of fat, strain, and other potential pathologic features that influence future cardiovascular risk. Ongoing epidemiologic and clinical research may demonstrate clinical benefit leading to increased future use. © RSNA, 2021.
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Affiliation(s)
- Cynthia Philip
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Rebecca Seifried
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - P Gabriel Peterson
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Robert Liotta
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Kevin Steel
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Marcio S Bittencourt
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
| | - Edward A Hulten
- Department of Medicine, Cardiology Service (C.P., R.S., E.A.H.) and Department of Radiology (P.G.P., R.L.), Walter Reed National Military Medical Center, Bethesda, Md; Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (C.P., R.S., P.G.P., R.L., E.A.H.); PeaceHealth Medical Group, Bellingham, Wash (K.S.); University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil (M.S.B.); Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil (M.S.B.); and DASA São Paulo, São Paulo, Brazil (M.S.B.)
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Prognostic value of myocardial extracellular volume fraction evaluation based on cardiac magnetic resonance T1 mapping with T1 long and short in hypertrophic cardiomyopathy. Eur Radiol 2021; 31:4557-4567. [PMID: 33449190 DOI: 10.1007/s00330-020-07650-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/14/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the prognostic significance of T1 mapping using T1 long and short in hypertrophic cardiomyopathy (HCM) patients. METHODS A total of 263 consecutive patients with HCM referred for cardiovascular magnetic resonance (CMR) imaging were enrolled in this study. The imaging protocol consisted of cine, late gadolinium enhancement (LGE), and T1 mapping with T1 long and short. All patients were followed up prospectively. Outcome events were divided into the primary and secondary endpoint events. Primary endpoint events included cardiac death, heart transplant, aborted sudden death, and cardiopulmonary resuscitation after syncope. The secondary endpoint event was defined as unplanned rehospitalization for heart failure. RESULT The average follow-up duration was 28.3 ± 12.1 (range: 1-78) months. In all, 17 patients (7.0%) experienced a primary endpoint including 13 cardiovascular deaths, three aborted sudden deaths, and one resuscitation after syncope, and 34 patients experienced a secondary endpoint. Patients with primary endpoints showed a trend towards more extensive LGE (p < 0.001), significantly higher ECV (p < 0.001), and native T1 (p = 0.028) than those without events. In multivariate Cox regression analysis, ECV was independently associated with primary and secondary endpoints (p < 0.001 and p = 0.047, respectively). For every 3% increase, ECV portended a 1.374-fold increase risk of a primary endpoint occurring (p < 0.001). In the Kaplan-Meier survival analysis, the incidence of primary and secondary endpoint events was significantly higher in HCM with increased ECV (p < 0.001 and p = 0.009, respectively). CONCLUSION In patients with HCM, ECV is a strong imaging marker for predicting adverse outcome. KEY POINTS • ECV is a potent imaging index which has a strong correlation with LVEF and LVEDVI and can evaluate myocardial tissue structure and function. • ECV and LGE can provide a prognostic value in patients with hypertrophic cardiomyopathy. • ECV has stronger predictive effectiveness than LGE; even in the subgroup with LGE, ECV shows independent predictive significance for adverse events.
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Xie LJ, Dong ZH, Yang ZG, Deng MY, Gao Y, Jiang L, Hu BY, Liu X, Ren Y, Xia CC, Li ZL, Zhang HP, Zhou XY, Guo YK. Assessment of left ventricular deformation in patients with type 2 diabetes mellitus by cardiac magnetic resonance tissue tracking. Sci Rep 2020; 10:13126. [PMID: 32753616 PMCID: PMC7403307 DOI: 10.1038/s41598-020-69977-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/22/2020] [Indexed: 02/05/2023] Open
Abstract
To quantify the global and regional left ventricular (LV) myocardial strain in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) tissue-tracking techniques and to determine the ability of myocardial strain parameters to assessment the LV deformation. Our study included 98 adult T2DM patients (preserved LV ejection fraction [LVEF], 72; reduced LVEF, 26) and 35 healthy controls. Conventional LV function, volume-time curve parameters and LV remodeling index were measured using CMR. Global and regional LV myocardial strain parameters were measured using CMR tissue tracking and compared between the different sub-groups. Receiver operating characteristic analysis was used to assess the diagnostic accuracy. Regression analyses were conducted to determine the relationship between strain parameters and the LV remodeling index. The results show that global radial peak strain (PS) and circumferential PS were not significantly different between the preserved-LVEF group and control group (P > 0.05). However, longitudinal PS was significantly lower in the preserved-LVEF group than in the control group (P = 0.005). Multivariate linear and logistic regression analyses showed that global longitudinal PS was independently associated (β = 0.385, P < 0.001) with the LV remodeling index. In conclusion, early quantitative evaluation of cardiac deformation can be successfully performed using CMR tissue tracking in T2DM patients. In addition, global longitudinal PS can complement LVEF in the assessment of cardiac function.
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Affiliation(s)
- Lin-Jun Xie
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Zhi-Hui Dong
- Department of Radiology, Luoyang Central Hospital Affiliated to Zhengzhou University, 288# Zhongzhou Middle Road, Luoyang, 471009, Henan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Ming-Yan Deng
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Bi-Yue Hu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Peng Zhang
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Xiao-Yue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China.
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Lipid Biomarkers as Predictors of Diastolic Dysfunction in Diabetes with Poor Glycemic Control. Int J Mol Sci 2020; 21:ijms21145079. [PMID: 32708413 PMCID: PMC7404098 DOI: 10.3390/ijms21145079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022] Open
Abstract
Uncontrolled type-1 diabetes (T1DM) can lead to dyslipidaemia and albuminuria, which may promote cardiovascular injuries. However, some lipidemic factors could be useful in predicting cardiac dysfunction. Seventy-eight adolescents under insulin treatment due to a 6-year history of T1DM and were retrospectively examined. Glycemia, lipidemia, and albuminuria were measured in addition to development of cardiovascular abnormalities Both girls and boys showed higher HbA1c and fasting blood glucose and 27.1% females and 33.3% males exhibited microalbuminuria though their plasma levels of total cholesterol (TC), triglycerides (TG), and low-density lipoproteins (LDL) and high-density lipoproteins (HDL lipoproteins were in the normal range. They exhibited a preserved systolic function, but 50% of females and 66.6% of males had developed diastolic failures. Interestingly, girls with diastolic dysfunction showed significantly lower concentrations of HDL and higher TC/HDL and TG/HDL ratios. In fact, low HDL levels (OR 0.93; 95% CI 0.88-0.99; p = 0.029) and high TC/HDL (OR 2.55; 95% CI 1.9-5.45; p = 0.016) and TG/HDL (OR 2.74; 95% CI 1.12-6.71; p = 0.028) ratios associated with the development of diastolic complications. The cut-off values for HDL, TC/HDL, and TG/HDL were 49 mg/dL, 3.0 and 1.85, respectively. HDL and TC/HDL and TG/HDL ratios may be useful for predicting diastolic dysfunction in girls with uncontrolled T1DM.
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15
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Kucukseymen S, Neisius U, Rodriguez J, Tsao CW, Nezafat R. Negative synergism of diabetes mellitus and obesity in patients with heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 2020; 36:2027-2038. [PMID: 32533279 DOI: 10.1007/s10554-020-01915-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
In patients with heart failure with preserved ejection fraction (HFpEF), diabetes mellitus (DM) and obesity are important comorbidities as well as major risk factors. Their conjoint impact on the myocardium provides insight into the HFpEF aetiology. We sought to investigate the association between obesity, DM, and their combined effect on alterations in the myocardial tissue in HFpEF patients. One hundred and sixty-two HFpEF patients (55 ± 12 years, 95 men) and 45 healthy subjects (53 ± 12 years, 27 men) were included. Patients were classified according to comorbidity prevalence (36 obese patients without DM, 53 diabetic patients without obesity, and 73 patients with both). Myocardial remodeling, fibrosis, and longitudinal contractility were quantified with cardiovascular magnetic resonance imaging using cine and myocardial native T1 images. Patients with DM and obesity had impaired global longitudinal strain (GLS) and increased myocardial native T1 compared to patients with only one comorbidity (DM + Obesity vs. DM and Obesity; GLS, - 15 ± 2.1 vs - 16.5 ± 2.4 and - 16.7 ± 2.2%; native T1, 1162 ± 37 vs 1129 ± 25 and 1069 ± 29 ms; P < 0.0001 for all). A negative synergistic effect of combined obesity and DM prevalence was observed for native T1 (np2 = 0.273, p = 0.002) and GLS (np2 = 0.288, p < 0.0001). Additionally, severity of insulin resistance was associated with GLS (R = 0.590, P < 0.0001), and native T1 (R = 0.349, P < 0.0001). The conjoint effect of obesity and DM in HFpEF patients is associated with diffuse myocardial fibrosis and deterioration in GLS. The negative synergistic effects observed on the myocardium may be related to severity of insulin resistance.
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Affiliation(s)
- Selcuk Kucukseymen
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Ulf Neisius
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Connie W Tsao
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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16
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Abstract
The term diabetic cardiomyopathy is defined as the presence of abnormalities in myocardial structure and function that occur in the absence of, or in addition to, well-established cardiovascular risk factors. A key contributor to this abnormal structural-functional relation is the complex interplay of myocardial metabolic remodeling, defined as the loss the flexibility in myocardial substrate metabolism and its downstream detrimental effects, such as mitochondrial dysfunction, inflammation, and fibrosis. In parallel with the growth in understanding of these biological underpinnings has been developmental advances in imaging tools such as positron emission tomography and magnetic resonance imaging and spectroscopy that permit the detection and in many cases quantification, of the processes that typifies the myocardial metabolic remodeling in diabetic cardiomyopathy. The imaging readouts can be obtained in both preclinical models of diabetes mellitus and patients with diabetes mellitus facilitating the bi-directional movement of information between bench and bedside. Moreover, imaging biomarkers provided by these tools are now being used to enhance discovery and development of therapies designed to reduce the myocardial effects of diabetes mellitus through metabolic modulation. In this review, the use of these imaging tools in the patient with diabetes mellitus from a mechanistic, therapeutic effect, and clinical management perspective will be discussed.
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Affiliation(s)
- Linda R Peterson
- From the Cardiovascular Division, Department of Medicine (L.R.P.), Washington University School of Medicine, St Louis, MO
| | - Robert J Gropler
- Division of Radiological Sciences, Edward Mallinckrodt Institute of Radiology (R.J.G.), Washington University School of Medicine, St Louis, MO
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17
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Yamamoto N, Maruyama T, Masaki Y, Nagano J, Irie M, Kajitani K, Tsuchimoto R, Sato T. Contributions of Anthropometrics and Lifestyle to Blood Pressure in Japanese University Students : Investigation by Annual Health Screening. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 67:174-181. [PMID: 32378603 DOI: 10.2152/jmi.67.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : High blood pressure (BP) is a healthcare problem in young persons. There are racial differences in anthropometrics, dietary habit and lifestyle relating to BP. Therefore, this study investigated the relationship between anthropometrics, lifestyle and BP obtained in the Japanese university students. Materials and Methods : Participants were recruited in annual health screening including questionnaire, measurements of BP and anthropometrics calculating body mass index (BMI). Totally, 14,280 students (10,273 males and 4,007 females) were eligible. Multiple regression analyses were applied to predict contributors to high BP. Results : BMI was the most powerful contributor to high BP in many subgroups divided by gender and graduation (p < 0.001). In lifestyle, contribution of lack of exercise to high BPs was observed in the undergraduates. Smoking, drinking and breakfast skipping had no significant impact on high BP. However, smoking and drinking permeated and exercise habit declined after graduation. Prevalence of obesity (BMI ≥ 25 kg / m2) and hypertension ( ≥ 140 / 90 mmHg) increased in subgroups with advanced age (p < 0.001). Conclusion: BMI was found to be the most powerful contributor to high BPs. Health literacy to modify lifestyle is important to prevent hypertension for university students who are exposed to social trends of unhealthy lifestyle. J. Med. Invest. 67 : 174-181, February, 2020.
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Affiliation(s)
- Noriko Yamamoto
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Toru Maruyama
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Yoshinori Masaki
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Jun Nagano
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Masahiro Irie
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Kosuke Kajitani
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Rikako Tsuchimoto
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Takeshi Sato
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
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18
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Dolan RS, Rahsepar AA, Blaisdell J, Sarnari R, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Yancy CW, Anderson AS, Carr JC, Markl M. Donor and Recipient Characteristics in Heart Transplantation Are Associated with Altered Myocardial Tissue Structure and Cardiac Function. Radiol Cardiothorac Imaging 2019; 1:e190009. [PMID: 32076670 PMCID: PMC6939741 DOI: 10.1148/ryct.2019190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To use structure-function cardiac MRI in the evaluation of relationships between donor and heart transplantation (HTx) recipient characteristics and changes in cardiac tissue structure and function. HTx candidates and donor hearts are evaluated for donor-recipient matches to improve survival, but the impact of donor and recipient characteristics on changes in myocardial tissue and function in the transplanted heart is not fully understood. MATERIALS AND METHODS Cardiac MRI at 1.5 T was performed from August 2014 to June 2017 in 58 HTx recipients (mean age, 51.1 years ± 12.6 [standard deviation], 26 female patients) and included T2 mapping (to evaluate edematous and/or inflammatory changes), precontrast and postcontrast T1 mapping (allowing the calculation of extracellular volume fraction [ECV] to estimate interstitial expansion), and tissue phase mapping (allowing the calculation of myocardial velocities and twist). Donor and recipient demographics (age, sex, height, weight, and body mass index [BMI]) and comorbidities (hypertension, diabetes, and smoking history) were evaluated for relationships with cardiac MRI measures. RESULTS Sex-influenced cardiac MRI measures of myocardial tissue and function are as follows: Female HTx recipients demonstrated increased precontrast T1 (P = .002) and reduced systolic peak long-axis velocities (P = .015). Increased age of the donor heart was associated with elevated T2 (r = 0.32; P < .05) and ECV (r = 0.47; P < .01), indicating increased edema and interstitial expansion, as well as impaired diastolic peak long-axis velocities (r = 0.41; P < .01). Recipient-donor differences in age, weight, and BMI were significantly associated with elevated ECV (r = 0.36-0.48; P < .05). Hypertension in donors resulted in increased ECV (31.0% ± 4.2 vs 26.0% ± 3.3; P = .001). CONCLUSION Donor and HTx recipient characteristics were significantly associated with cardiac MRI-derived measures of myocardial tissue structure and function.© RSNA, 2019.
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Affiliation(s)
- Ryan S. Dolan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Amir A. Rahsepar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Julie Blaisdell
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Roberto Sarnari
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Kambiz Ghafourian
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jane E. Wilcox
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Sadiya S. Khan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Esther E. Vorovich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jonathan D. Rich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Clyde W. Yancy
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Allen S. Anderson
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - James C. Carr
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Michael Markl
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
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19
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Shah AS, El Ghormli L, Vajravelu ME, Bacha F, Farrell RM, Gidding SS, Levitt Katz LE, Tryggestad JB, White NH, Urbina EM. Heart Rate Variability and Cardiac Autonomic Dysfunction: Prevalence, Risk Factors, and Relationship to Arterial Stiffness in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study. Diabetes Care 2019; 42:2143-2150. [PMID: 31501226 PMCID: PMC6804614 DOI: 10.2337/dc19-0993] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/22/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether prior type 2 diabetes (T2D) treatment or glycemic control over time are independently associated with heart rate variability (HRV) and whether the presence of cardiac autonomic dysfunction is associated with arterial stiffness in young adults with youth-onset T2D enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS Heartbeats over 10 min were measured to derive the normal R-Rs (NN intervals). Outcomes included the standard deviation of the NN intervals (SDNN), the root mean square differences of successive NN intervals (RMSSD), percent of NN beats that differ by more than 50 ms (PNN50), and the low-frequency (LF) power domain, high-frequency (HF) power domain, and their ratio (LF:HF). Autonomic dysfunction was defined as ≥3 of 5 abnormal HRV indices compared with obese controls from a separate study. RESULTS A total of 397 TODAY participants were evaluated 7 years after randomization. TODAY participants had reduced HRV (SDNN 58.1 ± 29.6 ms vs. controls 67.1 ± 25.4 ms; P < 0.0001) with parasympathetic loss (RMSSD 53.2 ± 36.7 ms vs. controls 67.9 ± 35.2 ms; P < 0.0001) with sympathetic overdrive (LF:HF ratio 1.4 ± 1.7 vs. controls 1.0 ± 1.1; P < 0.0001). Cardiac autonomic dysfunction was present in 8% of TODAY participants, and these participants had greater pulse wave velocity compared with those without dysfunction (P = 0.0001). HRV did not differ by randomized treatment, but higher hemoglobin A1c (HbA1c) over time was independently associated with lower SDNN and RMSSD and higher LF:HF ratio after adjustment for age, race-ethnicity, sex, and BMI. CONCLUSIONS Young adults with youth-onset T2D show evidence of cardiac autonomic dysfunction with both parasympathetic and sympathetic impairments that are associated with higher HbA1c.
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Affiliation(s)
- Amy S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD
| | | | - Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | | | | | | | - Neil H White
- Washington University in St. Louis, St. Louis, MO
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
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20
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Paiman EHM, van Eyk HJ, Bizino MB, Dekkers IA, de Heer P, Smit JWA, Jazet IM, Lamb HJ. Phenotyping diabetic cardiomyopathy in Europeans and South Asians. Cardiovasc Diabetol 2019; 18:133. [PMID: 31604432 PMCID: PMC6788052 DOI: 10.1186/s12933-019-0940-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 01/07/2023] Open
Abstract
Background The pathogenesis and cardiovascular impact of type 2 diabetes (T2D) may be different in South Asians compared with other ethnic groups. The phenotypic characterization of diabetic cardiomyopathy remains debated and little is known regarding differences in T2D-related cardiovascular remodeling across ethnicities. We aimed to characterize the differences in left ventricular (LV) diastolic and systolic function, LV structure, myocardial tissue characteristics and aortic stiffness between T2D patients and controls and to assess the differences in T2D-related cardiovascular remodeling between South Asians and Europeans. Methods T2D patients and controls of South Asian and European descent underwent 3 Tesla cardiovascular magnetic resonance imaging (CMR) and cardiac proton-magnetic resonance spectroscopy (1H-MRS). Differences in cardiovascular parameters between T2D patients and controls were examined using ANCOVA and were reported as mean (95% CI). Ethnic group comparisons in the association of T2D with cardiovascular remodeling were made by adding the interaction term between ethnicity and diabetes status to the model. Results A total of 131 individuals were included (54 South Asians [50.1 ± 8.7 years, 33% men, 33 patients vs. 21 controls) and 77 Europeans (58.8 ± 7.0 years, 56% men, 48 patients vs. 29 controls)]. The ratio of the transmitral early and late peak filling rate (E/A) was lower in T2D patients compared with controls, in South Asians [− 0.20 (− 0.36; − 0.03), P = 0.021] and Europeans [− 0.20 (− 0.36; − 0.04), P = 0.017], whereas global longitudinal strain and aortic pulse wave velocity were similar. South Asian T2D patients had a higher LV mass [+ 22 g (15; 30), P < 0.001] (P for interaction by ethnicity = 0.005) with a lower extracellular volume fraction [− 1.9% (− 3.4; − 0.4), P = 0.013] (P for interaction = 0.114), whilst European T2D patients had a higher myocardial triglyceride content [+ 0.59% (0.35; 0.84), P = 0.001] (P for interaction = 0.002) than their control group. Conclusions Diabetic cardiomyopathy was characterized by impaired LV diastolic function in South Asians and Europeans. Increased LV mass was solely observed among South Asian T2D patients, whereas differences in myocardial triglyceride content between T2D patients and controls were only present in the European cohort. The diabetic cardiomyopathy phenotype may differ between subsets of T2D patients, for example across ethnicities, and tailored strategies for T2D management may be required.
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Affiliation(s)
- Elisabeth H M Paiman
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands.
| | - Huub J van Eyk
- Dept. Internal Medicine, Leiden University Medical Center, P.O. Box 9600, Postal Zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Maurice B Bizino
- Dept. Internal Medicine, Leiden University Medical Center, P.O. Box 9600, Postal Zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Ilona A Dekkers
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Paul de Heer
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands
| | - Johannes W A Smit
- Dept. Internal Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ingrid M Jazet
- Dept. Internal Medicine, Leiden University Medical Center, P.O. Box 9600, Postal Zone C7-Q, 2300 RC, Leiden, The Netherlands
| | - Hildo J Lamb
- Dept. Radiology, Leiden University Medical Center, P.O. Box 9600, Postal Zone C2-S, 2300 RC, Leiden, The Netherlands
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21
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Homsi R, Yuecel S, Schlesinger-Irsch U, Meier-Schroers M, Kuetting D, Luetkens J, Sprinkart A, Schild HH, Thomas DK. Epicardial fat, left ventricular strain, and T1-relaxation times in obese individuals with a normal ejection fraction. Acta Radiol 2019; 60:1251-1257. [PMID: 30727747 DOI: 10.1177/0284185119826549] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rami Homsi
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Seyrani Yuecel
- Department of Cardiology, University of Rostock, Rostock, Germany
| | | | | | | | | | | | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
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22
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Sardanelli F, Schiaffino S, Zanardo M, Secchi F, Cannaò PM, Ambrogi F, Di Leo G. Point estimate and reference normality interval of MRI-derived myocardial extracellular volume in healthy subjects: a systematic review and meta-analysis. Eur Radiol 2019; 29:6620-6633. [DOI: 10.1007/s00330-019-06185-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022]
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23
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Scully PR, Bastarrika G, Moon JC, Treibel TA. Myocardial Extracellular Volume Quantification by Cardiovascular Magnetic Resonance and Computed Tomography. Curr Cardiol Rep 2018; 20:15. [PMID: 29511861 PMCID: PMC5840231 DOI: 10.1007/s11886-018-0961-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review article discusses the evolution of extracellular volume (ECV) quantification using both cardiovascular magnetic resonance (CMR) and computed tomography (CT). RECENT FINDINGS Visualizing diffuse myocardial fibrosis is challenging and until recently, was restricted to the domain of the pathologist. CMR and CT both use extravascular, extracellular contrast agents, permitting ECV measurement. The evidence base around ECV quantification by CMR is growing rapidly and just starting in CT. In conditions with high ECV (amyloid, oedema and fibrosis), this technique is already being used clinically and as a surrogate endpoint. Non-invasive diffuse fibrosis quantification is also generating new biological insights into key cardiac diseases. CMR and CT can estimate ECV and in turn diffuse myocardial fibrosis, obviating the need for invasive endomyocardial biopsy. CT is an attractive alternative to CMR particularly in those individuals with contraindications to the latter. Further studies are needed, particularly in CT.
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Affiliation(s)
- Paul R. Scully
- Cardiac Imaging Department, Barts Heart Centre, St Bartholomew’s Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE UK
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Gorka Bastarrika
- Clínica Universidad de Navarra, University of Navarra, Avda/Pio XII 55, 31008 Pamplona, Spain
| | - James C. Moon
- Cardiac Imaging Department, Barts Heart Centre, St Bartholomew’s Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE UK
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Thomas A. Treibel
- Cardiac Imaging Department, Barts Heart Centre, St Bartholomew’s Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE UK
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT UK
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Metwalley KA, Farghaly HS, Sherief T. Plasma adrenomedullin level in children with obesity: relationship to left ventricular function. World J Pediatr 2018; 14:84-91. [PMID: 29411326 DOI: 10.1007/s12519-017-0106-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obese children are at increased risk for abnormal cardiac structure and function. Little is known about adrenomedullin (AM), a cytokine produced in various organs and tissues, as a biomarker of cardiac hypertrophy in obese children. This study aimed to assess the plasma AM levels in a cohort of obese children and its relationship to left ventricular (LV) functions. METHODS The study included 60 obese children and 60 non-obese children matched for age and gender as control group. Blood pressure, serum lipid profile, fasting glucose, insulin and plasma AM and the homeostatic model assessment of insulin resistance (HOMA-IR) were measured. Cardiac dimensions and LV functions were assessed using conventional echocardiography. RESULTS Compared to control subjects, obese children had higher blood pressure (P = 0.01), insulin (P = 0.001), HOMA-IR (P = 0.001), and AM (P = 0.001). Moreover, obese children had higher LV mass index (LVMI) (P = 0.001), indicating LV hypertrophy; prolonged isovolumic relaxation times (P = 0.01), prolonged mitral deceleration time (DcT) (P = 0.01) and reduced ratio of mitral E-to-mitral A-wave peak velocity (P = 0.01), indicating LV diastolic dysfunction. Laboratory abnormalities were only present in children with LV hypertrophy. In multivariate analysis in obese children with LV hypertrophy, AM levels were positively correlated with LVMI [odds ratio (OR) 1.14, 95% confidence interval (Cl) 1.08-1.13, P = 0.0001] and mitral DcT (OR 2.25, 95% CI 1.15-2.05, P = 0.01) in the presence of higher blood pressure and HOMA-IR. A cut-off value of AM at 52 pg/mL could differentiate obese children with and without left ventricular hypertrophy at a sensitivity of 94.32% and specificity of 92.45%. CONCLUSIONS Plasma AM levels may be elevated in obese children particularly those with LV hypertrophy and is correlated with higher blood pressure and insulin resistance. Measurement of plasma AM levels in obese children may help to identify those at high risk of developing LV hypertrophy and dysfunction.
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Affiliation(s)
- Kotb Abbass Metwalley
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O, Assiut, 71111, Egypt.
| | - Hekma Saad Farghaly
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, B.O, Assiut, 71111, Egypt
| | - Tahra Sherief
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Increased myocardial extracellular volume assessed by cardiovascular magnetic resonance T1 mapping and its determinants in type 2 diabetes mellitus patients with normal myocardial systolic strain. Cardiovasc Diabetol 2018; 17:7. [PMID: 29301529 PMCID: PMC5755204 DOI: 10.1186/s12933-017-0651-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
Background Cardiac magnetic resonance (CMR) T1 mapping and tissue-tracking strain analysis are useful quantitative techniques that can characterize myocardial tissue and mechanical alterations, respectively, in patients with early diabetic cardiomyopathy. The purpose of this study was to assess the left ventricular myocardial T1 value, extracellular volume fraction (ECV), and systolic strain in asymptomatic patients with type 2 diabetes mellitus (T2DM) and their underlying relationships with clinical parameters. Methods We recruited 50 T2DM patients (mean age: 55 ± 7 years; 28 males) and 32 sex-, age-and BMI-matched healthy volunteers to undergo contrast-enhanced CMR examinations. The myocardial native T1, post-contrast T1 and ECV values of the left ventricle were measured from T1 and ECV maps acquired using the modified Look-Locker inversion recovery technique. The left ventricular global systolic strain and the strain rates were evaluated using routine cine images and tissue-tracking analysis software. The baseline clinical and biochemical indices were collected before the CMR examination. Results The myocardial ECV and native T1 values were significantly higher in the diabetic patients than in the controls. (ECV: 27.4 ± 2.5% vs. 24.6 ± 2.2%, p < 0.001; native T1: 1026.9 ± 30.0 ms vs. 1011.8 ± 26.0 ms, p = 0.022). However, the left ventricular global systolic strain, strain rate, volume, myocardial mass, ejection fraction, and left atrial volume were similar between the diabetic patients and the healthy controls. In the diabetic patients, the native T1 values were independently correlated with the hemoglobin A1c levels (standardized β = 0.368, p = 0.008). The ECVs were independently associated with the hemoglobin A1c levels (standardized β = 0.389, p = 0.002), angiotensin-converting enzyme inhibitor (ACEI) treatment (standardized β = − 0.271, p = 0.025) and HCT values (standardized β = − 0.397, p = 0.001). Conclusions Type 2 diabetes mellitus patients with normal myocardial systolic strain exhibit increased native T1 values and ECVs indicative of myocardial extracellular interstitial expansion, which might be related to poor glycemic control. The amelioration of myocardial interstitial matrix expansion might be associated with ACEI treatment. A valid assessment of the association of glucose control and ACEI treatment with myocardial fibrosis requires notably larger trials.
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Chung SJ, Ersig AL, McCarthy AM. The Influence of Peers on Diet and Exercise Among Adolescents: A Systematic Review. J Pediatr Nurs 2017; 36:44-56. [PMID: 28888511 DOI: 10.1016/j.pedn.2017.04.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 11/28/2022]
Abstract
Adolescents' diet and exercise are modifiable factors contributing to high rates of adolescent obesity. Diverse contextual factors, including family, social environment, and peers, affect adolescents' diet and exercise behaviors. Because peer influence increases during adolescence, peers' contributions to adolescents' diet and exercise behaviors should be examined as potential targets for intervention to reduce the prevalence of adolescent obesity. The purpose of this systematic review is to identify research examining the contribution of peers to diet and exercise of adolescents. The electronic databases PubMed, CINAHL, Web of Science, and SCOPUS were searched. A total of 24 unique articles were included: seven examined diet only, fourteen studied exercise only, and three explored diet and exercise. This review provided evidence that diet and exercise of adolescents were significantly associated with those of their peers. However, these associations differed depending on gender, the type of diet and exercise, and closeness of friends. Findings from this review suggest that peers could be possible targets for interventions to promote healthier diet and exercise among adolescents; however, more studies are needed to identify specific peer influences and develop tailored interventions.
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Affiliation(s)
| | | | - Ann Marie McCarthy
- The University of Iowa, College of Nursing, Iowa City, IA United States.
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Mecoli M, Kandil A, Campion M, Samuels P. Pediatric Obesity: Anesthetic Implications and Perioperative Considerations for Weight Loss Surgery. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0211-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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28
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Hulten EA, Bittencourt MS, Preston R, Singh A, Romagnolli C, Ghoshhajra B, Shah R, Abbasi S, Abbara S, Nasir K, Blaha M, Hoffmann U, Di Carli MF, Blankstein R. Obesity, metabolic syndrome and cardiovascular prognosis: from the Partners coronary computed tomography angiography registry. Cardiovasc Diabetol 2017; 16:14. [PMID: 28122619 PMCID: PMC5264456 DOI: 10.1186/s12933-017-0496-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/12/2017] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate the relationship among body mass index (BMI), cardiometabolic risk and coronary artery disease (CAD) among patients undergoing coronary computed tomography angiography (CTA). Methods Retrospective cohort study of 1118 patients, who underwent coronary CTA at two centers from September 2004 to October 2011. Coronary CTA were categorized as normal, nonobstructive CAD (<50%), or obstructive CAD (≥50%) in addition to segment involvement (SIS) and stenosis scores. Extensive CAD was defined as SIS > 4. Association of BMI with cardiovascular prognosis was evaluated using multivariable fractional polynomial models. Results Mean age of the cohort was 57 ± 13 years with median follow-up of 3.2 years. Increasing BMI was associated with MetS (OR 1.28 per 1 kg/m2, p < 0.001) and burden of CAD on a univariable basis, but not after multivariable adjustment. Prognosis demonstrated a J-shaped relationship with BMI. For BMI from 20–39.9 kg/m2, after adjustment for age, gender, and smoking, MetS (HR 2.23, p = 0.009) was more strongly associated with adverse events. Conclusions Compared to normal BMI, there was an increased burden of CAD for BMI > 25 kg/m2. Within each BMI category, metabolically unhealthy patients had greater extent of CAD, as measured by CCTA, compared to metabolically healthy patients.
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Affiliation(s)
- Edward A Hulten
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Marcio Sommer Bittencourt
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Ryan Preston
- Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Avinainder Singh
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carla Romagnolli
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Brian Ghoshhajra
- Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ravi Shah
- Cardiology Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Siddique Abbasi
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Suhny Abbara
- Cardiothoracic Imaging Division, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9316, USA
| | - Khurram Nasir
- Center for Wellness and Prevention Research, Baptist Health South Florida, Miami, FL, USA
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Murthy VL, Abbasi SA, Siddique J, Colangelo LA, Reis J, Venkatesh BA, Carr JJ, Terry JG, Camhi SM, Jerosch-Herold M, de Ferranti S, Das S, Freedman J, Carnethon MR, Lewis CE, Lima JAC, Shah RV. Transitions in Metabolic Risk and Long-Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study. J Am Heart Assoc 2016; 5:JAHA.116.003934. [PMID: 27737876 PMCID: PMC5121498 DOI: 10.1161/jaha.116.003934] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Despite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease. Methods and Results In 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a “metabolic” risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time‐dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low‐stable, low‐worsening, high‐stable, intermediate‐worsening, intermediate‐stable, and high‐worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher‐risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories. Conclusions Transitions in metabolic risk occur early in life. Obesity‐related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.
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Affiliation(s)
- Venkatesh L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, MI Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Siddique A Abbasi
- Providence VA Medical Center and Cardiovascular Institute, Alpert Medical School of Brown University, Providence, RI
| | - Juned Siddique
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Laura A Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Bharath A Venkatesh
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institute, Johns Hopkins University, Baltimore, MD
| | | | | | - Sarah M Camhi
- Exercise and Health Sciences Department, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Saumya Das
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jane Freedman
- Department of Medicine, University of Massachusetts at Worcester, MA
| | - Mercedes R Carnethon
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Cora E Lewis
- Division of Preventative Medicine, University of Alabama at Birmingham, AL
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institute, Johns Hopkins University, Baltimore, MD
| | - Ravi V Shah
- Department of Medicine, Massachusetts General Hospital, Boston, MA
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Di Bonito P, Pacifico L, Chiesa C, Invitti C, Miraglia Del Giudice E, Baroni MG, Moio N, Pellegrin MC, Tomat M, Licenziati MR, Manco M, Maffeis C, Valerio G. White blood cell count may identify abnormal cardiometabolic phenotype and preclinical organ damage in overweight/obese children. Nutr Metab Cardiovasc Dis 2016; 26:502-509. [PMID: 27048715 DOI: 10.1016/j.numecd.2016.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Subclinical inflammation is a central component of cardiometabolic disease risk in obese subjects. The aim of the study was to evaluate whether the white blood cell count (WBCc) may help to identify an abnormal cardiometabolic phenotype in overweight (Ow) or obese (Ob) children. METHODS AND RESULTS A cross-sectional sample of 2835 Ow/Ob children and adolescents (age 6-18 years) was recruited from 10 Italian centers for the care of obesity. Anthropometric and biochemical variables were assessed in the overall sample. Waist to height ratio (WhtR), alanine aminotransferase (ALT), lipids, 2 h post-load plasma glucose (2hPG), left ventricular (LV) geometry and carotid intima-media thickness (cIMT) were assessed in 2128, 2300, 1834, 535 and 315 children, respectively. Insulin resistance and whole body insulin sensitivity index (WBISI) were analyzed using homeostatic model assessment (HOMA-IR) and Matsuda's test. Groups divided in quartiles of WBCc significantly differed for body mass index, WhtR, 2hPG, HOMA-IR, WBISI, lipids, ALT, cIMT, LV mass and relative wall thickness. Children with high WBCc (≥8700 cell/mm(3)) showed a 1.3-2.5 fold increased probability of having high normal 2hPG, high ALT, high cIMT, or LV remodeling/concentric LV hypertrophy, after adjustment for age, gender, pubertal status, BMI and centers. CONCLUSIONS This study shows that WBCc is associated with early derangements of glucose metabolism and preclinical signs of liver, vascular and cardiac damage. The WBCc may be an effective and low-cost tool for identifying Ow and Ob children at the greatest risk of potential complications.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - L Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - C Chiesa
- Institute of Translational Pharmacology, National Research Council, Via Fosso del Cavaliere, 100, 00133, Rome, Italy.
| | - C Invitti
- IRCCS Istituto Auxologico Italiano, Department of Medical Sciences & Rehabilitation, Milan, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - M G Baroni
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - N Moio
- Department of Cardiology, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - M C Pellegrin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - M Tomat
- Pediatric Unit, AOU Udine, Udine, Italy
| | - M R Licenziati
- Department of Pediatrics, AORN Santobono-Pausilipon, Naples, Italy
| | - M Manco
- IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - C Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - G Valerio
- Department of Movement and Wellness Sciences, Parthenope University, Naples, Italy
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Abstract
Consensus has yet to be achieved on whether obesity is inexorably tied to poor fitness. We tested the hypothesis that appropriate reference of cardiopulmonary exercise testing (CPET) variables to lean body mass (LBM) would eliminate differences in fitness between high-BMI (≥ 95th percentile, n = 72, 50% female) and normal-BMI (< 85th percentile, n = 142, 49% female), otherwise-healthy children and adolescents typically seen when referencing body weight. We measured body composition with dual x-ray absorptiometry (DXA) and CPET variables from cycle ergometry using both peak values and submaximal exercise slopes (peak VO2, ΔVO2/ΔHR, ΔWR/ΔHR, ΔVO2/ΔWR, and ΔVE/ΔVCO2). In contrast to our hypothesis, referencing to LBM tended to lessen, but did not eliminate, the differences (peak VO2 [p < .004] and ΔVO2/ΔHR [p < .02]) in males and females; ΔWR/ΔHR differed between the two groups in females (p = .041) but not males (p = .1). The mean percent predicted values for all CPET variables were below 100% in the high-BMI group. The pattern of CPET abnormalities suggested a pervasive impairment of O2 delivery in the high-BMI group (ΔVO2/ΔWR was in fact highest in normal-BMI males). Tailoring lifestyle interventions to the specific fitness capabilities of each child (personalized exercise medicine) may be one of the ways to stem what has been an intractable epidemic.
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Xie L, Wang R, Huang M, Zhang Y, Shen J, Xiao T. Quantitative evaluation of myocardial fibrosis by cardiac integrated backscatter analysis in Kawasaki disease. Cardiovasc Ultrasound 2016; 14:3. [PMID: 26754855 PMCID: PMC4710029 DOI: 10.1186/s12947-016-0046-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/06/2016] [Indexed: 01/02/2023] Open
Abstract
Background Kawasaki disease is an acute, systemic vasculitis that affects the coronary arteries. However, the relationship between myocardial fibrosis and Kawasaki disease has been completely unknown until now. We aimed to provide quantitative information about myocardial fibrosis using cardiac integrated backscatter in Han race Kawasaki disease patients. Methods Ninety Kawasaki disease patients and 90 healthy control subjects were recruited. Based on Kawasaki disease status, the patients were categorized into 3 groups: acute, subacute, and convalescence phase. Based on coronary artery status, the Kawasaki disease patients were categorized into 3 groups: without coronary artery lesions, with coronary artery dilation, and with coronary artery aneurysms. All subjects underwent two-dimensional and Doppler examinations to measure clinical echocardiographic parameters. Myocardial fibrosis was detected with calibrated integrated backscatter imaging. Results Left ventricle systolic functions were normal in both the Kawasaki disease and control participants. The myocardial calibrated integrated backscatter values of the left ventricles of the acute (p < 0.001), subacute (p < 0.001) and convalescence phase (p < 0.001) Kawasaki disease patients were significantly greater than those of the healthy controls. The left ventricle myocardial calibrated integrated backscatter values were significantly smaller in the Kawasaki disease patients without coronary artery lesions than in the Kawasaki disease patients with coronary artery dilations and coronary artery aneurysms in different phases. The left ventricle myocardial calibrated integrated backscatter results were positively correlated with coronary artery status in the acute (r = 0.331, p < 0.001), subacute (r = 0.456, p < 0.001) and convalescence phases (r = 0.407, p < 0.001) of Kawasaki disease. Conclusion Our findings may suggest that myocardial fibrosis occurs during early episodes of Kawasaki disease given uncertainties that exist regarding correlations of calibrated integrated backscatter and myocardial fibrosis.
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Affiliation(s)
- Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China.
| | - Renjian Wang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Yongwei Zhang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
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Xie L, Man E, Cheung PT, Cheung YF. Myocardial Integrated Backscatter in Obese Adolescents: Associations with Measures of Adiposity and Left Ventricular Deformation. PLoS One 2015; 10:e0141149. [PMID: 26492195 PMCID: PMC4619589 DOI: 10.1371/journal.pone.0141149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/04/2015] [Indexed: 12/30/2022] Open
Abstract
Background Myocardial fibrosis has been proposed to play an important pathogenetic role in left ventricular (LV) dysfunction in obesity. This study tested the hypothesis that calibrated integrated backscatter (cIB) as a marker of myocardial fibrosis is altered in obese adolescents and explored its associations with adiposity, LV myocardial deformation, and metabolic parameters. Methods/Principal Findings Fifty-two obese adolescents and 38 non-obese controls were studied with conventional and speckle tracking echocardiography. The average cIB of ventricular septum and LV posterior wall was measured. In obese subjects, insulin resistance as estimated by homeostasis model assessment (HOMA-IR) and glucose tolerance were determined. Compared with controls, obese subjects had significantly greater cIB of ventricular septum (-16.8±7.8 dB vs -23.2±7.8 dB, p<0.001), LV posterior wall (-20.5±5.6 dBvs -25.0±5.1 dB, p<0.001) and their average (-18.7±5.7 dB vs -24.1±5.0 dB, p<0.001). For myocardial deformation, obese subjects had significantly reduced LV longitudinal systolic strain rate (SR) (p = 0.045) and early diastolic SR (p = 0.015), and LV circumferential systolic strain (p = 0.008), but greater LV longitudinal late diastolic SR (p<0.001), and radial early (p = 0.037) and late (p = 0.002) diastolic SR than controls. For the entire cohort, myocardial cIB correlated positively with body mass index (r = 0.45, p<0.001) and waist circumference (r = 0.45, p<0.001), but negatively with LV circumferential systolic strain (r = -0.23, p = 0.03) and systolic SR (r = -0.25, p = 0.016). Among obese subjects, cIB tended to correlate with HOMA-IR (r = 0.26, p = 0.07). Conclusion Obese adolescents already exhibit evidence of increased myocardial fibrosis, which is associated with measures of adiposity and impaired LV circumferential myocardial deformation.
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Affiliation(s)
- Lijian Xie
- Shanghai Children’s Hospital, Shanghai Jiaotong University, Shanghai, China
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Elim Man
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pik-to Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Yiu-fai Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
- * E-mail:
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Salerno A, Fragasso G, Esposito A, Canu T, Lattuada G, Manzoni G, Del Maschio A, Margonato A, De Cobelli F, Perseghin G. Effects of short-term manipulation of serum FFA concentrations on left ventricular energy metabolism and function in patients with heart failure: no association with circulating bio-markers of inflammation. Acta Diabetol 2015; 52:753-61. [PMID: 25559351 DOI: 10.1007/s00592-014-0695-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS We wanted to assess the effects of short-term changes in serum free fatty acids (FFAs) on left ventricular (LV) energy metabolism and function in patients with heart failure and whether they correlated with circulating markers of inflammation. METHODS AND RESULTS LV function and phosphocreatine (PCr)/ATP ratio were assessed using MR imaging (MRI) and 31P magnetic resonance spectroscopy (MRS) in 11 men with chronic heart failure in two experimental conditions 7 days apart. Study 1: MRI and 31P-MRS were performed before and 3-4 h after i.v. bolus + continuous heparin infusion titrated to achieve a serum FFA concentration of 1.20 mM. Study 2: The same protocol was performed before and after the oral administration of acipimox titrated to achieve a serum FFA concentration of 0.20 mM. Serum concentrations of IL6, TNF-α, PAI-1, resistin, visfatin and leptin were simultaneously assessed. Serum glucose and insulin concentrations were not different between studies. The PCr/ATP ratio (percent change from baseline: +6.0 ± 16.9 and -16.6 ± 16.1 % in Study 1 and Study 2, respectively; p = 0.005) and the LV ejection fraction (-1.5 ± 4.0 and -6.9 ± 6.3 % in Study 1 and Study 2, respectively; p = 0.044) were reduced during low FFA when compared to high FFA. Serum resistin was higher during Study 1 than in Study 2 (p < 0.05 repeated measures ANOVA); meanwhile, the other adipocytokines were not different. CONCLUSION FFA deprivation, but not excess, impaired LV energy metabolism and function within hours. Cautions should be used when sudden iatrogenic modulation of energy substrates may take place in vulnerable patients.
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Affiliation(s)
- A Salerno
- Clinical Cardiology - Heart Failure Clinic, Ospedale San Raffaele, Milan, Italy
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The Relationship Between Currently Recommended Ambulatory Systolic Blood Pressure Measures and Left Ventricular Mass Index in Pediatric Hypertension. Curr Hypertens Rep 2015; 17:534. [DOI: 10.1007/s11906-015-0534-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Riesenkampff E, Messroghli DR, Redington AN, Grosse-Wortmann L. Myocardial T1 mapping in pediatric and congenital heart disease. Circ Cardiovasc Imaging 2015; 8:e002504. [PMID: 25657297 DOI: 10.1161/circimaging.114.002504] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Eugénie Riesenkampff
- From the Labatt Family Heart Centre, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (E.R., A.N.R., L.G.-W.); Department of Congenital Heart Disease and Pediatric Cardiology and Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (D.R.M.); and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (L.G.-W.).
| | - Daniel R Messroghli
- From the Labatt Family Heart Centre, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (E.R., A.N.R., L.G.-W.); Department of Congenital Heart Disease and Pediatric Cardiology and Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (D.R.M.); and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (L.G.-W.)
| | - Andrew N Redington
- From the Labatt Family Heart Centre, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (E.R., A.N.R., L.G.-W.); Department of Congenital Heart Disease and Pediatric Cardiology and Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (D.R.M.); and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (L.G.-W.)
| | - Lars Grosse-Wortmann
- From the Labatt Family Heart Centre, Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (E.R., A.N.R., L.G.-W.); Department of Congenital Heart Disease and Pediatric Cardiology and Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany (D.R.M.); and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (L.G.-W.)
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Myocardial tissue characterization by magnetic resonance imaging: novel applications of T1 and T2 mapping. J Thorac Imaging 2014; 29:147-54. [PMID: 24576837 PMCID: PMC4252135 DOI: 10.1097/rti.0000000000000077] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is a well-established noninvasive imaging modality in clinical cardiology. Its unsurpassed accuracy in defining cardiac morphology and function and its ability to provide tissue characterization make it well suited for the study of patients with cardiac diseases. Late gadolinium enhancement was a major advancement in the development of tissue characterization techniques, allowing the unique ability of CMR to differentiate ischemic heart disease from nonischemic cardiomyopathies. Using T2-weighted techniques, areas of edema and inflammation can be identified in the myocardium. A new generation of myocardial mapping techniques are emerging, enabling direct quantitative assessment of myocardial tissue properties in absolute terms. This review will summarize recent developments involving T1-mapping and T2-mapping techniques and focus on the clinical applications and future potential of these evolving CMR methodologies.
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Myocardial tissue characterization by magnetic resonance imaging: novel applications of T1 and T2 mapping. J Thorac Imaging 2014. [PMID: 24576837 DOI: 10.1097/rti.0 000000000000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is a well-established noninvasive imaging modality in clinical cardiology. Its unsurpassed accuracy in defining cardiac morphology and function and its ability to provide tissue characterization make it well suited for the study of patients with cardiac diseases. Late gadolinium enhancement was a major advancement in the development of tissue characterization techniques, allowing the unique ability of CMR to differentiate ischemic heart disease from nonischemic cardiomyopathies. Using T2-weighted techniques, areas of edema and inflammation can be identified in the myocardium. A new generation of myocardial mapping techniques are emerging, enabling direct quantitative assessment of myocardial tissue properties in absolute terms. This review will summarize recent developments involving T1-mapping and T2-mapping techniques and focus on the clinical applications and future potential of these evolving CMR methodologies.
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39
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Kehler DS, Stammers AN, Susser SE, Hamm NC, Kimber DE, Hlynsky MW, Duhamel TA. Cardiovascular complications of type 2 diabetes in youth. Biochem Cell Biol 2014; 93:496-510. [PMID: 25629355 DOI: 10.1139/bcb-2014-0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in youth has increased dramatically over the past decades. The literature also suggests that the progression from an impaired glucose tolerance state to established T2DM is more rapid in youth, compared to adults. The presence of significant cardiovascular complications in youth with T2DM, including cardiac, macrovascular, and microvascular remodeling, is another major issue in this younger cohort and poses a significant threat to the healthcare system. However, this issue is only now emerging as a major public health concern, with few data to support optimal treatment targets and strategies to reduce cardiovascular disease (CVD) risk in youth with T2DM. Accordingly, the purpose of this minireview is to better understand the cardiovascular complications in youth with T2DM. We briefly describe the pathophysiology from youth studies, including oxidative stress, inflammation, renin-angiotensin aldosterone system, and epigenetics, which link T2DM and CVD. We also describe the literature concerning the early signs of CVD in youth and potential treatment options to reduce cardiovascular risk.
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Affiliation(s)
- D Scott Kehler
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Andrew N Stammers
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Shanel E Susser
- b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre.,c Department of Physiology, University of Manitoba
| | - Naomi C Hamm
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Dustin E Kimber
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Michael W Hlynsky
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre
| | - Todd A Duhamel
- a Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University Of Manitoba.,b Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre.,c Department of Physiology, University of Manitoba.,d Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
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Zachariah JP, Ingul CB, Marx GR. Linking pediatric obesity to subclinical alterations in cardiac structure and function. JACC Cardiovasc Imaging 2014; 7:1206-8. [PMID: 25457758 PMCID: PMC4282992 DOI: 10.1016/j.jcmg.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Justin P Zachariah
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Charlotte B Ingul
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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Bacharova L, Ugander M. Left ventricular hypertrophy: The relationship between the electrocardiogram and cardiovascular magnetic resonance imaging. Ann Noninvasive Electrocardiol 2014; 19:524-33. [PMID: 25367364 PMCID: PMC6932615 DOI: 10.1111/anec.12223] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Conventional assessment of left ventricular hypertrophy (LVH) using the electrocardiogram (ECG), for example, by the Sokolow-Lyon, Romhilt-Estes or Cornell criteria, have relied on assessing changes in the amplitude and/or duration of the QRS complex of the ECG to quantify LV mass. ECG measures of LV mass have typically been validated by imaging with echocardiography or cardiovascular magnetic resonance imaging (CMR). However, LVH can be the result of diverse etiologies, and LVH is also characterized by pathological changes in myocardial tissue characteristics on the genetic, molecular, cellular, and tissue level beyond a pure increase in the number of otherwise normal cardiomyocytes. For example, slowed conduction velocity through the myocardium, which can be due to diffuse myocardial fibrosis, has been shown to be an important determinant of conventional ECG LVH criteria regardless of LV mass. Myocardial tissue characterization by CMR has emerged to not only quantify LV mass, but also detect and quantify the extent and severity of focal or diffuse myocardial fibrosis, edema, inflammation, myocarditis, fatty replacement, myocardial disarray, and myocardial deposition of amyloid proteins (amyloidosis), glycolipids (Fabry disease), or iron (siderosis). This can be undertaken using CMR techniques including late gadolinium enhancement (LGE), T1 mapping, T2 mapping, T2* mapping, extracellular volume fraction (ECV) mapping, fat/water-weighted imaging, and diffusion tensor CMR. This review presents an overview of current and emerging concepts regarding the diagnostic possibilities of both ECG and CMR for LVH in an attempt to narrow gaps in our knowledge regarding the ECG diagnosis of LVH.
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Affiliation(s)
- Ljuba Bacharova
- International Laser CenterBratislavaSlovak Republic
- Institute of PathophysiologyMedical SchoolComenius UniversityBratislavaSlovak Republic
| | - Martin Ugander
- Department of Clinical PhysiologyKarolinska Institute and Karolinska University HospitalStockholmSweden
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Lima-Leopoldo AP, Leopoldo AS, da Silva DCT, do Nascimento AF, de Campos DHS, Luvizotto RAM, de Deus AF, Freire PP, Medeiros A, Okoshi K, Cicogna AC. Long-term obesity promotes alterations in diastolic function induced by reduction of phospholamban phosphorylation at serine-16 without affecting calcium handling. J Appl Physiol (1985) 2014; 117:669-78. [PMID: 24970855 DOI: 10.1152/japplphysiol.00088.2014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Few studies have evaluated the relationship between the duration of obesity, cardiac function, and the proteins involved in myocardial calcium (Ca(2+)) handling. We hypothesized that long-term obesity promotes cardiac dysfunction due to a reduction of expression and/or phosphorylation of myocardial Ca(2+)-handling proteins. Thirty-day-old male Wistar rats were distributed into two groups (n = 10 each): control (C; standard diet) and obese (Ob; high-fat diet) for 30 wk. Morphological and histological analyses were assessed. Left ventricular cardiac function was assessed in vivo by echocardiographic evaluation and in vitro by papillary muscle. Cardiac protein expression of sarcoplasmic reticulum (SR) Ca(2+)-ATPase (SERCA2a), calsequestrin, L-type Ca(2+) channel, and phospholamban (PLB), as well as PLB serine-16 phosphorylation (pPLB Ser(16)) and PLB threonine-17 phosphorylation (pPLB Thr(17)) were determined by Western blot. The adiposity index was higher (82%) in Ob rats than in C rats. Obesity promoted cardiac hypertrophy without alterations in interstitial collagen levels. Ob rats had increased endocardial and midwall fractional shortening, posterior wall shortening velocity, and A-wave compared with C rats. Cardiac index, early-to-late diastolic mitral inflow ratio, and isovolumetric relaxation time were lower in Ob than in C. The Ob muscles developed similar baseline data and myocardial responsiveness to increased extracellular Ca(2+). Obesity caused a reduction in cardiac pPLB Ser(16) and the pPLB Ser(16)/PLB ratio in Ob rats. Long-term obesity promotes alterations in diastolic function, most likely due to the reduction of pPLB Ser(16), but does not impair the myocardial Ca(2+) entry and recapture to SR.
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Affiliation(s)
- Ana Paula Lima-Leopoldo
- Center for Physical Education and Sports, Department of Sports, Federal University of Espírito Santo, Vitória;
| | - André S Leopoldo
- Center for Physical Education and Sports, Department of Sports, Federal University of Espírito Santo, Vitória
| | - Danielle C T da Silva
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | - André F do Nascimento
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | - Dijon H S de Campos
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | - Renata A M Luvizotto
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | - Adriana F de Deus
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | - Paula P Freire
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | | | - Katashi Okoshi
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
| | - Antonio C Cicogna
- Department of Clinic and Cardiology, School of Medicine, Universidade Estadual Paulista, Botucatu, São Paulo; and
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Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, Gatehouse PD, Arai AE, Friedrich MG, Neubauer S, Schulz-Menger J, Schelbert EB. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 2013; 15:92. [PMID: 24124732 PMCID: PMC3854458 DOI: 10.1186/1532-429x-15-92] [Citation(s) in RCA: 804] [Impact Index Per Article: 73.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/04/2013] [Indexed: 12/13/2022] Open
Abstract
Rapid innovations in cardiovascular magnetic resonance (CMR) now permit the routine acquisition of quantitative measures of myocardial and blood T1 which are key tissue characteristics. These capabilities introduce a new frontier in cardiology, enabling the practitioner/investigator to quantify biologically important myocardial properties that otherwise can be difficult to ascertain clinically. CMR may be able to track biologically important changes in the myocardium by: a) native T1 that reflects myocardial disease involving the myocyte and interstitium without use of gadolinium based contrast agents (GBCA), or b) the extracellular volume fraction (ECV)-a direct GBCA-based measurement of the size of the extracellular space, reflecting interstitial disease. The latter technique attempts to dichotomize the myocardium into its cellular and interstitial components with estimates expressed as volume fractions. This document provides recommendations for clinical and research T1 and ECV measurement, based on published evidence when available and expert consensus when not. We address site preparation, scan type, scan planning and acquisition, quality control, visualisation and analysis, technical development. We also address controversies in the field. While ECV and native T1 mapping appear destined to affect clinical decision making, they lack multi-centre application and face significant challenges, which demand a community-wide approach among stakeholders. At present, ECV and native T1 mapping appear sufficiently robust for many diseases; yet more research is required before a large-scale application for clinical decision-making can be recommended.
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Affiliation(s)
- James C Moon
- The Heart Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Daniel R Messroghli
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew D Robson
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peter D Gatehouse
- NIHR Cardiovascular BRU, Royal Brompton Hospital & Imperial College, London, UK
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthias G Friedrich
- Departments of Cardiology and Radiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jeanette Schulz-Menger
- Department of Cardiology and Nephrology, Working Group Cardiac MRI, Humboldt University Berlin, Berlin, Germany
- Charite Campus Buch Experimental and Clinical Research Center, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Erik B Schelbert
- UPMC Cardiovascular Magnetic Resonance Center, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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