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Toritani H, Yoshida K, Hosokawa T, Tanabe Y, Yamamoto Y, Nishiyama H, Kido T, Kawaguchi N, Matsuda M, Nakano S, Miyazaki S, Uetani T, Inaba S, Yamaguchi O, Kido T. The Feasibility of a Model-Based Iterative Reconstruction Technique Tuned for the Myocardium on Myocardial Computed Tomography Late Enhancement. J Comput Assist Tomogr 2024:00004728-990000000-00340. [PMID: 39095055 DOI: 10.1097/rct.0000000000001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study evaluated the feasibility of a model-based iterative reconstruction technique (MBIR) tuned for the myocardium on myocardial computed tomography late enhancement (CT-LE). METHODS Twenty-eight patients who underwent myocardial CT-LE and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) within 1 year were retrospectively enrolled. Myocardial CT-LE was performed using a 320-row CT with low tube voltage (80 kVp). Myocardial CT-LE images were scanned 7 min after CT angiography (CTA) without additional contrast medium. All myocardial CT-LE images were reconstructed with hybrid iterative reconstruction (HIR), conventional MBIR (MBIR_cardiac), and new MBIR tuned for the myocardium (MBIR_myo). Qualitative (5-grade scale) scores and quantitative parameters (signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]) were assessed as image quality. The sensitivity, specificity, and accuracy of myocardial CT-LE were evaluated at the segment level using an American Heart Association (AHA) 16-segment model, with LGE-MRI as a reference standard. These results were compared among the different CT image reconstructions. RESULTS In 28 patients with 448 segments, 160 segments were diagnosed with positive by LGE-MRI. In the qualitative assessment of myocardial CT-LE, the mean image quality scores were 2.9 ± 1.2 for HIR, 3.0 ± 1.1 for MBIR_cardiac, and 4.0 ± 1.0 for MBIR_myo. MBIR_myo showed a significantly higher score than HIR (P < 0.001) and MBIR_cardiac (P = 0.018). In the quantitative image quality assessment of myocardial CT-LE, the median image SNR was 10.3 (9.1-11.1) for HIR, 10.8 (9.8-12.1) for MBIR_cardiac, and 16.8 (15.7-18.4) for MBIR_myo. The median image CNR was 3.7 (3.0-4.6) for HIR, 3.8 (3.2-5.1) for MBIR_cardiac, and 6.4 (5.0-7.7) for MBIR_myo. MBIR_myo significantly improved the SNR and CNR of CT-LE compared to HIR and MBIR_cardiac (P < 0.001). The sensitivity, specificity, and accuracy for the detection of myocardial CT-LE were 70%, 92%, and 84% for HIR; 71%, 92%, and 85% for MBIR_cardiac; and 84%, 92%, and 89% for MBIR_myo, respectively. MBIR_myo showed significantly higher image quality, sensitivity, and accuracy than the others (P < 0.05). CONCLUSIONS MBIR tuned for myocardium improved image quality and diagnostic performance for myocardial CT-LE assessment.
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Affiliation(s)
| | - Kazuki Yoshida
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Takaaki Hosokawa
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Yuta Yamamoto
- Department of Radiology, Saiseikai Matsuyama Hospital, Matsuyama City, Ehime Prefecture
| | - Hikaru Nishiyama
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Megumi Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
| | - Shota Nakano
- Canon Medical Systems Corporation, Otawara City, Tochigi Prefecture
| | - Shigehiro Miyazaki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime Prefecture, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime Prefecture, Japan
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime Prefecture, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime Prefecture, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon City
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Naito T, Nakamura K, Abe Y, Watanabe H, Sakuragi S, Katayama Y, Kihara H, Okizaki A, Kawai Y, Yoshikawa M, Takaishi A, Fujio H, Otsuka H, Ogura S, Ito H, Nomura N, Matsumura Y, Nakashima M, Nikaido K, Ono T, Kawamura K, Arai J, Tobita S, Takahashi S, Tanimoto M. Prevalence of transthyretin amyloidosis among heart failure patients with preserved ejection fraction in Japan. ESC Heart Fail 2023. [DOI: 10.1002/ehf2.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Lau C, Gul U, Liu B, Captur G, Hothi SS. Cardiovascular Magnetic Resonance Imaging in Familial Dilated Cardiomyopathy. Medicina (B Aires) 2023; 59:medicina59030439. [PMID: 36984439 PMCID: PMC10057087 DOI: 10.3390/medicina59030439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is a common cause of non-ischaemic heart failure, conferring high morbidity and mortality, including sudden cardiac death due to systolic dysfunction or arrhythmic sudden death. Within the DCM cohort exists a group of patients with familial disease. In this article we review the pathophysiology and cardiac imaging findings of familial DCM, with specific attention to known disease subtypes. The role of advanced cardiac imaging cardiovascular magnetic resonance is still accumulating, and there remains much to be elucidated. We discuss its potential clinical roles as currently known, with respect to diagnostic utility and risk stratification. Advances in such risk stratification may help target pharmacological and device therapies to those at highest risk.
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Affiliation(s)
- Clement Lau
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Uzma Gul
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Boyang Liu
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Gabriella Captur
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London WC1E 6BT, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Centre for Inherited Heart Muscle Conditions, Cardiology Department, The Royal Free Hospital, London NW3 2QG, UK
| | - Sandeep S. Hothi
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence:
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Olausson E, Wertz J, Fridman Y, Bering P, Maanja M, Niklasson L, Wong TC, Fukui M, Cavalcante JL, Cater G, Kellman P, Bukhari S, Miller CA, Saba S, Ugander M, Schelbert EB. Diffuse myocardial fibrosis associates with incident ventricular arrhythmia in implantable cardioverter defibrillator recipients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.15.23285925. [PMID: 36824921 PMCID: PMC9949189 DOI: 10.1101/2023.02.15.23285925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background Diffuse myocardial fibrosis (DMF) quantified by extracellular volume (ECV) may represent a vulnerable phenotype and associate with life threatening ventricular arrhythmias more than focal myocardial fibrosis. This principle remains important because 1) risk stratification for implantable cardioverter defibrillators (ICD) remains challenging, and 2) DMF may respond to current or emerging medical therapies (reversible substrate). Objectives To evaluate the association between quantified by ECV in myocardium without focal fibrosis by late gadolinium enhancement (LGE) with time from ICD implantation to 1) appropriate shock, or 2) shock or anti-tachycardia pacing. Methods Among patients referred for cardiovascular magnetic resonance (CMR) without congenital disease, hypertrophic cardiomyopathy, or amyloidosis who received ICDs (n=215), we used Cox regression to associate ECV with incident ICD therapy. Results After a median of 2.9 (IQR 1.5-4.2) years, 25 surviving patients experienced ICD shock and 44 experienced shock or anti-tachycardia pacing. ECV ranged from 20.2% to 39.4%. No patient with ECV<25% experienced an ICD shock. ECV associated with both endpoints, e.g., hazard ratio 2.17 (95%CI 1.17-4.00) for every 5% increase in ECV, p=0.014 in a stepwise model for ICD shock adjusting for ICD indication, age, smoking, atrial fibrillation, and myocardial infarction, whereas focal fibrosis by LGE and global longitudinal strain (GLS) did not. Conclusions DMF measured by ECV associates with ventricular arrhythmias requiring ICD therapy in a dose-response fashion, even adjusting for potential confounding variables, focal fibrosis by LGE, and GLS. ECV-based risk stratification and DMF representing a therapeutic target to prevent ventricular arrhythmia warrant further investigation.
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Affiliation(s)
- Eric Olausson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | | | - Yaron Fridman
- Asheville Cardiology Associates, Mission Hospital, Asheville, NC, USA
| | | | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Louise Niklasson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Timothy C Wong
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
| | - Miho Fukui
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L. Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - George Cater
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Syed Bukhari
- Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Kolling Institute, Royal North Shore Hospital, and Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Samir Saba
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Kolling Institute, Royal North Shore Hospital, and Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Erik B. Schelbert
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
- Minneapolis Heart Institute East, United Hospital, Saint Paul, Minnesota
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Cardiac Magnetic Resonance Features Associated with the Risk of Cardiac Arrest in Patients with Acute Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
Background: Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). Besides the location and severity of coronary occlusion, different factors may have significant role in the pathogenesis of AMI-related cardiac arrest (CA), but their contribution is still under investigation. The aim of the study was to investigate the cardiac magnetic resonance (CMR) features of myocardial injury associated with a higher risk of CA accompanying an AMI.
Methods: In total, 918 myocardial segments from 54 post-AMI patients undergoing CMR imaging with delayed gadolinium enhancement were enrolled in the study, of which 18.54% presented CA during the acute phase of AMI. In all patients, infarct mass, the proportion of high transmurality extent, and scar mass at different myocardial segments were calculated using QMap software (Medis BV).
Results: Compared to patients without CA, those with CA had a significantly higher infarct size (p = 0.03) and a higher degree of transmurality (29.28% vs. 14.1%, p = 0.01). The risk of CA during the acute phase was significantly higher in patients in whom the location of myocardial injury was at the level of latero-apical, antero-lateral, and basal anterior segments. Group 1 presented a larger infarct size at the level of the latero-apical (33.9 ± 30.6 g vs. 13.6 ± 17.3 g, p = 0.02), anterolateral (26.5 ± 29.0 g vs. 8.9 ± 12.8 g, p = 0.02), and anterobasal segment (20.1 ± 21.5 g vs. 7.8 ± 14.7 g, p = 0.02).
Conclusions: CMR imaging identified infarct mass, high transmurality degree, and large myocardial injury as features associated with an increased risk of CA in the acute phase of AMI, especially at the level of anterolateral segments.
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Lau C, Elshibly MMM, Kanagala P, Khoo JP, Arnold JR, Hothi SS. The role of cardiac magnetic resonance imaging in the assessment of heart failure with preserved ejection fraction. Front Cardiovasc Med 2022; 9:922398. [PMID: 35924215 PMCID: PMC9339656 DOI: 10.3389/fcvm.2022.922398] [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: 04/17/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) is a major cause of morbidity and mortality worldwide. Current classifications of HF categorize patients with a left ventricular ejection fraction of 50% or greater as HF with preserved ejection fraction or HFpEF. Echocardiography is the first line imaging modality in assessing diastolic function given its practicality, low cost and the utilization of Doppler imaging. However, the last decade has seen cardiac magnetic resonance (CMR) emerge as a valuable test for the sometimes challenging diagnosis of HFpEF. The unique ability of CMR for myocardial tissue characterization coupled with high resolution imaging provides additional information to echocardiography that may help in phenotyping HFpEF and provide prognostication for patients with HF. The precision and accuracy of CMR underlies its use in clinical trials for the assessment of novel and repurposed drugs in HFpEF. Importantly, CMR has powerful diagnostic utility in differentiating acquired and inherited heart muscle diseases presenting as HFpEF such as Fabry disease and amyloidosis with specific treatment options to reverse or halt disease progression. This state of the art review will outline established CMR techniques such as transmitral velocities and strain imaging of the left ventricle and left atrium in assessing diastolic function and their clinical application to HFpEF. Furthermore, it will include a discussion on novel methods and future developments such as stress CMR and MR spectroscopy to assess myocardial energetics, which show promise in unraveling the mechanisms behind HFpEF that may provide targets for much needed therapeutic interventions.
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Affiliation(s)
- Clement Lau
- Department of Cardiology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Mohamed M. M. Elshibly
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Prathap Kanagala
- Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust and Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Jeffrey P. Khoo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jayanth Ranjit Arnold
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Sandeep Singh Hothi
- Department of Cardiology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Cornhill AK, Dykstra S, Satriano A, Labib D, Mikami Y, Flewitt J, Prosio E, Rivest S, Sandonato R, Howarth AG, Lydell C, Eastwood CA, Quan H, Fine N, Lee J, White JA. Machine Learning Patient-Specific Prediction of Heart Failure Hospitalization Using Cardiac MRI-Based Phenotype and Electronic Health Information. Front Cardiovasc Med 2022; 9:890904. [PMID: 35783851 PMCID: PMC9245012 DOI: 10.3389/fcvm.2022.890904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart failure (HF) hospitalization is a dominant contributor of morbidity and healthcare expenditures in patients with systolic HF. Cardiovascular magnetic resonance (CMR) imaging is increasingly employed for the evaluation of HF given capacity to provide highly reproducible phenotypic markers of disease. The combined value of CMR phenotypic markers and patient health information to deliver predictions of future HF events has not been explored. We sought to develop and validate a novel risk model for the patient-specific prediction of time to HF hospitalization using routinely reported CMR variables, patient-reported health status, and electronic health information.MethodsStandardized data capture was performed for 1,775 consecutive patients with chronic systolic HF referred for CMR imaging. Patient demographics, symptoms, Health-related Quality of Life, pharmacy, and routinely reported CMR features were provided to both machine learning (ML) and competing risk Fine-Gray-based models (FGM) for the prediction of time to HF hospitalization.ResultsThe mean age was 59 years with a mean LVEF of 36 ± 11%. The population was evenly distributed between ischemic (52%) and idiopathic non-ischemic cardiomyopathy (48%). Over a median follow-up of 2.79 years (IQR: 1.59–4.04) 333 patients (19%) experienced HF related hospitalization. Both ML and competing risk FGM based models achieved robust performance for the prediction of time to HF hospitalization. Respective 90-day, 1 and 2-year AUC values were 0.87, 0.83, and 0.80 for the ML model, and 0.89, 0.84, and 0.80 for the competing risk FGM-based model in a holdout validation cohort. Patients classified as high-risk by the ML model experienced a 34-fold higher occurrence of HF hospitalization at 90 days vs. the low-risk group.ConclusionIn this study we demonstrated capacity for routinely reported CMR phenotypic markers and patient health information to be combined for the delivery of patient-specific predictions of time to HF hospitalization. This work supports an evolving migration toward multi-domain data collection for the delivery of personalized risk prediction at time of diagnostic imaging.
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Affiliation(s)
- Aidan K. Cornhill
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Easter Prosio
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Carmen Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Cathy A. Eastwood
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- *Correspondence: James A. White,
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Fahmy AS, Rowin EJ, Chan RH, Manning WJ, Maron MS, Nezafat R. Improved Quantification of Myocardium Scar in Late Gadolinium Enhancement Images: Deep Learning Based Image Fusion Approach. J Magn Reson Imaging 2021; 54:303-312. [PMID: 33599043 PMCID: PMC8359184 DOI: 10.1002/jmri.27555] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quantification of myocardium scarring in late gadolinium enhanced (LGE) cardiac magnetic resonance imaging can be challenging due to low scar-to-background contrast and low image quality. To resolve ambiguous LGE regions, experienced readers often use conventional cine sequences to accurately identify the myocardium borders. PURPOSE To develop a deep learning model for combining LGE and cine images to improve the robustness and accuracy of LGE scar quantification. STUDY TYPE Retrospective. POPULATION A total of 191 hypertrophic cardiomyopathy patients: 1) 162 patients from two sites randomly split into training (50%; 81 patients), validation (25%, 40 patients), and testing (25%; 41 patients); and 2) an external testing dataset (29 patients) from a third site. FIELD STRENGTH/SEQUENCE 1.5T, inversion-recovery segmented gradient-echo LGE and balanced steady-state free-precession cine sequences ASSESSMENT: Two convolutional neural networks (CNN) were trained for myocardium and scar segmentation, one with and one without LGE-Cine fusion. For CNN with fusion, the input was two aligned LGE and cine images at matched cardiac phase and anatomical location. For CNN without fusion, only LGE images were used as input. Manual segmentation of the datasets was used as reference standard. STATISTICAL TESTS Manual and CNN-based quantifications of LGE scar burden and of myocardial volume were assessed using Pearson linear correlation coefficients (r) and Bland-Altman analysis. RESULTS Both CNN models showed strong agreement with manual quantification of LGE scar burden and myocardium volume. CNN with LGE-Cine fusion was more robust than CNN without LGE-Cine fusion, allowing for successful segmentation of significantly more slices (603 [95%] vs. 562 (89%) of 635 slices; P < 0.001). Also, CNN with LGE-Cine fusion showed better agreement with manual quantification of LGE scar burden than CNN without LGE-Cine fusion (%ScarLGE-cine = 0.82 × %Scarmanual , r = 0.84 vs. %ScarLGE = 0.47 × %Scarmanual , r = 0.81) and myocardium volume (VolumeLGE-cine = 1.03 × Volumemanual , r = 0.96 vs. VolumeLGE = 0.91 × Volumemanual , r = 0.91). DATA CONCLUSION CNN based LGE-Cine fusion can improve the robustness and accuracy of automated scar quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: 1.
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Affiliation(s)
- Ahmed S. Fahmy
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Ethan J. Rowin
- Hypertrophic Cardiomyopathy Center, Division of CardiologyTufts Medical CenterBostonMassachusettsUSA
| | - Raymond H. Chan
- Toronto General HospitalUniversity Health NetworkTorontoCanada
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
- RadiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Center, Division of CardiologyTufts Medical CenterBostonMassachusettsUSA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
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Yang T, Lu M, Ouyang W, Li B, Yang Y, Zhao S, Sun H. Prognostic value of myocardial scar by magnetic resonance imaging in patients undergoing coronary artery bypass graft. Int J Cardiol 2020; 326:49-54. [PMID: 33296720 DOI: 10.1016/j.ijcard.2020.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/01/2020] [Accepted: 10/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies demonstrated that scar tissue assessed by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) is associated with recovery of cardiac function after coronary artery bypass graft (CABG) in patients with a history of myocardial infarction (MI). However, information on the association between myocardial scar at baseline and long-term survival after CABG in these patients is lacking. METHODS From April 2010 to May 2013, consecutive patients with multivessel coronary artery disease (CAD, > 70% stenosis in ≥2 vessels) and MI (> 3 months) who underwent LGE-CMR within 1 month prior to isolated CABG were enrolled. Left ventricular functional parameters and scar tissue were assessed by LGE-CMR before surgery. A standard 17-segment model was used for scar quantification. Predictors for cardiovascular events (CVEs) were analyzed. RESULTS Of 148 patients who met the study inclusion/exclusion criteria, 140 cases had follow-up data and were included in final analysis. Of the latter, 27 (19.3%) patients suffered CVEs perioperatively or during mean 89.6 ± 12.0 months follow-up. In Cox proportional hazard regression model, the most significant predictor for CVEs after CABG was the number of scar segments on LGE-CMR (Hazard ratio 2.078, 95% Confidence Interval 1.133-3.814, P= 0.018). In Receiver-Operator-Characteristic (ROC) analysis, number of scar segments ≥6 predicted CVEs (sensitivity, 74.1%; specificity, 95.6%; area under the curve [AUC] = 0.934, P < 0.001). CONCLUSIONS Scar tissue identified by LGE-CMR appears to be an independent predictor of CVEs after CABG in patients with a history of MI, which might allow preoperative risk stratification.
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Affiliation(s)
- Tao Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Wenbin Ouyang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Baotong Li
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Yan Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Shihua Zhao
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Hansong Sun
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China..
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10
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Greulich S, Seitz A, Müller KAL, Grün S, Ong P, Ebadi N, Kreisselmeier KP, Seizer P, Bekeredjian R, Zwadlo C, Gräni C, Klingel K, Gawaz M, Sechtem U, Mahrholdt H. Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data. J Am Heart Assoc 2020; 9:e015351. [PMID: 32787653 PMCID: PMC7660832 DOI: 10.1161/jaha.119.015351] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is scarce data about the long‐term mortality as well as the prognostic value of cardiovascular magnetic resonance and late gadolinium enhancement (LGE) in patients with biopsy‐proven viral myocarditis. We sought to investigate: (1) mortality and (2) prognostic value of LGEcardiovascular magnetic resonance (location, pattern, extent, and distribution) in a >10‐year follow‐up in patients with biopsy‐proven myocarditis. Methods and Results Two‐hundred three consecutive patients with biopsy‐proven viral myocarditis and cardiovascular magnetic resonance were enrolled; 183 patients were eligible for standardized follow‐up. The median follow‐up was 10.1 years. End points were all‐cause death, cardiac death, and sudden cardiac death (SCD). We found substantial long‐term mortality in patients with biopsy‐proven myocarditis (39.3% all cause, 27.3% cardiac, and 10.9% SCD); 101 patients (55.2%) demonstrated LGE. The presence of LGE was associated with a more than a doubled risk of death (hazard ratio [HR], 2.40; 95% CI], 1.30–4.43), escalating to a HR of 3.00 (95% CI, 1.41–6.42) for cardiac death, and a HR of 14.79 (95% CI, 1.95–112.00) for SCD; all P≤0.009. Specifically, midwall, (antero‐) septal LGE, and extent of LGE were highly associated with death, all P<0.001. Septal LGE was the best independent predictor for SCD (HR, 4.59; 95% CI, 1.38–15.24; P=0.01). Conclusions In patients with biopsy‐proven viral myocarditis, the presence of midwall LGE in the (antero‐) septal segments is associated with a higher rate of mortality (including SCD) compared with absent LGE or other LGE patterns, underlining the prognostic benefit of a distinct LGE analysis in these patients.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Andreas Seitz
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Karin A L Müller
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Stefan Grün
- Department of Cardiology Rems-Murr-Klinikum Winnenden Winnenden Germany
| | - Peter Ong
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Nawid Ebadi
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | | | - Peter Seizer
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Raffi Bekeredjian
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Carolin Zwadlo
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Christoph Gräni
- Department of Cardiology Bern University Hospital Bern Switzerland.,Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Karin Klingel
- Cardiopathology Institute for Pathology and Neuropathology University of Tübingen Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Udo Sechtem
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Heiko Mahrholdt
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
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11
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Masri A, Bukhari S, Eisele YS, Soman P. Molecular Imaging of Cardiac Amyloidosis. J Nucl Med 2020; 61:965-970. [PMID: 32482792 DOI: 10.2967/jnumed.120.245381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/18/2020] [Indexed: 01/28/2023] Open
Abstract
Transthyretin and light-chain amyloidosis are the 2 main causes of cardiac amyloidosis. Recent developments in molecular imaging have transformed our ability to diagnose transthyretin cardiac amyloidosis noninvasively and unmasked a hitherto unrecognized prevalence of the disease. This review summarizes the current and evolving imaging approaches, their molecular structural basis, and the gaps in imaging capabilities that have arisen as a result of parallel developments in pharmacotherapy delivering the first effective treatment options for this condition.
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Affiliation(s)
- Ahmad Masri
- Division of Cardiology, Oregon Health and Science University, Portland, Oregon; and
| | - Syed Bukhari
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yvonne S Eisele
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Matusik PS, Bryll A, Matusik PT, Popiela TJ. Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction. Cardiol J 2020; 28:67-76. [PMID: 32037500 DOI: 10.5603/cj.a2020.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/27/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may reveal myocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantable cardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall is related to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was to assess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction. METHODS Sixty-seven patients were included (17.9% female, aged 45 [29-60] years), who underwent LGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography. RESULTS In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE were observed in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in 23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in the posterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previous myocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78% vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2% of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for its association with older age and previous MI (p = 0.08 and p = 0.12, respectively). CONCLUSIONS Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, and previous MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures.
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Affiliation(s)
- Patrycja S Matusik
- Department of Radiology, University Hospital, Skawińska 8 Street, 33-332 Kraków, Poland
| | - Amira Bryll
- Department of Diagnostic Imaging, Jagiellonian University Medical College
| | - Paweł T Matusik
- Institute of Cardiology, Jagiellonian University Medical College, Prądnicka 80 Street, 31-202 Kraków, Poland. .,Department of Electrocardiology, The John Paul II Hospital, Prądnicka 80 Street, 31-202 Kraków, Poland.
| | - Tadeusz J Popiela
- Department of Diagnostic Imaging, Jagiellonian University Medical College
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13
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Demir Ş, Ede H, Kaplan M, Yavuz F, Yücel C, Kurt İH. Neopterin as a novel marker; well correlated with mortality and morbidity in patients with advanced systolic heart failure. Acta Cardiol 2019; 74:216-221. [PMID: 29914304 DOI: 10.1080/00015385.2018.1478266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: The aim of this study is research relation of serum neopterin level with mortality and morbidity due to systolic HF and also its role in diagnosis of patients with systolic HF. Material and methods: Eighty-one patients with systolic heart failure (HF group) and eighty-one age- and gender-matched healthy subjects (the control group) were enrolled in the study. Echocardiographic examination was performed accordingly. At the beginning of the study, serum B type natriuretic peptide (BNP), neopterin, and high sensitive C-reactive protein (hs-CRP) were measured accordingly. The subjects were followed for one year then after. Mortality rate and number of hospitalisation due to HF were recorded. Results: Age and gender distribution over the groups were statistically similar (p > .05). LVEF of the control and HF groups were 62 ± 3 and 27 ± 3%, respectively (p < .001). Average neopterin value of HF group was significantly higher than that of the control group (p < .001). Both hs-CRP and BNP values were well correlated to neopterin values (p = .667 and .778, respectively). There was a significant correlation between number of hospitalisation and neopterin values among patients in HF group (p = .008). Also among HF group, neopterin value of patients died within first year of follow-up (n = 29) was higher than that of patients survived beyond first year (n = 52 and p = .011). Conclusions: Neopterin is a biomarker reflecting ongoing inflammatory process in deteriorating heart. High level of serum neopterin concentrations was associated with mortality and morbidity in systolic HF.
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Affiliation(s)
- Şerafettin Demir
- Cardiology Department, Adana City Hospital, Health and Science Unıversıty, Adana, Turkey
| | - Hüseyin Ede
- Cardiology Department, The Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Mehmet Kaplan
- Cardiology Department, Adana City Hospital, Health and Science Unıversıty, Adana, Turkey
| | - Fethi Yavuz
- Cardiology Department, Adana City Hospital, Health and Science Unıversıty, Adana, Turkey
| | - Ceyhun Yücel
- Cardiology Department, Adana City Hospital, Health and Science Unıversıty, Adana, Turkey
| | - İbrahim Halil Kurt
- Cardiology Department, Adana City Hospital, Health and Science Unıversıty, Adana, Turkey
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14
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Shanbhag SM, Greve AM, Aspelund T, Schelbert EB, Cao JJ, Danielsen R, þorgeirsson G, Sigurðsson S, Eiríksdóttir G, Harris TB, Launer LJ, Guðnason V, Arai AE. Prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in older adults. Eur Heart J 2019; 40:529-538. [PMID: 30445559 PMCID: PMC6657269 DOI: 10.1093/eurheartj/ehy713] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/25/2017] [Accepted: 10/11/2018] [Indexed: 12/23/2022] Open
Abstract
Aims Non-ischaemic cardiomyopathies (NICM) can cause heart failure and death. Cardiac magnetic resonance (CMR) detects myocardial scar/fibrosis associated with myocardial infarction (MI) and NICM with late gadolinium enhancement (LGE). The aim of this study was to determine the prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in a community-based sample of older adults. Methods and results The ICELAND-MI cohort, a substudy of the Age, Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) study, provided a well-characterized population of 900 subjects after excluding subjects with pre-existing heart failure. Late gadolinium enhancement CMR divided subjects into four groups: MI (n = 211), major (n = 54) non-ischaemic fibrosis (well-established, classic patterns, associated with myocarditis, infiltrative cardiomyopathies, or pathological hypertrophy), minor (n = 238) non-ischaemic fibrosis (remaining localized patterns not meeting major criteria), and a no LGE (n = 397) reference group. The primary outcome was time to death or first heart failure hospitalization. During a median follow-up of 5.8 years, 192 composite events occurred (115 deaths and 77 hospitalizations for incident heart failure). After inverse probability weighting, major non-ischaemic fibrosis [hazard ratio (HR) 3.2, P < 0.001] remained independently associated with the primary endpoint, while MI (HR 1.4, P = 0.10) and minor non-ischaemic LGE (HR 1.2, P = 0.39) did not. Major non-ischaemic fibrosis was associated with a poorer outcome than MI (HR = 2.3, P = 0.001) in the adjusted analysis. Conclusion Major non-ischaemic patterns of myocardial fibrosis portended worse prognosis than no fibrosis/scar in an older community-based cohort. Traditional risk factors largely accounted for the effect of MI and minor non-ischaemic LGE.
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Affiliation(s)
- Sujata M Shanbhag
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
| | - Anders M Greve
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
- Department of Clinical Biochemistry, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark
| | - Thor Aspelund
- Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
- University of Iceland, Sæmundargata 2, Reykjavik, Iceland
| | - Erik B Schelbert
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
- University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Lothrop St., Ste. A349, Pittsburgh, PA, USA
| | - J Jane Cao
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
- St. Francis Hospital, The heart Center, State University of New York at Stony Brook, 100 Port Washington Blvd, Roslyn, NY, USA
| | | | | | | | - Guðný Eiríksdóttir
- Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
| | - Tamara B Harris
- Laboratory of Epidemiology & Population Science, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, GWY Bldg Rm 2N300, 7201 Wisconsin Ave, Bethesda, MD, USA
| | - Lenore J Launer
- Laboratory of Epidemiology & Population Science, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, GWY Bldg Rm 2N300, 7201 Wisconsin Ave, Bethesda, MD, USA
| | - Vilmundur Guðnason
- Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
- University of Iceland, Sæmundargata 2, Reykjavik, Iceland
| | - Andrew E Arai
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
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15
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Nii M, Ishida M, Dohi K, Tanaka H, Kondo E, Ito M, Sakuma H, Ikeda T. Myocardial tissue characterization and strain analysis in healthy pregnant women using cardiovascular magnetic resonance native T1 mapping and feature tracking technique. J Cardiovasc Magn Reson 2018; 20:52. [PMID: 30068369 PMCID: PMC6090929 DOI: 10.1186/s12968-018-0476-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/19/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Peripartum cardiomyopathy is a life-threatening condition that occurs during the peripartum period in previously healthy women. Cardiovascular magnetic resonance (CMR) T1 mapping permits sensitive detection of tissue edema and fibrosis, and it may be useful in identifying altered myocardial tissue characteristics in peripartum cardiomyopathy. However, left ventricular (LV) volumes and mass increase considerably even in normal pregnancy, and it is not known whether altered tissue characteristics can be found in normal pregnancy. The aim of this study was to investigate whether the LV remodeling observed in normal pregnancy is associated with altered tissue characteristics determined by CMR. METHODS Twelve normal pregnant women and 15 non pregnant women underwent cine CMR and myocardial T1 measurement at 1.5 T. Pregnant women were scanned three times, in the 2nd and 3rd trimesters of pregnancy and at 1 month postpartum. LV volumes, LV mass (LVM), and global longitudinal strain (GLS) were analyzed by cine CMR. Native myocardial T1 was determined using modified Look-Locker inversion recovery (MOLLI) images. RESULTS LV end-diastolic volume (EDV) was significantly greater in the 3rd trimester (126 ± 22 mL) than in non-pregnant women (108 ± 14 mL, p < 0.05). LVM was significantly greater in the 3rd trimester (88.7 ± 11.8 g) than at 1 month postpartum (70.0 ± 9.8 g, p < 0.05) and in non-pregnant women (66.3 ± 13.9 g, p < 0.05). Myocardial native T1 among the 2nd and 3rd trimesters, 1 month postpartum, and non-pregnant women were similar (1133 ± 55 ms, 1138 ± 86 ms, 1105 ± 45 ms, and 1129 ± 52 ms, respectively, p = 0.59) as were GLS (- 19.5 ± 1.8, - 19.7% ± 2.2, - 19.0% ± 2.0%, and - 19.3% ± 1.9%, respectively, p = 0.66). CONCLUSIONS LV remodeling during normal pregnancy is associated with myocardial hypertrophy, but not with edema or diffuse fibrosis of the myocardium or LV contractile dysfunction. These results observed in normal pregnancy will serve as an important basis for identifying myocardial abnormalities in patients with peripartum cardiomyopathy and other pregnancy-related myocardial diseases.
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Affiliation(s)
- Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
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16
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Zareba W, Zareba KM. Cardiac Magnetic Resonance in Sudden Cardiac Arrest Survivors. Circ Cardiovasc Imaging 2017; 10:e007290. [PMID: 29237610 DOI: 10.1161/circimaging.117.007290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Wojciech Zareba
- From the Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, NY (W.Z.); and Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (K.M.Z.).
| | - Karolina M Zareba
- From the Heart Research Follow-Up Program, Cardiology Division, University of Rochester Medical Center, NY (W.Z.); and Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (K.M.Z.)
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17
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Di Bella G, Camastra G, Monti L, Dellegrottaglie S, Piaggi P, Moro C, Pepe A, Lanzillo C, Pontone G, Perazzolo Marra M, Di Roma M, Scatteia A, Aquaro GD. Left and right ventricular morphology, function and late gadolinium enhancement extent and localization change with different clinical presentation of acute myocarditis Data from the ITAlian multicenter study on MYocarditis (ITAMY). J Cardiovasc Med (Hagerstown) 2017; 18:881-887. [DOI: 10.2459/jcm.0000000000000574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Aquaro GD, Perfetti M, Camastra G, Monti L, Dellegrottaglie S, Moro C, Pepe A, Todiere G, Lanzillo C, Scatteia A, Di Roma M, Pontone G, Perazzolo Marra M, Barison A, Di Bella G. Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function: ITAMY Study. J Am Coll Cardiol 2017; 70:1977-1987. [PMID: 29025554 DOI: 10.1016/j.jacc.2017.08.044] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prognostic role of cardiac magnetic resonance (CMR) and late gadolinium enhancement (LGE) has not been clarified in acute myocarditis (AM) with preserved left ventricular (LV) ejection fraction (EF). OBJECTIVES This study sought to evaluate the role of CMR and LGE in the prognosis of AM with preserved LVEF. METHODS This study analyzed data from ITAMY (ITalian multicenter study on Acute MYocarditis) and evaluated CMR results from 386 patients (299 male; mean age 35 ± 15 years) with AM and preserved LVEF. Clinical follow-up was performed for a median of 1,572 days. A clinical combined endpoint of cardiac death, appropriate implantable cardioverter-defibrillator firing, resuscitated cardiac arrest, and hospitalization for heart failure was used. RESULTS Among the 374 patients with suitable images, LGE involved the subepicardial layer inferior and lateral wall in 154 patients (41%; IL group), the midwall layer of the anteroseptal wall in 135 patients (36%; AS [anteroseptal] group), and other segments in 59 patients (16%; other-LGE group), and it was absent in 26 patients (no-LGE group). The AS group had a greater extent of LGE and a higher LV end-diastolic volume index than other groups, but levels of inflammatory markers were lower than in the other groups. Kaplan-Meier curve analysis indicated that the AS group had a worse prognosis than the other groups (p < 0.0001). Finally, in multivariable analysis, AS LGE was the best independent CMR predictor of the combined endpoint (odds ratio: 2.73; 95% confidence interval: 1.2 to 5.9; p = 0.01). CONCLUSIONS In patients with AM and preserved LVEF, LGE in the midwall layer of the AS myocardial segment is associated with a worse prognosis than other patterns of presentation.
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Affiliation(s)
| | | | | | - Lorenzo Monti
- Radiology Department, Humanitas Research Hospital, Hospital Care and Research Institution (IRCCS), Rozzano, Milan, Italy
| | - Santo Dellegrottaglie
- Division of Cardiology, Villa dei Fiori, Acerra, Naples, Italy; Mount Sinai School of Medicine, New York, New York
| | - Claudio Moro
- Department of Cardiology and Coronary Intensive CareUnit, ASST Monza, Desio Hospital, Desio Monza e Brianza, Italy
| | - Alessia Pepe
- Gabriele Monasterio Foundation, Tuscan Region, Pisa, Italy
| | | | | | - Alessandra Scatteia
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Mauro Di Roma
- Radiological Department, European Hospital, Rome, Italy
| | | | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Andrea Barison
- Gabriele Monasterio Foundation, Tuscan Region, Pisa, Italy
| | - Gianluca Di Bella
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
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19
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Late gadolinium enhancement on cardiac magnetic resonance imaging is associated with coronary endothelial dysfunction in patients with dilated cardiomyopathy. Heart Vessels 2017; 33:393-402. [DOI: 10.1007/s00380-017-1069-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
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20
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Greene SJ, Vaduganathan M, Gheorghiade M. Finding the road to recovery: therapeutic and clinical trial implications of dysfunctional viable myocardium in heart failure with reduced ejection fraction. Eur J Heart Fail 2017; 19:870-872. [PMID: 28464398 DOI: 10.1002/ejhf.842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical Center, Boston, MA, USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Schelbert EB, Elkayam U, Cooper LT, Givertz MM, Alexis JD, Briller J, Felker GM, Chaparro S, Kealey A, Pisarcik J, Fett JD, McNamara DM. Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy. J Am Heart Assoc 2017; 6:JAHA.117.005472. [PMID: 28373243 PMCID: PMC5533034 DOI: 10.1161/jaha.117.005472] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In peripartum cardiomyopathy, the prevalence of focal myocardial damage detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is important to elucidate mechanisms of myocardial injury and cardiac dysfunction. LGE equates irreversible myocardial injury, but LGE prevalence in peripartum cardiomyopathy is uncertain. METHODS AND RESULTS Among 100 women enrolled within the Investigations of Pregnancy Associated Cardiomyopathy cohort, we recruited 40 women at 13 centers to undergo LGE cardiovascular magnetic resonance, enrolled within the first 13 weeks postpartum. Follow-up scans occurred at 6 months postpartum, and death/transplant rates at 12 months. Baseline characteristics did not differ significantly in the parent cohort according to cardiovascular magnetic resonance enrollment except for mechanical circulatory support. LGE was noted only in 2 women (5%) at baseline. While left ventricular dysfunction with enlargement was prevalent at baseline cardiovascular magnetic resonance scans (eg, ejection fraction 38% [Q1-Q3 31-50%], end diastolic volume index=108 mL/m2 [Q1-Q3 83-134 mL/m2]), most women demonstrated significant improvements at 6 months, consistent with a low prevalence of LGE. LGE was not related to baseline clinical variables, ejection fraction, New York Heart Association heart failure class, or mortality. Neither of the 2 women who died exhibited LGE. LGE was inversely associated with persistent left ventricular ejection fraction at 6 months (P=0.006). CONCLUSIONS Factors other than focal myocardial damage detectable by LGE explain the initial transient depressions in baseline left ventricular ejection fraction, yet focal myocardial damage may contribute to persistent myocardial dysfunction and hinder recovery in a small minority. Most women exhibit favorable changes in ventricular function over 6 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01085955.
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Affiliation(s)
| | - Uri Elkayam
- University of Southern California, Los Angeles, CA
| | | | | | - Jeffrey D Alexis
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | | | | | | | | | - James D Fett
- University of Pittsburgh Medical Center, Pittsburgh, PA
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22
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Greene SJ, Epstein SE, Kim RJ, Quyyumi AA, Cole RT, Anderson AS, Wilcox JE, Skopicki HA, Sikora S, Verkh L, Tankovich NI, Gheorghiade M, Butler J. Rationale and design of a randomized controlled trial of allogeneic mesenchymal stem cells in patients with nonischemic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2017; 18:283-290. [DOI: 10.2459/jcm.0000000000000303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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23
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Knudson JD, Cabrera AG. The Pathophysiology of Heart Failure in Children: The Basics. Curr Cardiol Rev 2016; 12:99-103. [PMID: 26585040 PMCID: PMC4861948 DOI: 10.2174/1573403x12666151119164525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/15/2015] [Indexed: 01/08/2023] Open
Abstract
Few data exist on the pathophysiologic changes in pediatric heart failure. Most of the knowledge has evolved from animal models of ischemic or idiopathic dilated cardiomyopathy. This review addresses the pathophysiologic changes that occur in the failing heart from animal models and the adult experience to unique aspects of heart failure in children.
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Affiliation(s)
| | - Antonio G Cabrera
- Division of Critical Care Medical Children's of Mississippi / Blair E. Batson Hospital for Children University of Mississippi Medical Center Office 2500 N State St Jackson, Mississipi, 39216, United States of America.
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24
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Delgado-Montero A, Tayal B, Goda A, Ryo K, Marek JJ, Sugahara M, Qi Z, Althouse AD, Saba S, Schwartzman D, Gorcsan J. Additive Prognostic Value of Echocardiographic Global Longitudinal and Global Circumferential Strain to Electrocardiographic Criteria in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.004241. [DOI: 10.1161/circimaging.115.004241] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
Background—
Response to cardiac resynchronization therapy is most favorable in patients with heart failure with QRS duration ≥150 ms and left bundle branch block and less predictable in those with QRS width 120 to 149 ms or non–left bundle branch block.
Methods and Results—
We studied 205 patients with heart failure referred for cardiac resynchronization therapy with QRS ≥120 ms and ejection fraction ≤35%. We tested the hypothesis that contractile function using speckle-tracking echocardiographic global circumferential strain (GCS) from 2 short-axis views and global longitudinal strain (GLS) from 3 apical views add prognostic value to electrocardiographic criteria. There were 112 patients (55%) with GLS >−9% and 136 patients (66%) with GCS >−9%. During 4 years, 81 patients reached the combined primary end point (death, circulatory support, or transplant) and 120 reached the secondary end point (heart failure hospitalization or death). Both GLS >−9% and GCS >−9% were associated with increased risk of unfavorable events as follows: for the primary end point (hazard ratio=2.91; 95% confidence interval, 1.88–4.49;
P
<0.001) and (hazard ratio=3.73; 95% confidence interval, 2.39–5.82;
P
<0.001) for the secondary end point (hazard ratio=2.10; 95% confidence interval, 1.45–3.05;
P
<0.001) and (hazard ratio=3.25; 95% confidence interval, 2.23–4.75;
P
<0.001). In a prespecified subgroup of 120 patients with QRS 120 to 149 ms or non–left bundle branch block, significant associations of baseline GLS and GCS and outcomes remained:
P
=0.014 and
P
=0.002 for the primary end point and
P
=0.049 and
P
=0.001 for the secondary end point. Global strain measures had additive prognostic value to routine clinical or electrocardiographic parameters (
P
<0.001).
Conclusions—
Baseline GCS and GLS were significantly associated with long-term outcome after cardiac resynchronization therapy and had additive prognostic value to routine clinical and electrocardiographic selection criteria for cardiac resynchronization therapy.
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Affiliation(s)
| | | | | | - Keiko Ryo
- From the University of Pittsburgh, PA
| | | | | | - Zhi Qi
- From the University of Pittsburgh, PA
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25
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Vaduganathan M, Butler J, Roessig L, Fonarow GC, Greene SJ, Metra M, Cotter G, Kupfer S, Zalewski A, Sato N, Filippatos G, Gheorghiade M. Clinical trials in hospitalized heart failure patients: targeting interventions to optimal phenotypic subpopulations. Heart Fail Rev 2016; 20:393-400. [PMID: 25894076 DOI: 10.1007/s10741-015-9485-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With one possible exception, the last decade of clinical trials in hospitalized heart failure (HHF) patients has failed to demonstrate improvement in long-term clinical outcomes. This trend necessitates a need to evaluate optimal drug development strategies and standards of trial conduct. It has become increasingly important to recognize the heterogeneity among HHF patients and the differential characterization of novel drug candidates. Targeting these agents to specific subpopulations may afford optimal net response related to the particular mode of action of the drug. Analyses of previous trials demonstrate profound differences in the baseline characteristics of patients enrolled across global regions and participating sites. Such differences may influence risks for events and interpretation of results. Therefore, the actual execution of trials and the epidemiology of HHF populations at the investigative sites must be taken into consideration. Collaboration among participating sites including the provision of registry data tailored to the planned development program will optimize trial conduct. Observational data prior to study initiation may enable sites to feedback and engage in protocol development to allow for feasible and valid clinical trial conduct. This site-centered, epidemiology-based network environment may facilitate studies in specific patient populations and promote optimal data collection and clear interpretation of drug safety and efficacy. This review summarizes the roundtable discussion held by a multidisciplinary team of representatives from academia, National Institutes of Health, industry, regulatory agencies, payers, and contract and academic research organizations to answer the question: Who should be targeted for novel therapies in HHF?
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Affiliation(s)
- Muthiah Vaduganathan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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26
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Gonzalez JA, Kramer CM. Role of Imaging Techniques for Diagnosis, Prognosis and Management of Heart Failure Patients: Cardiac Magnetic Resonance. Curr Heart Fail Rep 2016; 12:276-83. [PMID: 26041670 DOI: 10.1007/s11897-015-0261-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cardiac magnetic resonance (CMR) has evolved into a major tool for the diagnosis and assessment of prognosis of patients suffering from heart failure. Anatomical and structural imaging, functional assessment, T1 and T2 mapping tissue characterization, and late gadolinium enhancement (LGE) have provided clinicians with tools to distinguish between non-ischemic and ischemic cardiomyopathies and to identify the etiology of non-ischemic cardiomyopathies. LGE is a useful tool to predict the likelihood of functional recovery after revascularization in patients with CAD and to guide the left ventricular (LV) lead placement in those who qualify for cardiac resynchronization (CRT) therapy. In addition, the presence of LGE and its extent in myocardial tissue relate to overall cardiovascular outcomes. Emerging roles for cardiac imaging in heart failure with preserved ejection fraction (HFpEF) are being studied, and CMR continues to be among the most promising noninvasive imaging alternatives in the diagnosis of this disease.
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Affiliation(s)
- Jorge A Gonzalez
- Department of Medicine (Division of Cardiology), and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
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27
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Schelbert EB, Messroghli DR. State of the Art: Clinical Applications of Cardiac T1 Mapping. Radiology 2016; 278:658-76. [DOI: 10.1148/radiol.2016141802] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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28
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Uemura T, Yamamuro M, Kaikita K, Takashio S, Utsunomiya D, Hirakawa K, Nakayama M, Sakamoto K, Yamamoto E, Tsujita K, Kojima S, Hokimoto S, Yamashita Y, Ogawa H. Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure. Heart Vessels 2016; 31:1969-1979. [PMID: 26892530 PMCID: PMC5122619 DOI: 10.1007/s00380-016-0816-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/05/2016] [Indexed: 12/15/2022]
Abstract
Myocardial fibrosis and microvascular dysfunction are key determinants of outcome in heart failure (HF); we examined their relationship in patients with HF. Our study included 61 consecutive patients with HF but without coronary stenosis. All underwent gadolinium-enhanced cardiac magnetic resonance to evaluate late gadolinium enhancement (LGE) and an acetylcholine (ACh) provocation test to evaluate microvascular dysfunction. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations. We quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. We detected LGE in 34 patients (LGE-positive); 27 were LGE-negative. Coronary blood flow volume increased significantly after the ACh provocation test only in LGE-negative patients (before vs. after ACh, 47.5 ± 36.8 vs. 69.2 ± 48.0 ml/min, respectively; p = 0.004). The myocardial lactate extraction ratio (LER) significantly decreased after the ACh test in both groups (LGE-negative, p = 0.001; LGE-positive, p < 0.001), significantly more so in the LGE-positive group (p = 0.017). Multivariate logistic regression analysis showed that a post-ACh LER < 0 (indicating myocardial lactate production) was a significant predictor of LGE-positivity (odds ratio 4.54; 95 % confidence interval 1.38-14.93; p = 0.013). In the LGE-positive group, an LGE volume greater than the median significantly predicted a post-ACh LER of <0 (p = 0.042; odds ratio 6.02; 95 % confidence interval 1.07-33.86). ACh-provoked coronary vasomotor abnormality is closely correlated with myocardial fibrosis in patients with HF but without organic coronary stenosis. Coronary vasomotor abnormalities in fibrotic myocardium may worsen HF.
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Affiliation(s)
- Tomoaki Uemura
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Megumi Yamamuro
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Koichi Kaikita
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Daisuke Utsunomiya
- Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kyoko Hirakawa
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Mina Nakayama
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenji Sakamoto
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Eiichiro Yamamoto
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Sunao Kojima
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Seiji Hokimoto
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yasuyuki Yamashita
- Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisao Ogawa
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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29
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Fabregat-Andrés Ó, Estornell-Erill J, Ridocci-Soriano F, Pérez-Boscá JL, García-González P, Payá-Serrano R, Morell S, Cortijo J. Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure. Arq Bras Cardiol 2016; 106:226-35. [PMID: 26840055 PMCID: PMC4811278 DOI: 10.5935/abc.20160020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/24/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. OBJECTIVE We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). METHODS Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVR were calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. RESULTS 105 patients (average LVEF 26.0 ± 7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7 estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). CONCLUSIONS In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
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Affiliation(s)
- Óscar Fabregat-Andrés
- Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain
| | - Jordi Estornell-Erill
- Unidad de Imagen Cardiaca - ERESA, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Pilar García-González
- Unidad de Imagen Cardiaca - ERESA, Hospital General Universitario de Valencia, Valencia, Spain
| | - Rafael Payá-Serrano
- Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain
| | - Salvador Morell
- Departamento de Cardiologia, Hospital General Universitario de Valencia, Valencia, Spain
| | - Julio Cortijo
- Fundación para la Investigación, Hospital General Universitario de Valencia, Valencia, Spain
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30
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“Targeting the Heart” in Heart Failure. JACC-HEART FAILURE 2015; 3:661-9. [DOI: 10.1016/j.jchf.2015.04.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/08/2015] [Accepted: 04/18/2015] [Indexed: 12/15/2022]
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31
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Arunamata A, Buccola Stauffer KJ, Punn R, Chan FP, Maeda K, Balasubramanian S. Diagnosis of Anomalous Aortic Origin of the Left Coronary Artery in a Pediatric Patient. World J Pediatr Congenit Heart Surg 2015; 6:470-3. [PMID: 26180168 DOI: 10.1177/2150135114558689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous aortic origin of the left coronary artery is rare and confers increased risk of sudden cardiac death. Accurate diagnosis is crucial and often requires many diagnostic modalities. This case report highlights the echocardiographic characteristics and pitfalls in diagnosing the anomaly in addition to the advantages of using computed tomography and magnetic resonance imaging in a pediatric patient.
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Affiliation(s)
- Alisa Arunamata
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | - Katie Jo Buccola Stauffer
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | - Rajesh Punn
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | - Frandics P Chan
- Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Katsuhide Maeda
- Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Sowmya Balasubramanian
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
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32
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Kato S, Saito N, Kirigaya H, Gyotoku D, Iinuma N, Kusakawa Y, Iguchi K, Nakachi T, Fukui K, Futaki M, Iwasawa T, Taguri M, Kimura K, Umemura S. Incremental prognostic value of the SYNTAX score to late gadolinium-enhanced magnetic resonance images for patients with stable coronary artery disease. Heart Vessels 2015; 31:871-80. [DOI: 10.1007/s00380-015-0685-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
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33
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Abstract
Autophagy is an important physiological process in the heart, and alterations in autophagic activity can exacerbate or mitigate injury during various pathological processes. Methods to assess autophagy have changed rapidly because the field of research has expanded. As with any new field, methods and standards for data analysis and interpretation evolve as investigators acquire experience and insight. The purpose of this review is to summarize current methods to measure autophagy, selective mitochondrial autophagy (mitophagy), and autophagic flux. We will examine several published studies where confusion arose in data interpretation, to illustrate the challenges. Finally, we will discuss methods to assess autophagy in vivo and in patients.
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Affiliation(s)
- Roberta A Gottlieb
- From the Cedars-Sinai Heart Institute and the Barbra Streisand Women's Heart Center Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Allen M Andres
- From the Cedars-Sinai Heart Institute and the Barbra Streisand Women's Heart Center Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon Sin
- From the Cedars-Sinai Heart Institute and the Barbra Streisand Women's Heart Center Cedars-Sinai Medical Center, Los Angeles, CA
| | - David P J Taylor
- From the Cedars-Sinai Heart Institute and the Barbra Streisand Women's Heart Center Cedars-Sinai Medical Center, Los Angeles, CA
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34
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Fabregat-Andres O, Estornell-Erill J, Ridocci-Soriano F, Garcia-Gonzalez P, Bochard-Villanueva B, Cubillos-Arango A, Espriella-Juan RDL, Facila L, Morell S, Cortijo J. Prognostic value of pulmonary vascular resistance estimated by cardiac magnetic resonance in patients with chronic heart failure. Eur Heart J Cardiovasc Imaging 2014; 15:1391-9. [DOI: 10.1093/ehjci/jeu147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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35
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von Elverfeldt D, Maier A, Duerschmied D, Braig M, Witsch T, Wang X, Mauler M, Neudorfer I, Menza M, Idzko M, Zirlik A, Heidt T, Bronsert P, Bode C, Peter K, von Zur Muhlen C. Dual-contrast molecular imaging allows noninvasive characterization of myocardial ischemia/reperfusion injury after coronary vessel occlusion in mice by magnetic resonance imaging. Circulation 2014; 130:676-87. [PMID: 24951772 DOI: 10.1161/circulationaha.113.008157] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inflammation and myocardial necrosis play important roles in ischemia/reperfusion injury after coronary artery occlusion and recanalization. The detection of inflammatory activity and the extent of myocardial necrosis itself are of great clinical and prognostic interest. We developed a dual, noninvasive imaging approach using molecular magnetic resonance imaging in an in vivo mouse model of myocardial ischemia and reperfusion. METHODS AND RESULTS Ischemia/reperfusion injury was induced in 10-week-old C57BL/6N mice by temporary ligation of the left anterior descending coronary artery. Activated platelets were targeted with a contrast agent consisting of microparticles of iron oxide (MPIOs) conjugated to a single-chain antibody directed against a ligand-induced binding site (LIBS) on activated glycoprotein IIb/IIIa (LIBS-MPIOs). After injection and imaging of LIBS-MPIOs, late gadolinium enhancement was used to depict myocardial necrosis; these imaging experiments were also performed in P2Y12 (-/-) mice. All imaging results were correlated to immunohistochemistry findings. Activated platelets were detectable by magnetic resonance imaging via a significant signal effect caused by LIBS-MPIOs in the area of left anterior descending coronary artery occlusion 2 hours after reperfusion. In parallel, late gadolinium enhancement identified the extent of myocardial necrosis. Immunohistochemistry confirmed that LIBS-MPIOs bound significantly to microthrombi in reperfused myocardium. Only background binding was found in P2Y12 (-/-) mice. CONCLUSIONS Dual molecular imaging of myocardial ischemia/reperfusion injury allows characterization of platelet-driven inflammation by LIBS-MPIOs and myocardial necrosis by late gadolinium enhancement. This noninvasive imaging strategy is of clinical interest for both diagnostic and prognostic purposes and highlights the potential of molecular magnetic resonance imaging for characterizing ischemia/reperfusion injury.
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Affiliation(s)
- Dominik von Elverfeldt
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Alexander Maier
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Daniel Duerschmied
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Moritz Braig
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Thilo Witsch
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Xiaowei Wang
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Maximilian Mauler
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Irene Neudorfer
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Marius Menza
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Marco Idzko
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Andreas Zirlik
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Timo Heidt
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Peter Bronsert
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Christoph Bode
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Karlheinz Peter
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.)
| | - Constantin von Zur Muhlen
- From the Department of Radiology-Medical Physics (D.v.E., M.B., M. Menza), Department of Pneumology (M.I.), and Institute of Pathology and Comprehensive Cancer Center (P.B.), University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany (A.M., D.D., T.W., M. Mauler, I.N., A.Z., T.H., C.B., C.v.z.M.); Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (X.W., K.P.); Faculty of Biology, University Freiburg, Freiburg, Germany (M. Mauler); and Center for Systems Biology, Massachusetts General Hospital, Boston (T.H.).
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Therapeutic targets in heart failure: refocusing on the myocardial interstitium. J Am Coll Cardiol 2014; 63:2188-98. [PMID: 24657693 DOI: 10.1016/j.jacc.2014.01.068] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/28/2013] [Accepted: 01/14/2014] [Indexed: 01/13/2023]
Abstract
New therapeutic targets, agents, and strategies are needed to prevent and treat heart failure (HF) after a decade of failed research efforts to improve long-term patient outcomes, especially in patients after hospitalization for HF. Conceptually, an accurate assessment of left ventricular structure is an essential step in the development of novel therapies because heterogeneous pathophysiologies underlie chronic HF and hospitalization for HF. Improved left ventricular characterization permits the identification and targeting of the intrinsic fundamental disease-modifying pathways that culminate in HF. Interstitial heart disease is one such pathway, characterized by extracellular matrix (ECM) expansion that is associated with mechanical, electrical, and vasomotor dysfunction and adverse outcomes. Previous landmark trials that appear to treat interstitial heart disease were effective in improving outcomes. Advances in cardiovascular magnetic resonance now enable clinicians and researchers to assess the interstitium and quantify ECM expansion using extracellular volume fraction measures and other derangements in cardiovascular structure. These capabilities may provide a mechanistic platform to advance understanding of the role of the ECM, foster the development of novel therapeutics, and target specific disease-modifying pathways intrinsic to the ventricle. Refocusing on the interstitium may potentially improve care through the identification and targeted treatment of key patient subgroups.
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Maestrini V, Treibel TA, White SK, Fontana M, Moon JC. T1 Mapping for Characterization of Intracellular and Extracellular Myocardial Diseases in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014; 7:9287. [PMID: 25152807 PMCID: PMC4133016 DOI: 10.1007/s12410-014-9287-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heart failure (HF) is a major and growing cause of morbidity and mortality. Despite initial successes, there have been few recent therapeutic advances. A better understanding of HF pathophysiology is needed with renewed focus on the myocardium itself. A new imaging technique is now available that holds promise. T1 mapping is a cardiovascular magnetic resonance (CMR) technique for non-invasive myocardial tissue characterization. T1 alters with disease. Pre-contrast (native) T1 changes with a number of processes such as fibrosis, edema and infiltrations. If a post contrast scan is also done, the extracellular volume fraction (ECV) can be measured, a direct measure of the interstitium and its reciprocal, the cell volume. This dichotomy is fundamental - and now measurable promising more targeted therapy and new insights into disease biology.
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Affiliation(s)
- Viviana Maestrini
- The Heart Hospital Imaging Centre, University College London Hospitals, 16-18 Westmoreland Street, London, W1G 8PH UK
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology & Geriatric Sciences, Sapienza University, Rome, Italy
| | - Thomas A. Treibel
- The Heart Hospital Imaging Centre, University College London Hospitals, 16-18 Westmoreland Street, London, W1G 8PH UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT UK
| | - Steven K. White
- The Heart Hospital Imaging Centre, University College London Hospitals, 16-18 Westmoreland Street, London, W1G 8PH UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT UK
| | - Marianna Fontana
- The Heart Hospital Imaging Centre, University College London Hospitals, 16-18 Westmoreland Street, London, W1G 8PH UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT UK
| | - James C. Moon
- The Heart Hospital Imaging Centre, University College London Hospitals, 16-18 Westmoreland Street, London, W1G 8PH UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT UK
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