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Segeroth M, Winkel DJ, Vosshenrich J, Breit HC, Giese D, Haaf P, Zellweger MJ, Bremerich J, Santini F, Pradella M. Cardiac Cine MRI Using a Commercially Available 0.55-T Scanner. Radiol Cardiothorac Imaging 2024; 6:e230331. [PMID: 38990132 PMCID: PMC11369657 DOI: 10.1148/ryct.230331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/02/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
Purpose To compare parameters of left ventricular (LV) and right ventricular (RV) volume and function between a commercially available 0.55-T low-field-strength cardiac cine MRI scanner and a 1.5-T scanner. Materials and Methods In this prospective study, healthy volunteers (May 2022 to July 2022) underwent same-day cine imaging using both scanners (0.55 T, 1.5 T). Volumetric and functional parameters were assessed by two experts. After analyzing the results of a blinded crossover reader study of the healthy volunteers, 20 participants with clinically indicated cardiac MRI were prospectively included (November 2022 to February 2023). In a second blinded expert reading, parameters from clinical 1.5-T scans in these participants were compared with those same-day 0.55-T scans. Results are displayed as Bland-Altman plots. Results Eleven healthy volunteers (mean age: 33 years [95% CI: 27, 40]; four of 11 [36%] female, seven of 11 [64%] male) were included. Very strong mean correlation was observed (r = 0.98 [95% CI: 0.97, 0.98]). Average deviation between MRI systems was 1.6% (95% CI: 0.3, 2.9) for both readers. Twenty participants with clinically indicated cardiac MRI were included (mean age: 55 years [95% CI: 48, 62], six of 20 [30%] female, 14 of 20 [70%] male). Mean correlation was very strong (r = 0.98 [95% CI: 0.97, 0.98]). LV and RV parameters demonstrated an average deviation of 1.1% (95% CI: 0.1, 2.1) between MRI systems. Conclusion Cardiac cine MRI at 0.55 T yielded comparable results for quantitative biventricular volumetric and functional parameters compared with routine imaging at 1.5 T, if acquisition time is doubled. Keywords: Cardiac, Comparative Studies, Heart, Cardiovascular MRI, Cine, Myocardium Supplemental material is available for this article. ©RSNA, 2024.
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Affiliation(s)
- Martin Segeroth
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - David J. Winkel
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - Jan Vosshenrich
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - Hanns-Christian Breit
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - Daniel Giese
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - Philip Haaf
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - Michael J. Zellweger
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
| | - Jens Bremerich
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B.,
F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel,
Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens
Healthcare, Erlangen, Germany (D.G.)
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Chen Z, Ren H, Li Q, Li X. Motion correction and super-resolution for multi-slice cardiac magnetic resonance imaging via an end-to-end deep learning approach. Comput Med Imaging Graph 2024; 115:102389. [PMID: 38692199 PMCID: PMC11144076 DOI: 10.1016/j.compmedimag.2024.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/08/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
Accurate reconstruction of a high-resolution 3D volume of the heart is critical for comprehensive cardiac assessments. However, cardiac magnetic resonance (CMR) data is usually acquired as a stack of 2D short-axis (SAX) slices, which suffers from the inter-slice misalignment due to cardiac motion and data sparsity from large gaps between SAX slices. Therefore, we aim to propose an end-to-end deep learning (DL) model to address these two challenges simultaneously, employing specific model components for each challenge. The objective is to reconstruct a high-resolution 3D volume of the heart (VHR) from acquired CMR SAX slices (VLR). We define the transformation from VLR to VHR as a sequential process of motion correction and super-resolution. Accordingly, our DL model incorporates two distinct components. The first component conducts motion correction by predicting displacement vectors to re-position each SAX slice accurately. The second component takes the motion-corrected SAX slices from the first component and performs the super-resolution to fill the data gaps. These two components operate in a sequential way, and the entire model is trained end-to-end. Our model significantly reduced inter-slice misalignment from originally 3.33±0.74 mm to 1.36±0.63 mm and generated accurate high resolution 3D volumes with Dice of 0.974±0.010 for left ventricle (LV) and 0.938±0.017 for myocardium in a simulation dataset. When compared to the LAX contours in a real-world dataset, our model achieved Dice of 0.945±0.023 for LV and 0.786±0.060 for myocardium. In both datasets, our model with specific components for motion correction and super-resolution significantly enhance the performance compared to the model without such design considerations. The codes for our model are available at https://github.com/zhennongchen/CMR_MC_SR_End2End.
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Affiliation(s)
- Zhennong Chen
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Hui Ren
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Xiang Li
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
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3
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Villegas-Martinez M, de Villedon de Naide V, Muthurangu V, Bustin A. The beating heart: artificial intelligence for cardiovascular application in the clinic. MAGMA (NEW YORK, N.Y.) 2024; 37:369-382. [PMID: 38907767 DOI: 10.1007/s10334-024-01180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/25/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Artificial intelligence (AI) integration in cardiac magnetic resonance imaging presents new and exciting avenues for advancing patient care, automating post-processing tasks, and enhancing diagnostic precision and outcomes. The use of AI significantly streamlines the examination workflow through the reduction of acquisition and postprocessing durations, coupled with the automation of scan planning and acquisition parameters selection. This has led to a notable improvement in examination workflow efficiency, a reduction in operator variability, and an enhancement in overall image quality. Importantly, AI unlocks new possibilities to achieve spatial resolutions that were previously unattainable in patients. Furthermore, the potential for low-dose and contrast-agent-free imaging represents a stride toward safer and more patient-friendly diagnostic procedures. Beyond these benefits, AI facilitates precise risk stratification and prognosis evaluation by adeptly analysing extensive datasets. This comprehensive review article explores recent applications of AI in the realm of cardiac magnetic resonance imaging, offering insights into its transformative potential in the field.
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Affiliation(s)
- Manuel Villegas-Martinez
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Hôpital Xavier Arnozan, Université de Bordeaux-INSERM U1045, Avenue du Haut Lévêque, 33604, Pessac, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Victor de Villedon de Naide
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Hôpital Xavier Arnozan, Université de Bordeaux-INSERM U1045, Avenue du Haut Lévêque, 33604, Pessac, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Vivek Muthurangu
- Center for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, London, WC1N 1EH, UK
| | - Aurélien Bustin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Hôpital Xavier Arnozan, Université de Bordeaux-INSERM U1045, Avenue du Haut Lévêque, 33604, Pessac, France.
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France.
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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4
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Ciocca N, Lu H, Tzimas G, Muller O, Masi A, Maurizi N, Skalidis I, Gissler MC, Monney P, Schwitter J, Ge Y, Antiochos P. Head-to-Head Comparison and Temporal Trends of Cardiac MRI Recommendations in ESC versus ACC/AHA Guidelines: A Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2024; 6:e230271. [PMID: 38842455 PMCID: PMC11211940 DOI: 10.1148/ryct.230271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024]
Abstract
Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Nicola Ciocca
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Henri Lu
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Georgios Tzimas
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Olivier Muller
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Ambra Masi
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Niccolò Maurizi
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Ioannis Skalidis
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Mark Colin Gissler
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Pierre Monney
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
| | - Juerg Schwitter
- From the Division of Cardiology, Lausanne University Hospital and
University of Lausanne, Rue du Bugnon, 1005 Lausanne, Switzerland (N.C., H.L.,
G.T., O.M., A.M., N.M., I.S., P.M., J.S., P.A.); Division of Cardiovascular
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Mass (H.L.); Department of Cardiology, University of Crete, Herakleion, Greece
(I.S.); Department of Cardiology and Angiology, University Heart Center
Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg,
Germany (M.C.G.); and Division of Cardiology, St Michael’s Hospital,
University of Toronto, Toronto, Canada (Y.G.)
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Kollmann A, Lohr D, Ankenbrand MJ, Bille M, Terekhov M, Hock M, Elabyad I, Baltes S, Reiter T, Schnitter F, Bauer WR, Hofmann U, Schreiber LM. Cardiac function in a large animal model of myocardial infarction at 7 T: deep learning based automatic segmentation increases reproducibility. Sci Rep 2024; 14:11009. [PMID: 38744988 PMCID: PMC11094053 DOI: 10.1038/s41598-024-61417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
Cardiac magnetic resonance (CMR) imaging allows precise non-invasive quantification of cardiac function. It requires reliable image segmentation for myocardial tissue. Clinically used software usually offers automatic approaches for this step. These are, however, designed for segmentation of human images obtained at clinical field strengths. They reach their limits when applied to preclinical data and ultrahigh field strength (such as CMR of pigs at 7 T). In our study, eleven animals (seven with myocardial infarction) underwent four CMR scans each. Short-axis cine stacks were acquired and used for functional cardiac analysis. End-systolic and end-diastolic images were labelled manually by two observers and inter- and intra-observer variability were assessed. Aiming to make the functional analysis faster and more reproducible, an established deep learning (DL) model for myocardial segmentation in humans was re-trained using our preclinical 7 T data (n = 772 images and labels). We then tested the model on n = 288 images. Excellent agreement in parameters of cardiac function was found between manual and DL segmentation: For ejection fraction (EF) we achieved a Pearson's r of 0.95, an Intraclass correlation coefficient (ICC) of 0.97, and a Coefficient of variability (CoV) of 6.6%. Dice scores were 0.88 for the left ventricle and 0.84 for the myocardium.
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Affiliation(s)
- Alena Kollmann
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - David Lohr
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany.
| | - Markus J Ankenbrand
- Faculty of Biology, Center for Computational and Theoretical Biology (CCTB), University of Würzburg, Würzburg, Germany
| | - Maya Bille
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Maxim Terekhov
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Michael Hock
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Ibrahim Elabyad
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Steffen Baltes
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
| | - Theresa Reiter
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Florian Schnitter
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang R Bauer
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Hofmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Laura M Schreiber
- Comprehensive Heart Failure Center (CHFC), Chair of Molecular and Cellular Imaging, University Hospital Würzburg, Würzburg, Germany
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6
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Carresi C, Cardamone A, Coppoletta AR, Caminiti R, Macrì R, Lorenzo F, Scarano F, Mollace R, Guarnieri L, Ruga S, Nucera S, Musolino V, Gliozzi M, Palma E, Muscoli C, Volterrani M, Mollace V. The protective effect of Bergamot Polyphenolic Fraction on reno-cardiac damage induced by DOCA-salt and unilateral renal artery ligation in rats. Biomed Pharmacother 2024; 171:116082. [PMID: 38242036 DOI: 10.1016/j.biopha.2023.116082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
To date, the complex pathological interactions between renal and cardiovascular systems represent a real global epidemic in both developed and developing countries. In this context, renovascular hypertension (RVH) remains among the most prevalent, but also potentially reversible, risk factor for numerous reno-cardiac diseases in humans and pets. Here, we investigated the anti-inflammatory and reno-cardiac protective effects of a polyphenol-rich fraction of bergamot (BPF) in an experimental model of hypertension induced by unilateral renal artery ligation. Adult male Wistar rats underwent unilateral renal artery ligation and treatment with deoxycorticosterone acetate (DOCA) (20 mg/kg, s.c.), twice a week for a period of 4 weeks, and 1% sodium chloride (NaCl) water (n = 10). A subgroup of hypertensive rats received BPF (100 mg/kg/day for 28 consecutive days, n = 10) by gavage. Another group of animals was treated with a sub-cutaneous injection of vehicle (that served as control, n = 8). Unilateral renal artery ligation followed by treatment with DOCA and 1% NaCl water resulted in a significant increase in mean arterial blood pressure (MAP; p< 0.05. vs CTRL) which strongly increased the resistive index (RI; p<0.05 vs CTRL) of contralateral renal artery flow and kidney volume after 4 weeks (p<0.001 vs CTRL). Renal dysfunction also led to a dysfunction of cardiac tissue strain associated with overt dyssynchrony in cardiac wall motion when compared to CTRL group, as shown by the increased time-to-peak (T2P; p<0.05) and the decreased whole peak capacity (Pk; p<0.01) in displacement and strain rate (p<0.05, respectively) in longitudinal motion. Consequently, the hearts of RAL DOCA-Salt rats showed a larger time delay between the fastest and the lowest region (Maximum Opposite Wall Delay-MOWD) when compared to CTRL group (p<0.05 in displacement and p <0.01 in strain rate). Furthermore, a significant increase in the levels of the circulating pro-inflammatory cytokines and chemokines (p< 0.05 for IL-12(40), p< 0.01 for GM-CSF, KC, IL-13, and TNF- α) and in the NGAL expression of the ligated kidney (p< 0.001) was observed compared to CTRL group. Interestingly, this pathological condition is prevented by BPF treatment. In particular, BPF treatment prevents the increase of blood pressure in RAL DOCA-Salt rats (p< 0.05) and exerts a protective effect on the volume of the contralateral kidney (p <0.01). Moreover, BPF ameliorates cardiac tissue strain dysfunction by increasing Pk in displacement (p <0.01) and reducing the T2P in strain rate motion (p<0.05). These latter effects significantly improve MOWD (p <0.05) preventing the overt dyssynchrony in cardiac wall motion. Finally, the reno-cardiac protective effect of BPF was associated with a significant reduction in serum level of some pro-inflammatory cytokines and chemokines (p<0.05 for KC and IL-12(40), p<0.01 for GM-CSF, IL-13, and TNF- α) restoring physiological levels of renal neutrophil gelatinase-associated lipocalin (NGAL, p<0.05) protein of the tethered kidney. In conclusion, the present results show, for the first time, that BPF promotes an efficient renovascular protection preventing the progression of inflammation and reno-cardiac damage. Overall, these data point to a potential clinical and veterinary role of dietary supplementation with the polyphenol-rich fraction of citrus bergamot in counteracting hypertension-induced reno-cardiac syndrome.
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Affiliation(s)
- Cristina Carresi
- Veterinary Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
| | - Antonio Cardamone
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Anna Rita Coppoletta
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Rosamaria Caminiti
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Roberta Macrì
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Francesca Lorenzo
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Federica Scarano
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Rocco Mollace
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Lorenza Guarnieri
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Stefano Ruga
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Saverio Nucera
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Vincenzo Musolino
- Laboratory of Pharmaceutical Biology, Department of Health Sciences, Institute of Research for Food Safety & Health IRC-FSH, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy
| | - Micaela Gliozzi
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Ernesto Palma
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Carolina Muscoli
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | | | - Vincenzo Mollace
- Pharmacology Laboratory, Institute of Research for Food Safety and Health IRC-FSH, Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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Jathanna N, Strachan K, Erhayiem B, Kamaruddin H, Swoboda P, Auer D, Chen X, Jamil-Copley S. The Nottingham Ischaemic Cardiovascular Magnetic Resonance resource (NotIs CMR): a prospective paired clinical and imaging scar database-protocol. J Cardiovasc Magn Reson 2023; 25:69. [PMID: 38008732 PMCID: PMC10680206 DOI: 10.1186/s12968-023-00978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION Research utilising artificial intelligence (AI) and cardiovascular magnetic resonance (CMR) is rapidly evolving with various objectives, however AI model development, generalisation and performance may be hindered by availability of robust training datasets including contrast enhanced images. METHODS NotIs CMR is a large UK, prospective, multicentre, observational cohort study to guide the development of a biventricular AI scar model. Patients with ischaemic heart disease undergoing clinically indicated contrast-enhanced cardiac magnetic resonance imaging will be recruited at Nottingham University Hospitals NHS Trust and Mid-Yorkshire Hospital NHS Trust. Baseline assessment will include cardiac magnetic resonance imaging, demographic data, medical history, electrocardiographic and serum biomarkers. Participants will undergo monitoring for a minimum of 5 years to document any major cardiovascular adverse events. The main objectives include (1) AI training, validation and testing to improve the performance, applicability and adaptability of an AI biventricular scar segmentation model being developed by the authors and (2) develop a curated, disease-specific imaging database to support future research and collaborations and, (3) to explore associations in clinical outcome for future risk prediction modelling studies. CONCLUSION NotIs CMR will collect and curate disease-specific, paired imaging and clinical datasets to develop an AI biventricular scar model whilst providing a database to support future research and collaboration in Artificial Intelligence and ischaemic heart disease.
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Affiliation(s)
- Nikesh Jathanna
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queen's Medical Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Kevin Strachan
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bara Erhayiem
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hazlyna Kamaruddin
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Dorothee Auer
- Queen's Medical Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Xin Chen
- Department of Computer Science, University of Nottingham, Nottingham, UK
| | - Shahnaz Jamil-Copley
- Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Queen's Medical Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.
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Suwalski P, Golpour A, Musigk N, Wilke F, Landmesser U, Heidecker B. Case report: Recurrence of inflammatory cardiomyopathy detected by magnetocardiography. Front Cardiovasc Med 2023; 10:1225057. [PMID: 37808876 PMCID: PMC10556648 DOI: 10.3389/fcvm.2023.1225057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background The diagnosis of inflammatory cardiomyopathies remains challenging. Life-threatening conditions such as acute coronary syndrome (ACS) always have to be considered as differential diagnoses due to similarities in presentation. Diagnostic methods for inflammatory cardiomyopathy include endomyocardial biopsy (EMB), cardiac magnetic resonance imaging (CMR), and positron emission tomography-computed tomography (PET-CT). We report a case in whom magnetocardiography (MCG) led to an initial diagnosis of inflammatory cardiomyopathy and in whom MCG was used for subsequent monitoring of treatment response under immunosuppression. Case presentation A 53-year-old man presented with two recurrent episodes of inflammatory cardiomyopathy within a 2-year period. The patient initially presented with reduced exercise capacity. Echocardiography revealed a moderately reduced left ventricular ejection fraction (LVEF 40%). Coronary angiography ruled out obstructive coronary artery disease (CAD) and an EMB was performed. The EMB revealed inflammatory cardiomyopathy without viral pathogens or replication. Moreover, we performed MCG, which confirmed a pathological Tbeg-Tmax vector of 0.108. We recently established a cutoff value of Tbeg-Tmax of 0.051 or greater for the diagnosis of inflammatory cardiomyopathy. Immunosuppressive therapy with prednisolone was initiated, resulting in clinical improvement and an LVEF increase from 40% to 45% within 1 month. Furthermore, the MCG vector improved to 0.036, which is considered normal based on our previous findings. The patient remained clinically stable for 23 months. During a routine follow-up, MCG revealed an abnormal Tbeg-Tmax vector of 0.069. The patient underwent additional testing including routine laboratory values, echocardiography (LVEF 35%), and PET-CT. PET-CT revealed increased metabolism in the myocardium-primarily in the lateral wall. Therapy with prednisolone and azathioprine was initiated and MCG was used to monitor the effect of immunosuppressive therapy. Conclusion In addition to diagnostic screening, MCG has the potential to become a valuable method for surveillance monitoring of patients who have completed treatment for inflammatory cardiomyopathy. Furthermore, it could be used for treatment monitoring. While changes in the magnetic vector of the heart are not specific to inflammatory cardiomyopathy, as they may also occur in other types of cardiomyopathies, MCG offers a tool of broad and efficient diagnostic screening for cardiac pathologies without side effects.
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Affiliation(s)
| | | | | | | | | | - Bettina Heidecker
- Department of Cardiology, Angiology and Intensive Care Medicine CBF, Deutsches Herzzentrum der Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
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Autore C, Omran Y, Nirthanakumaran DR, Negishi K, Kozor R, Pathan F. Health Economic Analysis of CMR: A Systematic Review. Heart Lung Circ 2023; 32:914-925. [PMID: 37479645 DOI: 10.1016/j.hlc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Uptake of cardiac magnetic resonance (CMR) in Australia has been limited by issues of cost and access. There is a need to inform future application of CMR by evaluating pertinent health economic literature. We sought to perform a systematic review on the health economic data as it pertains to CMR. METHODS Eight databases (biomedical/health economic) were searched for relevant articles highlighting economic evaluations of CMR. Following screening, studies that reported health economic outcomes (e.g., dollars saved, quality adjusted life years [QALY] and cost effectiveness ratios) were included. Data on cost effectiveness, clinical/disease characteristics, type of modelling were extracted and summarised. RESULTS Thirty-eight (38) articles informed the systematic review. Health economic models used to determine cost effectiveness included both trial-based studies (n=14) and Markov modelling (n=24). Comparative strategies ranged from nuclear imaging, stress echocardiography and invasive angiography. The disease states examined included coronary artery disease (23/38), acute coronary syndrome (3/38), heart failure (5/38) and miscellaneous (7/38). The majority of studies (n=29/38) demonstrated CMR as a strategy which is either economically dominant, cost-effective or cost-saving. CONCLUSION This systematic review demonstrates that CMR is cost-effective depending on diagnostic strategy, population and disease state. The lack of standardised protocols for application of CMR, economic models used and outcomes reported limits the ability to meta-analyse the available health economic data.
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Affiliation(s)
- Chloe Autore
- Charles Perkins Centre, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
| | - Yaseen Omran
- Department of Cardiology Nepean Hospital, Sydney, NSW, Australia
| | - Deva Rajan Nirthanakumaran
- Charles Perkins Centre, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology Nepean Hospital, Sydney, NSW, Australia
| | - Kazuaki Negishi
- Charles Perkins Centre, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology Nepean Hospital, Sydney, NSW, Australia
| | - Rebecca Kozor
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The Kolling Institute, Royal North Shore Hospital, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Faraz Pathan
- Charles Perkins Centre, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology Nepean Hospital, Sydney, NSW, Australia.
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von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology: a comprehensive summary and update. J Cardiovasc Magn Reson 2023; 25:42. [PMID: 37482604 PMCID: PMC10364363 DOI: 10.1186/s12968-023-00950-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) has been established as a valuable tool in clinical and scientific cardiology. This study summarizes the current evidence and role of CMR in the guidelines of the European Society of Cardiology (ESC) and is an update of a former guideline analysis. METHODS Since the last guideline analysis performed in 2015, 28 new ESC guideline documents have been published. Twenty-seven ESC practice guidelines are currently in use. They were screened regarding CMR in the text, tables and figures. The main CMR-related sentences and recommendations were extracted. RESULTS Nineteen of the 27 guidelines (70.4%) contain relevant text passages regarding CMR in the text and include 92 specific recommendations regarding the use of CMR. Seven guidelines (25.9%) mention CMR in the text, and 1 (3.7%, dyslipidemia) does not mention CMR. The 19 guidelines with recommendations regarding the use of CMR contain 40 class-I recommendations (43.5%), 28 class-IIa recommendations (30.4%), 19 class-IIb recommendations (20.7%) and 5 class-III recommendations (5.4%). Most of the recommendations have evidence level C (56/92; 60.9%), followed by level B (34/92; 37.0%) and level A (2/92; 2.2%). Twenty-one recommendations refer to the field of cardiomyopathies, 21 recommendations to stress perfusion imaging, 20 recommendations to vascular assessment, 12 to myocardial tissue characterization in general, 8 to left and right ventricular function assessment, 5 to the pericardium and 5 to myocarditis. CONCLUSIONS CMR is integral part of the majority of the ESC guidelines. Its representation in the guidelines has increased since the last analysis from 2015, now comprising 92 instead of formerly 63 specific recommendations. To enable patient management in accordance to the ESC guidelines, CMR must become more widely available.
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Affiliation(s)
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Lindenberger Weg 80, 13125 Berlin, Germany
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Michaud K, Jacobsen C, Basso C, Banner J, Blokker BM, de Boer HH, Dedouit F, O'Donnell C, Giordano C, Magnin V, Grabherr S, Suvarna SK, Wozniak K, Parsons S, van der Wal AC. Application of postmortem imaging modalities in cases of sudden death due to cardiovascular diseases-current achievements and limitations from a pathology perspective : Endorsed by the Association for European Cardiovascular Pathology and by the International Society of Forensic Radiology and Imaging. Virchows Arch 2023; 482:385-406. [PMID: 36565335 PMCID: PMC9931788 DOI: 10.1007/s00428-022-03458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Postmortem imaging (PMI) is increasingly used in postmortem practice and is considered a potential alternative to a conventional autopsy, particularly in case of sudden cardiac deaths (SCD). In 2017, the Association for European Cardiovascular Pathology (AECVP) published guidelines on how to perform an autopsy in such cases, which is still considered the gold standard, but the diagnostic value of PMI herein was not analyzed in detail. At present, significant progress has been made in the PMI diagnosis of acute ischemic heart disease, the most important cause of SCD, while the introduction of postmortem CT angiography (PMCTA) has improved the visualization of several parameters of coronary artery pathology that can support a diagnosis of SCD. Postmortem magnetic resonance (PMMR) allows the detection of acute myocardial injury-related edema. However, PMI has limitations when compared to clinical imaging, which severely impacts the postmortem diagnosis of myocardial injuries (ischemic versus non-ischemic), the age-dating of coronary occlusion (acute versus old), other potentially SCD-related cardiac lesions (e.g., the distinctive morphologies of cardiomyopathies), aortic diseases underlying dissection or rupture, or pulmonary embolism. In these instances, PMI cannot replace a histopathological examination for a final diagnosis. Emerging minimally invasive techniques at PMI such as image-guided biopsies of the myocardium or the aorta, provide promising results that warrant further investigations. The rapid developments in the field of postmortem imaging imply that the diagnosis of sudden death due to cardiovascular diseases will soon require detailed knowledge of both postmortem radiology and of pathology.
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Affiliation(s)
- Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans H de Boer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France
| | - Chris O'Donnell
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Virginie Magnin
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - S Kim Suvarna
- Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
| | - Krzysztof Wozniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sarah Parsons
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Allard C van der Wal
- Department of Pathology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands.
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Experience of 500 cardiovascular magnetic resonance imaging and systematic analysis of cases. North Clin Istanb 2023; 10:108-121. [PMID: 36910429 PMCID: PMC9996649 DOI: 10.14744/nci.2022.28445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/23/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Cardiovascular magnetic resonance imaging (MRI) is a widely accepted reference imaging technique in routine cardiology clinics in many centers due to its advantages in providing preferable functional, morphologic information. However, there is little information about national experience in clinical application and findings of cardiovascular MRI. The objective of this study was to demonstrate the clinical and demographic characteristics of patients admitted to our cardiac imaging department. METHODS A total of 500 cardiovascular MRI examinations performed between 2016 and 2019 were enrolled in this retrospective study. Clinical indications, demographic, and cardiovascular MRI findings of the patients were retrospectively evaluated. RESULTS Five hundred patients (M/F=301/199) were included in this retrospective, single center study. The majority of the examinations were performed for the assessment of congenital heart disease (n=254, 50.8%). The other indications were for myocardial disease (n=160, 32%), cardiac mass (n=44, 8.8%), valvular heart disease (n=20, 4%), magnetic resonance angiography (n=12, 2.4% for aorta and pulmonary artery [n=9, 1.8%] and for coronary arteries [n=3, 0.6%]), and vasculitis (n=7, 1.7%), pericardial disease (n=3, 0.6%). Minor complication was seen during the contrast agent injection in three patients (0.06%). CONCLUSION Cardiovascular MRI is a reliable and accurate imaging tool in identifying the various cardiac pathology with widely accepted use in the clinical area. Our single-center experience of 500 cases demonstrates the varieties of clinical indications in daily practice that may contribute to the national data pool.
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Consequences of COVID-19 on the cardiovascular and renal systems. Sleep Med 2022; 100:31-38. [PMID: 35994936 PMCID: PMC9345655 DOI: 10.1016/j.sleep.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/11/2023]
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Alachkar MN, Mischke T, Mahnkopf C. [Cardiac magnetic resonance imaging and the myocardium : Differentiation between vital and nonvital tissue]. Herzschrittmacherther Elektrophysiol 2022; 33:272-277. [PMID: 35781833 DOI: 10.1007/s00399-022-00874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
Cardiac magnetic resonance (cMR), a well-established imaging tool, is indispensable in the diagnosis and management of cardiovascular disease. Given its high spatial resolution and ability to characterize tissue, cMR represents the gold standard in determining myocardial viability. Gadolinium-based contrast-enhanced cMR can accurately identify myocardial scars and fibrosis in the ventricle and the atria, and differentiate it from normal myocardium. Gadolinium is an extracellular molecule which has been shown to be safe and beneficial in magnetic resonance imaging (MRI). Due to the larger extracellular space in myocardial scars, there is more uptake (wash-in) and slower elimination (wash-out) of gadolinium in those areas as opposed to normal myocardium. When imaged several minutes after intravenous administration of gadolinium, nonviable myocardial areas appear brighter than viable myocardium. The use of late-gadolinium enhancement (LGE) technique in assessing myocardial viability has been shown to highly correlate with histological examinations. Furthermore, this technique is highly reproducible and has very high intra- and interobserver agreement. Extent of LGE after myocardial infarction predicts the occurrence of adverse cardiovascular events. Moreover, LGE is highly accurate in predicting functional recovery of dysfunctional myocardial segments in patients undergoing revascularization and consequently has a key role in guiding revascularization procedures. In addition, use of LGE in the identification of myocardial fibrosis or myocardial damage in inflammatory myocardial disease helps to differentiate the type of cardiomyopathy and to predict sudden cardiac death among patients with heart failure. The role of LGE-MRI in the field of electrophysiology through recognition of different substrate for arrythmias and guiding the ablation therapy is steadily increasing and has fundamentally changed our understanding of atrial myopathy.
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Affiliation(s)
- Mhd Nawar Alachkar
- Klinik für Kardiologie und Angiologie, REGIOMED Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.
| | - Thomas Mischke
- Klinik für Kardiologie und Angiologie, REGIOMED Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland
| | - Christian Mahnkopf
- Klinik für Kardiologie und Angiologie, REGIOMED Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland
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The role of cardiac magnetic resonance in identifying appropriate candidates for cardiac resynchronization therapy - a systematic review of the literature. Heart Fail Rev 2022; 27:2095-2118. [PMID: 36045189 DOI: 10.1007/s10741-022-10263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
Despite the strict indications for cardiac resynchronization therapy (CRT) implantation, a significant proportion of patients will fail to adequately respond to the treatment. This systematic review aims to present the existing evidence about the role of cardiac magnetic resonance (CMR) in identifying patients who are likely to respond better to the CRT. A systematic search in the MedLine database and Cochrane Library from their inception to August 2021 was performed, without any limitations, by two independent investigators. We considered eligible observational studies or randomized clinical trials (RCTs) that enrolled patients > 18 years old with heart failure (HF) of ischaemic or non-ischaemic aetiology and provided data about the association of baseline CMR variables with clinical or echocardiographic response to CRT for at least 3 months. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). Following our search strategy, 47 studies were finally included in our review. CMR appears to have an additive role in identifying the subgroup of patients who will respond better to CRT. Specifically, the presence and the extent of myocardial scar were associated with increased non-response rates, while those with no scar respond better. Furthermore, existing data show that scar location can be associated with CRT response rates. CMR-derived markers of mechanical desynchrony can also be used as predictors of CRT response. CMR data can be used to optimize the position of the left ventricular lead during the CRT implantation procedure. Specifically, positioning the left ventricular lead in a branch of the coronary sinus that feeds an area with transmural scar was associated with poorer response to CRT. CMR can be used as a non-invasive optimization tool to identify patients who are more likely to achieve better clinical and echocardiographic response following CRT implantation.
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Jáuregui B, Calvo N, Olóriz T, López-Perales C, Asso A. Cardiac Magnetic Resonance and Ventricular Arrhythmia Risk Assessment in Chronic Ischemic Cardiomyopathy: An Unmet Need? Rev Cardiovasc Med 2022; 23:246. [PMID: 39076917 PMCID: PMC11266788 DOI: 10.31083/j.rcm2307246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 07/31/2024] Open
Abstract
Ischemic cardiomyopathy (ICM) constitutes a major public health issue, directly involved in the prevalence and incidence of heart failure, ventricular arrhythmias (VA) and sudden cardiac death (SCD). Severe impairment of left ventricular ejection fraction (LVEF) is considered a high-risk marker for SCD, conditioning the criteria that determine an implantable cardiac defibrillator (ICD) placement in primary prevention according to current clinical guidelines. However, its sensitivity and specificity values for the prediction of SCD in ICM may not be highest. Myocardial characterization using cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) sequences has made it possible to answer clinically relevant questions that are currently not assessable with LVEF alone. There is growing scientific evidence in favor of the relationship between fibrosis evaluated with CMR and the appearance of VA/SCD in patients with ICM. This evidence should make us contemplate a more realistic clinical value of LVEF in our daily clinical decision-making.
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Affiliation(s)
- Beatriz Jáuregui
- Arrhytmia Section, Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Naiara Calvo
- Arrhytmia Section, Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Teresa Olóriz
- Arrhytmia Section, Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Carlos López-Perales
- Arrhytmia Section, Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Antonio Asso
- Arrhytmia Section, Cardiology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
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18
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Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
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Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, India
- Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King’s College London, Queen Square, London WC1N 3BG, UK
- High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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19
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Gröschel J, Trauzeddel RF, Blaszczyk E, Schulz-Menger J. [Role of cardiovascular magnetic resonance in cardiovascular diagnostics]. Dtsch Med Wochenschr 2022; 147:528-537. [PMID: 35468634 DOI: 10.1055/a-1554-8382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cardiovascular magnetic resonance (CMR) has become an accepted method for noninvasive imaging in cardiology. As part of a multimodality concept, this method can contribute valuable diagnostic aspects, often even as a first-choice method in a variety of diseases. Currently the availability is still limited, but the increasing time efficiency, technical stability and the growing competence will lead to more guideline-compliant use. The increase of CMR inclusion into guidelines of various societies is mainly based on the unique selling point of CMR, which is noninvasive myocardial tissue differentiation. In addition to efficient ischemia diagnosis, the ability to differentiate active from chronic inflammatory processes as well as the identification of reversible and irreversible damage are some aspects CMR can offer. New developments are sequences which allow for a parametric assessment of myocardial tissue based on T1- and T2-relaxation times. This is especially useful if the exact pathophysiology is unclear, as it is often the case in left ventricular hypertrophy for example. Next to the noninvasive myocardial tissue characterization CMR allows for quantitative hemodynamic assessment of the heart and the related pathologies. Flows as well as gradients can be quantified based on 2D-flow-sequences. New 4D-sequences are aiming to further characterize blood flow in the heart and the great vessels beyond flow volume and gradients. As with any diagnostic method a qualified application is crucial. In recent years, the technique itself has become much more stable and consensus recommendations of the Society for Cardiovascular Magnetic Resonance are available for the main indications, both for the MRI scan procedure and for the evaluation. Appropriate qualifications and certification opportunities are offered both nationally and internationally.
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20
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Abstract
Cardiomyopathies (CMPs) are a heterogeneous group of diseases, frequently genetic, affecting the heart muscle. The symptoms range from asymptomatic to dyspnea, arrhythmias, syncope, and sudden cardiac death. This study is focused on MYH7 (beta-myosin heavy chain), as this gene is commonly mutated in cardiomyopathy patients. Due to the high combined prevalence of MYH7 variants and severe health outcomes, it is one of the most frequently tested genes in clinical settings. We analyzed the clinical presentation and natural history of 48 patients with MYH7-related cardiomyopathy belonging to a cohort from a tertiary center at Helsinki University Hospital, Finland. We made special reference to three age subgroups (0–1, 1–12, and >12 years). Our results characterize a clinically significant MYH7 cohort, emphasizing the high variability of the CMP phenotype depending on age. We observed a subgroup of infants (0–1 years) with MYH7 associated severe DCM phenotype. We further demonstrate that patients under the age of 12 years have a similar symptom burden compared to older patients.
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21
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Raman SV, Markl M, Patel AR, Bryant J, Allen BD, Plein S, Seiberlich N. 30-minute CMR for common clinical indications: a Society for Cardiovascular Magnetic Resonance white paper. J Cardiovasc Magn Reson 2022; 24:13. [PMID: 35232470 PMCID: PMC8886348 DOI: 10.1186/s12968-022-00844-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite decades of accruing evidence supporting the clinical utility of cardiovascular magnetic resonance (CMR), adoption of CMR in routine cardiovascular practice remains limited in many regions of the world. Persistent use of long scan times of 60 min or more contributes to limited adoption, though techniques available on most scanners afford routine CMR examination within 30 min. Incorporating such techniques into standardize protocols can answer common clinical questions in daily practice, including those related to heart failure, cardiomyopathy, ventricular arrhythmia, ischemic heart disease, and non-ischemic myocardial injury. BODY: In this white paper, we describe CMR protocols of 30 min or shorter duration with routine techniques with or without stress perfusion, plus specific approaches in patient and scanner room preparation for efficiency. Minimum requirements for the scanner gradient system, coil hardware and pulse sequences are detailed. Recent advances such as quantitative myocardial mapping and other add-on acquisitions can be incorporated into the proposed protocols without significant extension of scan duration for most patients. CONCLUSION Common questions in clinical cardiovascular practice can be answered in routine CMR protocols under 30 min; their incorporation warrants consideration to facilitate increased access to CMR worldwide.
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Affiliation(s)
- Subha V. Raman
- Division of Cardiovascular Medicine and Krannert CV Research Center, Indiana University School of Medicine, Indianapolis, IN USA
- Cardiovascular Institute, IU Health, Indianapolis, IN USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL USA
| | - Amit R. Patel
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Jennifer Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109 USA
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22
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Xu J, Yang W, Zhao S, Lu M. State-of-the-art myocardial strain by CMR feature tracking: clinical applications and future perspectives. Eur Radiol 2022; 32:5424-5435. [PMID: 35201410 DOI: 10.1007/s00330-022-08629-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 01/13/2023]
Abstract
Based on conventional cine sequences of cardiac magnetic resonance (CMR), feature tracking (FT) is an emerging tissue tracking technique that evaluates myocardial motion and deformation quantitatively by strain, strain rate, torsion, and dyssynchrony. It has been widely accepted in modern literature that strain analysis can offer incremental information in addition to classic global and segmental functional analysis. Furthermore, CMR-FT facilitates measurement of all cardiac chambers, including the relatively thin-walled atria and the right ventricle, which has been a difficult measurement to obtain with the reference standard technique of myocardial tagging. CMR-FT objectively quantifies cardiovascular impairment and characterizes myocardial function in a novel way through direct assessment of myocardial fiber deformation. The purpose of this review is to discuss the current status of clinical applications of myocardial strain by CMR-FT in a variety of cardiovascular diseases. KEY POINTS: • CMR-FT is of great value for differential diagnosis and provides incremental value for evaluating the progression and severity of diseases. • CMR-FT guides the early diagnosis of various cardiovascular diseases and provides the possibility for the early detection of myocardial impairment and additional information regarding subclinical cardiac abnormalities. • Direct assessment of myocardial fiber deformation using CMR-FT has the potential to provide prognostic information incremental to common clinical and CMR risk factors.
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Affiliation(s)
- Jing Xu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wenjing Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing, 100037, China. .,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, 100037, China.
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23
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Menacho KD, Ramirez S, Perez A, Dragonetti L, Perez de Arenaza D, Katekaru D, Illatopa V, Munive S, Rodriguez B, Shimabukuro A, Cupe K, Bansal R, Bhargava V, Rodriguez I, Seraphim A, Knott K, Abdel-Gadir A, Guerrero S, Lazo M, Uscamaita D, Rivero M, Amaya N, Sharma S, Peix A, Treibel T, Manisty C, Mohiddin S, Litt H, Han Y, Fernandes J, Jacob R, Westwood M, Ntusi N, Herrey A, Walker JM, Moon J. Improving cardiovascular magnetic resonance access in low- and middle-income countries for cardiomyopathy assessment: rapid cardiovascular magnetic resonance. Eur Heart J 2022; 43:2496-2507. [PMID: 35139531 PMCID: PMC9259377 DOI: 10.1093/eurheartj/ehac035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
AIMS To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). METHODS AND RESULTS Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees-potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6 min (contrast) and 12 ± 4 min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1-2 days per week, 30 min slots). CONCLUSIONS Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time.
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Affiliation(s)
- Katia Devorha Menacho
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | | | - Aylen Perez
- Cardiology and Cardiovascular Surgery National Institute, La Havana, Cuba
| | | | | | - Diana Katekaru
- Military National Hospital, Cardiac Imaging Department, Lima, Peru
| | | | - Sara Munive
- National Cardiovascular Institute—INCOR, Lima, Peru
| | | | - Ana Shimabukuro
- Guillermo Almenara Irigoyen Hospital, National Hospital, Lima, Peru
| | - Kelly Cupe
- Guillermo Almenara Irigoyen Hospital, National Hospital, Lima, Peru
| | - Rajiv Bansal
- Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, India
| | | | | | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Kris Knott
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Marco Lazo
- Ramiro Priale National Hospital, Huancayo, Peru
| | - David Uscamaita
- Edgardo Rebagliati Hospital, MRI and CT Department, Lima, Peru
| | | | - Neil Amaya
- Edgardo Rebagliati Hospital, MRI and CT Department, Lima, Peru
| | - Sanjiv Sharma
- AlI India Institute of Medical Sciences, New Delhi, India
| | - Amelia Peix
- Cardiology and Cardiovascular Surgery National Institute, La Havana, Cuba
| | - Thomas Treibel
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Sam Mohiddin
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Harold Litt
- Department of Medicine (Cardiovascular Division), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ron Jacob
- Lancaster General Health Hospital, Lancaster, USA
| | - Mark Westwood
- St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna Herrey
- Institute of Cardiovascular Science, University College London, London, UK,St Bartholomew’s Hospital, Barts Heart Centre, London EC1A 7BE, UK
| | - John Malcolm Walker
- Institute of Cardiovascular Science, University College London, London, UK,The Hatter Cardiovascular Institute, University College London Hospital, London, UK
| | - James Moon
- Corresponding author. Tel: +44 203 8870566,
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24
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Funama Y, Oda S, Kidoh M, Sakabe D, Nakaura T. Effect of image quality on myocardial extracellular volume quantification using cardiac computed tomography: a phantom study. Acta Radiol 2022; 63:159-165. [PMID: 33461303 DOI: 10.1177/0284185120986938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The image quality directly affects the accuracy of computed tomography (CT) extracellular volume (ECV) quantification. PURPOSE To investigate the effects of image quality and acquisition protocol on the accuracy of ECV quantification. MATERIAL AND METHODS One-volume scans were performed on a 320-row multidetector CT volume scanner using a multi-energy CT phantom. To simulate the blood pool and myocardium, solid rods representing blood and soft tissue were used in precontrast CT. Moreover, the solid rods including different iodine concentrations were used in postcontrast CT. The tube voltage was set at 120 kVp, and the tube current was changed from 750 mA (100% dose) to 190 mA (25% dose). All images underwent full- and half-scan reconstructions based on model-based iterative reconstruction. The ECV was calculated from the CT numbers between pre- and postcontrast. RESULTS The mean ECV with full- and half-scan reconstructions at the central portion was 0.275 at 100% scan dose to 0.271 at 25% scan dose and 0.276 at 100% scan dose to 0.269 at 25% scan dose. Compared with that in the 100% scan dose, the variation in each ECV increased with decreasing radiation dose. The ECV at the center of the image along the z-axis had lower variation than that at outer portion of the images. On the reconstruction algorithm, there was no statistical difference in ECVs with full- and half-scan reconstructions. CONCLUSION For stable ECV quantifications, excessive radiation dose reduction may be inappropriate, and it is better to consider the variations in ECV values depending on the slice location.
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Affiliation(s)
- Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sakabe
- Department of Radiology, Kumamoto University Hospital, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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25
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Conte E, Carbucicchio C, Catto V, Kochi AN, Mushtaq S, De Iuliis PG, Guglielmo M, Baggiano A, Sattin T, Pontone G, Pepi M, Tondo C, Andreini D. Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardia. J Cardiovasc Comput Tomogr 2021; 16:262-265. [PMID: 34991995 DOI: 10.1016/j.jcct.2021.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping). METHODS We prospectively enrolled a consecutive cohort of patients with clinical indication to EAM before radiofrequency catheter ablation (RFCA) of refractory ventricular tachycardia (VT) and an absolute contraindication to cardiac magnetic resonance. All patients underwent per protocol CCT for myocardial fibrosis and coronary anatomy evaluation. Diagnostic performance was assessed for myocardial fibrosis evaluation with CCT vs EAM. Live integration feasibility of CCT vs EAM was evaluated for every patients. RESULTS A total of 19 patients were included in the present study with 323 myocardial segments analyzed for myocardial fibrosis at CCT. In all patients CCT data were successfully integrated with EAM during RFCA procedure. All patients had myocardial fibrosis correctly identified at CCT vs EAM on a per-patients basis. A diagnostic accuracy on a per-segment basis of 94.1% for detection of any type of myocardial fibrosis at CCT vs EAM was recorded. CONCLUSIONS CCT identification of myocardial fibrosis is feasible and accurate vs EAM in a very selected high risk patients with clinical indication to RFCA of VT and contraindication to CMR.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | | | | | | | - Andrea Baggiano
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
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26
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Eder MD, Upadhyaya K, Park J, Ringer M, Malinis M, Young BD, Sugeng L, Hur DJ. Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review. Front Cardiovasc Med 2021; 8:750573. [PMID: 34988125 PMCID: PMC8720921 DOI: 10.3389/fcvm.2021.750573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022] Open
Abstract
Infective endocarditis is a common and treatable condition that carries a high mortality rate. Currently the workup of infective endocarditis relies on the integration of clinical, microbiological and echocardiographic data through the use of the modified Duke criteria (MDC). However, in cases of prosthetic valve endocarditis (PVE) echocardiography can be normal or non-diagnostic in a high proportion of cases leading to decreased sensitivity for the MDC. Evolving multimodality imaging techniques including leukocyte scintigraphy (white blood cell imaging), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), multidetector computed tomographic angiography (MDCTA), and cardiac magnetic resonance imaging (CMRI) may each augment the standard workup of PVE and increase diagnostic accuracy. While further studies are necessary to clarify the ideal role for each of these imaging techniques, nevertheless, these modalities hold promise in determining the diagnosis, prognosis, and care of PVE. We start by presenting a clinical vignette, then evidence supporting various modality strategies, balanced by limitations, and review of formal guidelines, when available. The article ends with the authors' summary of future directions and case conclusion.
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Affiliation(s)
- Maxwell D. Eder
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Krishna Upadhyaya
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
- Ascension Medical Group, Section of Cardiovascular Medicine, Milwaukee, WI, United States
| | - Jakob Park
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, United States
| | - Matthew Ringer
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Maricar Malinis
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Bryan D. Young
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - David J. Hur
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
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27
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Vergani V, Razavi R, Puyol-Antón E, Ruijsink B. Deep Learning for Classification and Selection of Cine CMR Images to Achieve Fully Automated Quality-Controlled CMR Analysis From Scanner to Report. Front Cardiovasc Med 2021; 8:742640. [PMID: 34722674 PMCID: PMC8551568 DOI: 10.3389/fcvm.2021.742640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/09/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction: Deep learning demonstrates great promise for automated analysis of CMR. However, existing limitations, such as insufficient quality control and selection of target acquisitions from the full CMR exam, are holding back the introduction of deep learning tools in the clinical environment. This study aimed to develop a framework for automated detection and quality-controlled selection of standard cine sequences images from clinical CMR exams, prior to analysis of cardiac function. Materials and Methods: Retrospective study of 3,827 subjects that underwent CMR imaging. We used a total of 119,285 CMR acquisitions, acquired with scanners of different magnetic field strengths and from different vendors (1.5T Siemens and 1.5T and 3.0T Phillips). We developed a framework to select one good acquisition for each conventional cine class. The framework consisted of a first pre-processing step to exclude still acquisitions; two sequential convolutional neural networks (CNN), the first (CNNclass) to classify acquisitions in standard cine views (2/3/4-chamber and short axis), the second (CNNQC) to classify acquisitions according to image quality and orientation; a final algorithm to select one good acquisition of each class. For each CNN component, 7 state-of-the-art architectures were trained for 200 epochs, with cross entropy loss and data augmentation. Data were divided into 80% for training, 10% for validation, and 10% for testing. Results: CNNclass selected cine CMR acquisitions with accuracy ranging from 0.989 to 0.998. Accuracy of CNNQC reached 0.861 for 2-chamber, 0.806 for 3-chamber, and 0.859 for 4-chamber. The complete framework was presented with 379 new full CMR studies, not used for CNN training/validation/testing, and selected one good 2-, 3-, and 4-chamber acquisition from each study with sensitivity to detect erroneous cases of 89.7, 93.2, and 93.9%, respectively. Conclusions: We developed an accurate quality-controlled framework for automated selection of cine acquisitions prior to image analysis. This framework is robust and generalizable as it was developed on multivendor data and could be used at the beginning of a pipeline for automated cine CMR analysis to obtain full automatization from scanner to report.
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Affiliation(s)
- Vittoria Vergani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Adult and Paediatric Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Esther Puyol-Antón
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, Netherlands
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Conte E, Mushtaq S, Muscogiuri G, Formenti A, Annoni A, Mancini E, Ricci F, Melotti E, Gigante C, Lorenza Z, Guglielmo M, Baggiano A, Maragna R, Giacari CM, Carbucicchio C, Catto V, Pepi M, Andreini D, Pontone G. The Potential Role of Cardiac CT in the Evaluation of Patients With Known or Suspected Cardiomyopathy: From Traditional Indications to Novel Clinical Applications. Front Cardiovasc Med 2021; 8:709124. [PMID: 34595219 PMCID: PMC8476802 DOI: 10.3389/fcvm.2021.709124] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
After 15 years from its advent in the clinical field, coronary computed tomography (CCTA) is now widely considered as the best first-step test in patients with low-to-moderate pre-test probability of coronary artery disease. Technological innovation was of pivotal importance for the extensive clinical and scientific interest in CCTA. Recently, the advent of last generation wide-coverage CT scans paved the way for new clinical applications of this technique beyond coronary arteries anatomy evaluation. More precisely, both biventricular volume and systolic function quantification and myocardial fibrosis identification appeared to be feasible with last generation CT. In the present review we would focus on potential applications of cardiac computed tomography (CCT), beyond CCTA, for a comprehensive assessment patients with newly diagnosed cardiomyopathy, from technical requirements to novel clinical applications.
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Affiliation(s)
- Edoardo Conte
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Saima Mushtaq
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alberto Formenti
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Annoni
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Elisabetta Mancini
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Francesca Ricci
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Eleonora Melotti
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Gigante
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Zanotto Lorenza
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marco Guglielmo
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Baggiano
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Riccardo Maragna
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Carlo Maria Giacari
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Corrado Carbucicchio
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Valentina Catto
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mauro Pepi
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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von Knobelsdorff-Brenkenhoff F, Reiter S, Menini A, Janich MA, Schunke T, Ziegler K, Scheck R, Höfling B, Pilz G. Influence of motion correction on the visual analysis of cardiac magnetic resonance stress perfusion imaging. MAGMA (NEW YORK, N.Y.) 2021; 34:757-766. [PMID: 33839986 DOI: 10.1007/s10334-021-00923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/12/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Image post-processing corrects for cardiac and respiratory motion (MoCo) during cardiovascular magnetic resonance (CMR) stress perfusion. The study analyzed its influence on visual image evaluation. MATERIALS AND METHODS Sixty-two patients with (suspected) coronary artery disease underwent a standard CMR stress perfusion exam during free-breathing. Image post-processing was performed without (non-MoCo) and with MoCo (image intensity normalization; motion extraction with iterative non-rigid registration; motion warping with the combined displacement field). Images were evaluated regarding the perfusion pattern (perfusion deficit, dark rim artifact, uncertain signal loss, and normal perfusion), the general image quality (non-diagnostic, imperfect, good, and excellent), and the reader's subjective confidence to assess the images (not confident, confident, very confident). RESULTS Fifty-three (non-MoCo) and 52 (MoCo) myocardial segments were rated as 'perfusion deficit', 113 vs. 109 as 'dark rim artifacts', 9 vs. 7 as 'uncertain signal loss', and 817 vs. 824 as 'normal'. Agreement between non-MoCo and MoCo was high with no diagnostic difference per-patient. The image quality of MoCo was rated more often as 'good' or 'excellent' (92 vs. 63%), and the diagnostic confidence more often as "very confident" (71 vs. 45%) compared to non-MoCo. CONCLUSIONS The comparison of perfusion images acquired during free-breathing and post-processed with and without motion correction demonstrated that both methods led to a consistent evaluation of the perfusion pattern, while the image quality and the reader's subjective confidence to assess the images were rated more favorably for MoCo.
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Affiliation(s)
| | - Stephanie Reiter
- Department of Cardiology, Academic Teaching Hospital Agatharied of the Ludwig-Maximilians-University Munich, Agatharied, Germany
| | - Anne Menini
- GE Healthcare, Applied Science Lab, Menlo Park, CA, USA
| | | | - Tobias Schunke
- Department of Cardiology, Academic Teaching Hospital Agatharied of the Ludwig-Maximilians-University Munich, Agatharied, Germany
| | - Karl Ziegler
- Department of Cardiology, Academic Teaching Hospital Agatharied of the Ludwig-Maximilians-University Munich, Agatharied, Germany
| | - Roland Scheck
- Department of Radiology, Academic Teaching Hospital Agatharied of the Ludwig-Maximilians-University Munich, Agatharied, Germany
| | - Berthold Höfling
- Department of Cardiology, Academic Teaching Hospital Agatharied of the Ludwig-Maximilians-University Munich, Agatharied, Germany
| | - Günter Pilz
- Department of Cardiology, Academic Teaching Hospital Agatharied of the Ludwig-Maximilians-University Munich, Agatharied, Germany
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30
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Delso G, Farré L, Ortiz-Pérez JT, Prat S, Doltra A, Perea RJ, Caralt TM, Lorenzatti D, Vega J, Sotes S, Janich MA, Sitges M. Improving the robustness of MOLLI T1 maps with a dedicated motion correction algorithm. Sci Rep 2021; 11:18546. [PMID: 34535689 PMCID: PMC8448777 DOI: 10.1038/s41598-021-97841-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/25/2021] [Indexed: 01/03/2023] Open
Abstract
Myocardial tissue T1 constitutes a reliable indicator of several heart diseases related to extracellular changes (e.g. edema, fibrosis) as well as fat, iron and amyloid content. Magnetic resonance (MR) T1-mapping is typically achieved by pixel-wise exponential fitting of a series of inversion or saturation recovery measurements. Good anatomical alignment between these measurements is essential for accurate T1 estimation. Motion correction is recommended to improve alignment. However, in the case of inversion recovery sequences, this correction is compromised by the intrinsic contrast variation between frames. A model-based, non-rigid motion correction method for MOLLI series was implemented and validated on a large database of cardiac clinical cases (n = 186). The method relies on a dedicated similarity metric that accounts for the intensity changes caused by T1 magnetization relaxation. The results were compared to uncorrected series and to the standard motion correction included in the scanner. To automate the quantitative analysis of results, a custom data alignment metric was defined. Qualitative evaluation was performed on a subset of cases to confirm the validity of the new metric. Motion correction caused noticeable (i.e. > 5%) performance degradation in 12% of cases with the standard method, compared to 0.3% with the new dedicated method. The average alignment quality was 85% ± 9% with the default correction and 90% ± 7% with the new method. The results of the qualitative evaluation were found to correlate with the quantitative metric. In conclusion, a dedicated motion correction method for T1 mapping MOLLI series has been evaluated on a large database of clinical cardiac MR cases, confirming its increased robustness with respect to the standard method implemented in the scanner.
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Affiliation(s)
- Gaspar Delso
- MR Applications & Workflow, GE Healthcare, Barcelona, Spain
| | | | | | | | | | | | | | | | - Julián Vega
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Santi Sotes
- Hospital Clínic de Barcelona, Barcelona, Spain
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31
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Schuster A, Thiele H, Katus H, Werdan K, Eitel I, Zeiher AM, Baldus S, Rolf A, Kelle S. Kompetenz und Innovation in der kardiovaskulären MRT: Stellungnahme der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung. DER KARDIOLOGE 2021. [PMCID: PMC8361824 DOI: 10.1007/s12181-021-00494-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diese Stellungnahme der Deutschen Gesellschaft für Kardiologie (DGK) beschäftigt sich mit der Bedeutung kardiologischer Kompetenz im Gebiet der kardiovaskulären Magnetresonanztomographie (CMR) und deren Aus- und Wechselwirkungen auf klinisches Management im Bereich der Diagnostik, Therapieplanung und Therapie von kardiologischen Patienten. Zahlreiche Innovationen sowohl im technischen als auch klinischen Bereich der CMR basieren auf Publikationen deutscher und europäischer Kardiologen und haben Einzug in die nationalen, europäischen und auch US-amerikanischen Leitlinien gefunden. Hier sollen Empfehlungen zur sicheren, qualitativ hochwertigen und kompetenten Durchführung von CMR-Untersuchungen gegeben werden, im Sinne einer optimalen Nutzung dieser Technik mit unmittelbarer klinischer Einordnung des Untersuchungsergebnisses für die Planung einer Therapiestrategie des kardiovaskulär erkrankten Patienten.
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Affiliation(s)
- Andreas Schuster
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Deutschland
- Partner Site Göttingen, Deutsches Zentrum für Herz-Kreislauf-Forschung, Göttingen, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig, Klinik für Innere Medizin und Kardiologie, Universität Leipzig, Leipzig, Deutschland
- Leipzig Heart Science gGmbH, Leipzig, Deutschland
| | - Hugo Katus
- Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Ingo Eitel
- Medizinische Klinik II – Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Andreas M. Zeiher
- Klinik für Kardiologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Stephan Baldus
- Medizinische Klinik III – Abteilung für Kardiologie, Pneumologie, Angiologie und Intensivmedizin, Universität Köln, Köln, Deutschland
| | - Andreas Rolf
- Klinik für Kardiologie, Herz‑, Lungen‑, Gefäß- und Rheumazentrum, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - Sebastian Kelle
- Deutsches Herzzentrum Berlin, Berlin, Deutschland
- Klinik für Innere Medizin und Kardiologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Deutschland
- Partner Site Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Deutschland
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32
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Mizia-Stec K, Charron P, Gimeno Blanes JR, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Felix SB, Dominguez F, Ojrzynska N, Losi MA, Limongelli G, Barriales-Villa R, Seferovic PM, Biagini E, Wybraniec M, Laroche C, Caforio ALP. Current use of cardiac magnetic resonance in tertiary referral centres for the diagnosis of cardiomyopathy: the ESC EORP Cardiomyopathy/Myocarditis Registry. Eur Heart J Cardiovasc Imaging 2021; 22:781-789. [PMID: 33417664 PMCID: PMC8219354 DOI: 10.1093/ehjci/jeaa329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/12/2020] [Indexed: 01/10/2023] Open
Abstract
Aims Cardiac magnetic resonance (CMR) is recommended in the diagnosis of cardiomyopathies, but it is time-consuming, expensive, and limited in availability in some European regions. The aim of this study was to determine the use of CMR in cardiomyopathy patients enrolled into the European Society of Cardiology (ESC) cardiomyopathy registry [part of the EURObservational Research Programme (EORP)]. Methods and results Three thousand, two hundred, and eight consecutive adult patients (34.6% female; median age: 53.0 ± 15 years) with cardiomyopathy were studied: 1260 with dilated (DCM), 1739 with hypertrophic (HCM), 66 with restrictive (RCM), and 143 with arrhythmogenic right ventricular cardiomyopathy (ARVC). CMR scans were performed at baseline in only 29.4% of patients. CMR utilization was variable according to cardiomyopathy subtypes: from 51.1% in ARVC to 36.4% in RCM, 33.8% in HCM, and 20.6% in DCM (P < 0.001). CMR use in tertiary referral centres located in different European countries varied from 1% to 63.2%. Patients undergoing CMR were younger, less symptomatic, less frequently had implantable cardioverter-defibrillator (ICD)/pacemaker implanted, had fewer cardiovascular risk factors and comorbidities (P < 0.001). In 28.6% of patients, CMR was used along with transthoracic echocardiography (TTE); 67.6% patients underwent TTE alone, and 0.9% only CMR. Conclusion Less than one-third of patients enrolled in the registry underwent CMR and the use varied greatly between cardiomyopathy subtypes, clinical profiles of patients, and European tertiary referral centres. This gap with current guidelines needs to be considered carefully by scientific societies to promote wider availability and use of CMR in patients with cardiomyopathies.
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Affiliation(s)
- Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Center, 47 Ziolowa St., 40-635 Katowice, Poland
| | - Philippe Charron
- APHP, Centre de Référence des Maladies Cardiaques Héréditaires, Assistance Publique-Hôpitaux de Paris, ICAN, Hôpital Pitié-Salpêtrière, Paris, France and Sorbonne Université, Inserm UMR1166, Paris, France.,Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands
| | - Juan Ramon Gimeno Blanes
- Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.,Cardiac Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Perry Elliott
- Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.,Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew's Hospital, University College London (UCL), London, UK
| | - Juan Pablo Kaski
- Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, University College London Institute of Cardiovascular Science, London, UK
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Center, Firenze, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Michał Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Fernando Dominguez
- Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.,Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giuseppe Limongelli
- Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.,Ospedale Monaldi, A.O. Colli, Naples, Italy
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Complejo Hospitalario Universitario A Coruña, CIBERCV, A Coruña, Spain
| | - Petar M Seferovic
- Faculty of Medicine, University of Belgrade; Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Elena Biagini
- Cardiac Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesia Medical Center, 47 Ziolowa St., 40-635 Katowice, Poland
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Alida L P Caforio
- Members of the European Reference Network on Heart Diseases (ERN GUARD-HEART), Coordinating Centre: Academic Medical Center, Amsterdam, the Netherlands.,Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Lin L, Zhou X, Dekkers IA, Lamb HJ. Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management. J Pers Med 2021; 11:734. [PMID: 34442378 PMCID: PMC8400880 DOI: 10.3390/jpm11080734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/24/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiorenal syndrome (CRS) concerns the interconnection between heart and kidneys in which the dysfunction of one organ leads to abnormalities of the other. The main clinical challenges associated with cardiorenal syndrome are the lack of tools for early diagnosis, prognosis, and evaluation of therapeutic effects. Ultrasound, computed tomography, nuclear medicine, and magnetic resonance imaging are increasingly used for clinical management of cardiovascular and renal diseases. In the last decade, rapid development of imaging techniques provides a number of promising biomarkers for functional evaluation and tissue characterization. This review summarizes the applicability as well as the future technological potential of each imaging modality in the assessment of CRS. Furthermore, opportunities for a comprehensive imaging approach for the evaluation of CRS are defined.
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Affiliation(s)
- Ling Lin
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 510833, China
| | - Ilona A. Dekkers
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Hildo J. Lamb
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
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Avesani M, Degrelle B, Di Salvo G, Thambo JB, Iriart X. Vector flow mapping: A review from theory to practice. Echocardiography 2021; 38:1405-1413. [PMID: 34259359 DOI: 10.1111/echo.15154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The interest in intra-cardiac blood flow analysis is rapidly growing, and it has encouraged the development of different non-invasive imaging techniques. Among these, Vector Flow Mapping (VFM), combing Color-Doppler imaging and speckle tracking data, seems to be a promising approach, feasible in adult and children population. AIM OF THE REVIEW The aim of this review is to give a historical perspective on the development of VFM method and a summary of the current algorithms and parameters potentially evaluable. Then, we will present the current state-of-the-art of VFM with an overview of clinical studies and applications of this technique.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Bastien Degrelle
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France
| | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
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35
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Caleyachetty R, Littlejohns T, Lacey B, Bešević J, Conroy M, Collins R, Allen N. United Kingdom Biobank (UK Biobank): JACC Focus Seminar 6/8. J Am Coll Cardiol 2021; 78:56-65. [PMID: 34210415 DOI: 10.1016/j.jacc.2021.03.342] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/21/2021] [Indexed: 11/19/2022]
Abstract
An increasing number of people are now living with cardiovascular disease (CVD), with concomitant CVD-related hospitalizations, operations, and prescriptions. To ultimately deliver optimal cardiovascular care, access to population-based biobanks with data on multiomics, phenotypes, and lifestyle risk factors are crucial. UK Biobank is a cohort study that incorporated data between 2006 and 2010 from over half a million individuals (40 to 69 years of age) at recruitment from across the United Kingdom. As one of the most accessible, largest, and in-depth cohort studies in the world, UK Biobank continues to enhance the resource with the addition of data from various omics platforms (eg, genomics, metabolomics, proteomics), multimodal imaging, self-reported risk factors and health outcomes, and linkage to electronic health records. The vision of UK Biobank is to allow as many researchers as possible to apply their expertise and imagination to undertake research to prevent, diagnose, and treat a wide range of chronic conditions, including CVD.
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Affiliation(s)
- Rishi Caleyachetty
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Thomas Littlejohns
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ben Lacey
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | - Jelena Bešević
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Megan Conroy
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rory Collins
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Naomi Allen
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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36
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Zou Q, Xu HY, Fu C, Zhou XY, Xu R, Yang MX, Yang ZG, Guo YK. Utility of single-shot compressed sensing cardiac magnetic resonance cine imaging for assessment of biventricular function in free-breathing and arrhythmic pediatric patients. Int J Cardiol 2021; 338:258-264. [PMID: 34181995 DOI: 10.1016/j.ijcard.2021.06.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to explore the feasibility and accuracy of single-shot compressed-sensing (CS) cardiac magnetic resonance cine technology for the assessment of biventricular function and morphology in free-breathing (FB) pediatrics, especially those with arrhythmia. METHODS Seventy consecutive pediatric participants (6.27 ± 3.8 years, range:0.5-14 years) were enrolled between August 2019 and July 2020. Single-shot CS and conventional balanced steady-state free-precession (bSSFP) cine were obtained. The total scanning time, image quality and biventricular function parameters were compared for both sequences. RESULTS Single-shot CS cine had shorter acquisition time compared with the conventional bSSFP cine (all P < 0.001). The single-shot CS cine also had fewer artifacts than conventional bSSFP cine (breath-hold (BH): 4.6 ± 0.6 vs. 4.3 ± 0.6; FB without ongoing arrhythmia: 4.5 ± 0.6 vs. 3.6 ± 0.9; FB with ongoing arrhythmia: 4.7 ± 0.5 vs. 2.6 ± 1.1; all P < 0.05). No statistical difference of left ventricular parameters and right ventricular end-systolic volume/ejection fraction were found between the single-shot CS and conventional bSSFP cine in both BH and FB without ongoing arrhythmia group. There was an excellent correlation (R2 = 0.60-0.98, all P < 0.001) and good intra-(range: R2 = 0.57-0.99, P < 0.001)/inter-observer agreements (range: R2 = 0.76-1, P < 0.001) for single-shot CS cine images in terms of biventricular function parameters. CONCLUSIONS The single-shot CS cine can significantly reduce the image acquisition time, offering reliable quantification of biventricular function in free breathing condition for arrhythmic patients.
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Affiliation(s)
- Qing Zou
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China; Department of Radiology, Deyang People's Hospital, 173# Section 3 Tai Shan Road, Deyang, Sichuan 618400, China
| | - Hua-Yan Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China
| | - Chuan Fu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China
| | - Xiao-Yue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Rong Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China
| | - Meng-Xi Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China.
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37
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Arai AE, Bradley AJ, Sirajuddin A. Risk Stratification for Sudden Death and Arrhythmias: A Role for Gadolinium-Enhanced CMR. J Am Coll Cardiol 2021; 77:42-44. [PMID: 33413939 DOI: 10.1016/j.jacc.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
| | - Andrew J Bradley
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Arlene Sirajuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Backhaus SJ, Schuster A, Lange T, Stehning C, Billing M, Lotz J, Pieske B, Hasenfuß G, Kelle S, Kowallick JT. Impact of fully automated assessment on interstudy reproducibility of biventricular volumes and function in cardiac magnetic resonance imaging. Sci Rep 2021; 11:11648. [PMID: 34078942 PMCID: PMC8172876 DOI: 10.1038/s41598-021-90702-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging provides reliable assessments of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards novel artificial intelligence-based fully automated analyses. Hence, we sought to investigate the impact of artificial intelligence-based fully automated assessments on the inter-study variability of biventricular volumes and function. Eighteen participants (11 with normal, 3 with heart failure and preserved and 4 with reduced ejection fraction (EF)) underwent serial CMR imaging at in median 63 days (range 49–87) interval. Short axis cine stacks were acquired for the evaluation of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic, end-systolic and stroke volumes as well as EF. Assessments were performed manually (QMass, Medis Medical Imaging Systems, Leiden, Netherlands) by an experienced (3 years) and inexperienced reader (no active reporting, 45 min of training with five cases from the SCMR consensus data) as well as fully automated (suiteHEART, Neosoft, Pewaukee, WI, USA) without any manual corrections. Inter-study reproducibility was overall excellent with respect to LV volumetric indices, best for the experienced observer (intraclass correlation coefficient (ICC) > 0.98, coefficient of variation (CoV, < 9.6%) closely followed by automated analyses (ICC > 0.93, CoV < 12.4%) and lowest for the inexperienced observer (ICC > 0.86, CoV < 18.8%). Inter-study reproducibility of RV volumes was excellent for the experienced observer (ICC > 0.88, CoV < 10.7%) but considerably lower for automated and inexperienced manual analyses (ICC > 0.69 and > 0.46, CoV < 22.8% and < 28.7% respectively). In this cohort, fully automated analyses allowed reliable serial investigations of LV volumes with comparable inter-study reproducibility to manual analyses performed by an experienced CMR observer. In contrast, RV automated quantification with current algorithms still relied on manual post-processing for reliability.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Marcus Billing
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Burkert Pieske
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany. .,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Menacho Medina K, Seraphim A, Katekaru D, Abdel-Gadir A, Han Y, Westwood M, Walker JM, Moon JC, Herrey AS. Noninvasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in low-middle income countries. Expert Rev Cardiovasc Ther 2021; 19:387-398. [PMID: 33836619 DOI: 10.1080/14779072.2021.1915130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cardiac Magnetic Resonance (CMR) is a crucial diagnostic imaging test that redefines diagnosis and enables targeted therapies, but the access to CMR is limited in low-middle Income Countries (LMICs) even though cardiovascular disease is an emergent primary cause of mortality in LMICs. New abbreviated CMR protocols can be less expensive, faster, whilst maintaining accuracy, potentially leading to a higher utilization in LMICs.Areas covered: This article will review cardiovascular disease in LMICs and the current role of CMR in cardiac diagnosis and enable targeted therapy, discussing the main obstacles to prevent the adoption of CMR in LMICs. We will then review the potential utility of abbreviated, cost-effective CMR protocols to improve cardiac diagnosis and care, the clinical indications of the exam, current evidence and future directions.Expert opinion: Rapid CMR protocols, provided that they are utilized in potentially high yield cases, could reduce cost and increase effectiveness. The adoption of these protocols, their integration into care pathways, and prioritizing key treatable diagnoses can potentially improve patient care. Several LMIC countries are now pioneering these approaches and the application of rapid CMR protocols appears to have a bright future if delivered effectively.
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Affiliation(s)
- Katia Menacho Medina
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | | | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, UK
| | - Yuchi Han
- Departments of Medicine (Cardiovascular Division) and Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Westwood
- Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - J Malcolm Walker
- Institute of Cardiovascular Science, University College London, London, UK.,Cardiology Department, University College London Hospitals NHS Foundation Trust, London, UK.,The Hatter Cardiovascular Institute, University College London Hospital, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - Anna S Herrey
- Institute of Cardiovascular Science, University College London, London, UK.,Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
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40
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Mills MT, Grafton-Clarke C, Williams G, Gosling RC, Al Baraikan A, Kyriacou AL, Morris PD, Gunn JP, Swoboda PP, Levelt E, Tsampasian V, van der Geest RJ, Swift AJ, Greenwood JP, Plein S, Vassiliou V, Garg P. Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation. Wellcome Open Res 2021; 6:73. [PMID: 34095509 PMCID: PMC8150120 DOI: 10.12688/wellcomeopenres.16655.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (-4.8, 95% CI -15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI -4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Gareth Williams
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca C Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al Baraikan
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas L Kyriacou
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Vass Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Ordovas KG, Baldassarre LA, Bucciarelli-Ducci C, Carr J, Fernandes JL, Ferreira VM, Frank L, Mavrogeni S, Ntusi N, Ostenfeld E, Parwani P, Pepe A, Raman SV, Sakuma H, Schulz-Menger J, Sierra-Galan LM, Valente AM, Srichai MB. Cardiovascular magnetic resonance in women with cardiovascular disease: position statement from the Society for Cardiovascular Magnetic Resonance (SCMR). J Cardiovasc Magn Reson 2021; 23:52. [PMID: 33966639 PMCID: PMC8108343 DOI: 10.1186/s12968-021-00746-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 01/09/2023] Open
Abstract
This document is a position statement from the Society for Cardiovascular Magnetic Resonance (SCMR) on recommendations for clinical utilization of cardiovascular magnetic resonance (CMR) in women with cardiovascular disease. The document was prepared by the SCMR Consensus Group on CMR Imaging for Female Patients with Cardiovascular Disease and endorsed by the SCMR Publications Committee and SCMR Executive Committee. The goals of this document are to (1) guide the informed selection of cardiovascular imaging methods, (2) inform clinical decision-making, (3) educate stakeholders on the advantages of CMR in specific clinical scenarios, and (4) empower patients with clinical evidence to participate in their clinical care. The statements of clinical utility presented in the current document pertain to the following clinical scenarios: acute coronary syndrome, stable ischemic heart disease, peripartum cardiomyopathy, cancer therapy-related cardiac dysfunction, aortic syndrome and congenital heart disease in pregnancy, bicuspid aortic valve and aortopathies, systemic rheumatic diseases and collagen vascular disorders, and cardiomyopathy-causing mutations. The authors cite published evidence when available and provide expert consensus otherwise. Most of the evidence available pertains to translational studies involving subjects of both sexes. However, the authors have prioritized review of data obtained from female patients, and direct comparison of CMR between women and men. This position statement does not consider CMR accessibility or availability of local expertise, but instead highlights the optimal utilization of CMR in women with known or suspected cardiovascular disease. Finally, the ultimate goal of this position statement is to improve the health of female patients with cardiovascular disease by providing specific recommendations on the use of CMR.
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Affiliation(s)
| | | | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, UK
- Bristol National Institute of Health Research (NIHR) Biomedical , Research Centre, Bristol, UK
- University Hospitals Bristol, Bristol, UK
- University of Bristol, Bristol, UK
| | - James Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- Medical College of Wisconsin, Wisconsin, USA
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
- Kapodistrian University of Athens, Athens, Greece
| | - Ntobeko Ntusi
- University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R., Pisa, Italy
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University, Indianapolis, USA
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Mie, Japan
| | - Jeanette Schulz-Menger
- harite Hospital, University of Berlin, Berlin, Germany
- HELIOS-Clinics Berlin-Buch, Berlin, Germany
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42
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Riffel JH, Siry D, Salatzki J, Andre F, Ochs M, Weberling LD, Giannitsis E, Katus HA, Friedrich MG. Feasibility of fast cardiovascular magnetic resonance strain imaging in patients presenting with acute chest pain. PLoS One 2021; 16:e0251040. [PMID: 33939756 PMCID: PMC8092784 DOI: 10.1371/journal.pone.0251040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/18/2021] [Indexed: 01/23/2023] Open
Abstract
Background Cardiovascular magnetic resonance (CMR) is the current reference standard for the quantitative assessment of ventricular function. Fast Strain-ENCoded (fSENC)-CMR imaging allows for the assessment of myocardial deformation within a single heartbeat. The aim of this pilot study was to identify obstructive coronary artery disease (oCAD) with fSENC-CMR in patients presenting with new onset of chest pain. Methods and results In 108 patients presenting with acute chest pain, we performed fSENC-CMR after initial clinical assessment in the emergency department. The final clinical diagnosis, for which cardiology-trained physicians used clinical information, serial high-sensitive Troponin T (hscTnT) values and—if necessary—further diagnostic tests, served as the standard of truth. oCAD was defined as flow-limiting CAD as confirmed by coronary angiography with typical angina or hscTnT dynamics. Diagnoses were divided into three groups: 0: non-cardiac, 1: oCAD, 2: cardiac, non-oCAD. The visual analysis of fSENC bull´s eye maps (blinded to final diagnosis) resulted in a sensitivity of 82% and specificity of 87%, as well as a negative predictive value of 96% for identification of oCAD. Both, global circumferential strain (GCS) and global longitudinal strain (GLS) accurately identified oCAD (area under the curve/AUC: GCS 0.867; GLS 0.874; p<0.0001 for both), outperforming ECG, hscTnT dynamics and EF. Furthermore, the fSENC analysis on a segmental basis revealed that the number of segments with impaired strain was significantly associated with the patient´s final diagnosis (p<0.05 for all comparisons). Conclusion In patients with acute chest pain, myocardial strain imaging with fSENC-CMR may serve as a fast and accurate diagnostic tool for ruling out obstructive coronary artery disease.
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Affiliation(s)
- Johannes H. Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Deborah Siry
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Florian Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Berlin, Germany
| | - Marco Ochs
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Lukas D. Weberling
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Berlin, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Berlin, Germany
| | - Matthias G. Friedrich
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Berlin, Germany
- Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec, Canada
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Myocardial Extracellular Volume Quantification Using Cardiac Computed Tomography: A Comparison of the Dual-energy Iodine Method and the Standard Subtraction Method. Acad Radiol 2021; 28:e119-e126. [PMID: 32402786 DOI: 10.1016/j.acra.2020.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To clarify the accuracy of two measurement methods for myocardial extracellular volume (ECV) quantification (ie, the standard subtraction method [ECVsub] and the dual-energy iodine method [ECViodine]) with the use of cardiac CT in comparison to cardiac magnetic resonance imaging (CMR) as a reference standard. MATERIALS AND METHODS Equilibrium phase cardiac images of 21 patients were acquired with a dual-layer spectral detector CT and CMR, and the images were retrospectively analyzed. CT-ECV was calculated using ECVsub and ECViodine. The correlation between the ECV values measured by each method was assessed. Bland-Altman analysis was used to identify systematic errors and to determine the limits of agreement between the CT-ECV and CMR-ECV values. Root mean squared errors and residual values for the ECVsub and ECViodine were also assessed. RESULTS The correlations between ECVsub and ECViodine for both septal and global measurement were r = 0.95 (p < 0.01) and 0.91 (p < 0.01), respectively, while those between the mean ECVsub and CMR-ECV were r = 0.90 (septal, p < 0.01) and 0.84 (global, p < 0.01), and those between ECViodine and CMR-ECV were r = 0.94 (septal, p < 0.01) and 0.95 (global, p < 0.01). Bland-Altman plots showed lower 95% limits of agreement between ECViodine and CMR-ECV compared with that between ECVsub and CMR-ECV in both septal and global measurement. The root mean squared error of ECVsub was higher than that of ECViodine. The mean residual value of ECVsub was significantly higher than that of ECViodine. CONCLUSION ECViodine yielded more accurate myocardial ECV quantification than ECVsub, and provided a comparable ECV value to that obtained by CMR.
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Cha MJ, Cho I, Hong J, Kim SW, Shin SY, Paek MY, Bi X, Kim SM. Free-Breathing Motion-Corrected Single-Shot Phase-Sensitive Inversion Recovery Late-Gadolinium-Enhancement Imaging: A Prospective Study of Image Quality in Patients with Hypertrophic Cardiomyopathy. Korean J Radiol 2021; 22:1044-1053. [PMID: 33856138 PMCID: PMC8236358 DOI: 10.3348/kjr.2020.1296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Motion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM). Materials and Methods Between April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing moco-ss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test. Results The moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785). Conclusion Motion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Wook Kim
- Division of Cardiology, Department of Internal medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Yong Shin
- Division of Cardiology, Department of Internal medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Xiaoming Bi
- Siemens Medical Solutions USA, Inc., Los Angeles, CA, USA
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
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45
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Markousis-Mavrogenis G, Sfikakis PP, Koutsogeorgopoulou L, Dimitroulas T, Katsifis G, Giannakopoulou A, Voulgari P, Kolovou G, Kitas GD, Mavrogeni SI. Cardiovascular Magnetic Resonance Reveals Cardiac Pathophysiology in Autoimmune Rheumatic Diseases. Mediterr J Rheumatol 2021; 32:15-20. [PMID: 34386698 PMCID: PMC8314875 DOI: 10.31138/mjr.32.1.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/26/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background/Aims The high incidence of cardiovascular disease (CVD) in patients with autoimmune rheumatic diseases (ARDs) is the main driver towards increased mortality in this patient group. Cardiovascular magnetic resonance (CMR) can non-invasively and robustly detect CVD in ARD patients at an early stage of development. The review summarises the diagnostic information provided by CMR in ARD patients. Summary CMR uses a strong magnetic field combined with radio-frequency pulses (pulse sequences) to generate images. Firstly, balanced steady-state free precession (bSSFP) can be used for evaluating cardiac anatomy, mass, wall motion, atrial/ventricular function. Secondly, T2-weighted imaging (T2-W) can be used for oedema detection, which appears as a high signal intensity area on STIR (short tau inversion recovery) images. T2 mapping is a newer T2-W technique that can provide more optimal identification of myocardial oedema. Lastly, late gadolinium enhanced (LGE) T1-W images, taken 15 min. after injection of contrast agent, allow the detection of myocardial replacement fibrosis, which appears as a bright area in a background of black myocardium. However, LGE has inherent disadvantages for the assessment of diffuse myocardial fibrosis. Therefore, T1 mapping and extracellular volume fraction (ECV) have been developed to quantify diffuse myocardial fibrosis. Results Although multicentre studies are still missing, the CMR parameters have been extensively applied for the identification of oedema/fibrosis and treatment decision making in ARDs. Conclusions Tissue characterisation with CMR allows early and robust identification of CVD in ARD patients and contributes to personalized management in the patients.
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Affiliation(s)
| | - Petros P Sfikakis
- Joint Rheumatology, Laikon Hospital, Athens, Greece.,Department of Pathophysiology, Laikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Loukia Koutsogeorgopoulou
- Department of Pathophysiology, Laikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Dimitroulas
- Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | - George D Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, United Kingdom
| | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece.,Department of Pathophysiology, Laikon Hospital, National Kapodistrian University of Athens, Athens, Greece
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Mills MT, Grafton-Clarke C, Williams G, Gosling RC, Al Baraikan A, Kyriacou AL, Morris PD, Gunn JP, Swoboda PP, Levelt E, Tsampasian V, van der Geest RJ, Swift AJ, Greenwood JP, Plein S, Vassiliou V, Garg P. Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation. Wellcome Open Res 2021; 6:73. [PMID: 34095509 PMCID: PMC8150120 DOI: 10.12688/wellcomeopenres.16655.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/12/2023] Open
Abstract
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (-4.8, 95% CI -15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI -4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Gareth Williams
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca C Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al Baraikan
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas L Kyriacou
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Vass Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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47
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Vietheer JM, Hamm CW, Rolf A. [Current role of cardiac magnetic resonance (CMR) in diagnosis and therapy of myocardial diseases]. Dtsch Med Wochenschr 2021; 146:461-465. [PMID: 33780992 DOI: 10.1055/a-1218-8972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiac magnetic resonance is the only imaging modality, that allows for characterising myocardial tissue with respect to fibrosis and edema. It has therefore become gold standard in diagnosing myocardial inflammation by combining scar, fibrosis and edema imaging. Recent developements in T1- and T2 mapping have improved diagnostic accuracy and prognostic information.
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48
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Potential Role of Artificial Intelligence in Cardiac Magnetic Resonance Imaging: Can It Help Clinicians in Making a Diagnosis? J Thorac Imaging 2021; 36:142-148. [PMID: 33769416 DOI: 10.1097/rti.0000000000000584] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the era of modern medicine, artificial intelligence (AI) is a growing field of interest which is experiencing a steady development. Several applications of AI have been applied to various aspects of cardiac magnetic resonance to assist clinicians and engineers in reducing the costs of exams and, at the same time, to improve image acquisition and reconstruction, thus simplifying their analysis, interpretation, and decision-making process as well. In fact, the role of AI and machine learning in cardiovascular imaging relies on evaluating images more quickly, improving their quality, nulling intraobserver and interobserver variability in their interpretation, upgrading the understanding of the stage of the disease, and providing with a personalized approach to cardiovascular care. In addition, AI algorithm could be directed toward workflow management. This article presents an overview of the existing AI literature in cardiac magnetic resonance, with its strengths and limitations, recent applications, and promising developments. We conclude that AI is very likely be used in all the various process of diagnosis routine mode for cardiac care of patients.
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49
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Saunderson CED, Plein S, Manisty CH. Role of cardiovascular magnetic resonance imaging in cardio-oncology. Eur Heart J Cardiovasc Imaging 2021; 22:383-396. [PMID: 33404058 DOI: 10.1093/ehjci/jeaa345] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Advances in cancer therapy have led to significantly longer cancer-free survival times over the last 40 years. Improved survivorship coupled with increasing recognition of an expanding range of adverse cardiovascular effects of many established and novel cancer therapies has highlighted the impact of cardiovascular disease in this population. This has led to the emergence of dedicated cardio-oncology services that can provide pre-treatment risk stratification, surveillance, diagnosis, and monitoring of cardiotoxicity during cancer therapies, and late effects screening following completion of treatment. Cardiovascular imaging and the development of imaging biomarkers that can accurately and reliably detect pre-clinical disease and enhance our understanding of the underlying pathophysiology of cancer treatment-related cardiotoxicity are becoming increasingly important. Multi-parametric cardiovascular magnetic resonance (CMR) is able to assess cardiac structure, function, and provide myocardial tissue characterization, and hence can be used to address a variety of important clinical questions in the emerging field of cardio-oncology. In this review, we discuss the current and potential future applications of CMR in the investigation and management of cancer patients.
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Affiliation(s)
- Christopher E D Saunderson
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Charlotte H Manisty
- Department of Cardio-Oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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50
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Affiliation(s)
- Florian von Knobelsdorff
- Praxis für Herz- und Gefäßmedizin, KIZ – Kardiologie im Zentrum, Eisenmannstr. 4, 80331 München, Deutschland
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