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Song W, Zhang N, Lv T, Zhao Y, Li G, Tse G, Liu T. Prognostic value of cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis: A systematic review and meta-analysis. CANCER INNOVATION 2024; 3:e109. [PMID: 38947756 PMCID: PMC11212299 DOI: 10.1002/cai2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 07/02/2024]
Abstract
Background Immune checkpoint inhibitors (ICI) are increasingly used in the first-line treatment of malignant tumors. There is increasing recognition of their cardiotoxicity and, in particular, their potential to lead to myocarditis. Cardiovascular magnetic resonance (CMR) can quantify pathological changes, such as myocardial edema and fibrosis. The purpose of this systematic review and meta-analysis was to examine the evidence for the roles of CMR in predicting prognosis in ICI-associated myocarditis. Methods PubMed, Cochrane Library, and Web of Science databases were searched until October 2023 for published works investigating the relationship between CMR parameters and adverse events in patients with ICI-associated myocarditis. The analysis included studies reporting the incidence of late gadolinium enhancement (LGE), T1 values, T2 values, and CMR-derived left ventricular ejection fraction (LVEF). Odds ratios (OR) and weighted mean differences (WMD) were combined for binary and continuous data, respectively. Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Results Five cohort studies were included (average age 65-68 years; 25.4% female). Of these, four studies were included in the meta-analysis of LGE-related findings. Patients with major adverse cardiovascular events (MACE) had a higher incidence of LGE compared with patients without MACE (OR = 4.18, 95% CI: 1.72-10.19, p = 0.002). A meta-analysis, incorporating data from two studies, showed that patients who developed MACE exhibited significantly higher T1 value (WMD = 36.16 ms, 95% CI: 21.43-50.89, p < 0.001) and lower LVEF (WMD = - 8.00%, 95% CI: -13.60 to -2.40, p = 0.005). Notably, T2 value (WMD = -0.23 ms, 95% CI: -1.86 to -1.39, p = 0.779) was not associated with MACE in patients with ICI-related myocarditis. Conclusions LGE, T1 value, and LVEF measured by CMR imaging have potential prognostic value for long-term adverse events in patients with ICI-related myocarditis.
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Affiliation(s)
- Wenhua Song
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Tonglian Lv
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Yang Zhao
- Department of RadiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
- Cardiac Electrophysiology UnitCardiovascular Analytics Group, PowerHealth LimitedHong KongChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
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Tian Y, Wang T, Tian L, Yang Y, Xue C, Sheng W, Wang C. Early detection and serial monitoring during chemotherapy-radiation therapy: Using T1 and T2 mapping cardiac magnetic resonance imaging. Front Cardiovasc Med 2023; 10:1085737. [PMID: 37063950 PMCID: PMC10090395 DOI: 10.3389/fcvm.2023.1085737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
PurposeTo confirm the ability of native T1 and T2 values in detecting and monitoring early myocardial injuries of chest radiotherapy in neoplasm patients.Materials and methodsFifteen participants received non-anthracycline chemotherapy and chest radiotherapy, and 30 age/gender-matched controls were enrolled in this prospective study. Cardiac magnetic resonance scans were performed within 2 days, 3 months, and 6 months after chest radiotherapy. Myocardial native T1 and T2 values were measured in irradiated and nonirradiated areas. Meanwhile, the parameters of left ventricular function and left ventricular myocardial strain were obtained.ResultsThere were no significant differences in left ventricular function, native T1, T2, and strain between patients and controls before chest radiotherapy. In 15 participants who were followed up for 6 months, there was a significant change only in left ventricular ejection fraction (LVEF) among baseline and the first follow-up (P = 0.021), while the adjusted P-value was higher than 0.05 after Bonferroni correction, as well as other parameters. Native T1 values were elevated at 3 and 6 months in irradiated areas compared with baseline (1,288.72 ± 66.59 ms vs. 1,212.51 ± 45.41 ms; 1,348.01 ± 54.16 ms vs. 1,212.51 ± 45.41 ms; P < 0.001 for both). However, T2 values only changed at 3 months in irradiated areas compared with baseline (44.21 ± 3.35 ms vs. 39.14 ± 1.44 ms; P = 0.006). Neither the native T1 nor T2 values changed in nonirradiated areas during the follow-up period (all P > 0.05). There were no significant differences in strain changes during the follow-up period (all P > 0.05).ConclusionNative T1 and T2 values elevated at 3 months after chest radiotherapy, whereas LVEF showed no significant change during the 6-month follow-up.
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Affiliation(s)
- Yaotian Tian
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Teng Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Liwen Tian
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yucheng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chen Xue
- Department of Radiology, Shandong Provincial Hospital, Binzhou Medical University, Jinan, China
| | - Wei Sheng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Cuiyan Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Correspondence: Cuiyan Wang
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Emerging Role of Cardiac Magnetic Resonance Imaging in Diagnosing Myocarditis: A Blunder or The Way To Get the Problem Sorted? J Thorac Imaging 2022; 37:W12-W27. [PMID: 35191862 DOI: 10.1097/rti.0000000000000634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute myocarditis is a disease affecting the myocardial tissue, which is caused by infections, rheumatic diseases, especially sarcoidosis, or certain therapies. Its diagnosis may be difficult, owing to its variable clinical presentation. In this setting, cardiac magnetic resonance plays a pivotal role in detecting myocardial inflammation through qualitative, semiquantitative, and quantitative parameters, in particular with the new quantitative techniques such as T1 and T2 mapping, combined or not with late gadolinium enhancement evaluation. This is in accordance with the revised Lake Louise criteria. In this review, the emerging role of the new cutting-edge cardiac magnetic resonance imaging techniques in diagnosing myocarditis is extensively presented.
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Faron A, Isaak A, Mesropyan N, Reinert M, Schwab K, Sirokay J, Sprinkart AM, Bauernfeind FG, Dabir D, Pieper CC, Heine A, Kuetting D, Attenberger U, Landsberg J, Luetkens JA. Cardiac MRI Depicts Immune Checkpoint Inhibitor-induced Myocarditis: A Prospective Study. Radiology 2021; 301:602-609. [PMID: 34581628 DOI: 10.1148/radiol.2021210814] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) for cancer treatment are associated with a spectrum of immune-related adverse events, including ICI-induced myocarditis; however, the extent of subclinical acute cardiac effects related to ICI treatment is unclear. Purpose To explore the extent of cardiac injury and inflammation related to ICI therapy that can be detected with use of cardiac MRI. Materials and Methods In this prospective study from November 2019 to April 2021, oncologic participants, without known underlying structural heart disease or cardiac symptoms, underwent multiparametric cardiac MRI before planned ICI therapy (baseline) and 3 months after starting ICI therapy (follow-up). The cardiac MRI protocol incorporated assessment of cardiac function, including systolic myocardial strain, myocardial edema, late gadolinium enhancement (LGE), T1 and T2 relaxation times, and extracellular volume fraction. The paired t test, Wilcoxon signed-rank test, and McNemar test were used for intraindividual comparisons. Results Twenty-two participants (mean age ± standard deviation, 65 years ± 14; 13 men) were evaluated, receiving a median of four infusions of ICI therapy (interquartile range, four to six infusions). Compared with baseline MRI, participants displayed increased markers of diffuse myocardial edema at follow-up (T1 relaxation time, 972 msec ± 26 vs 1006 msec ± 36 [P < .001]; T2 relaxation time, 54 msec ± 3 vs 58 msec ± 4 [P < .001]; T2 signal intensity ratio, 1.5 ± 0.3 vs 1.7 ± 0.3 [P = .03]). Left ventricular average systolic longitudinal strain had decreased at follow-up MRI (-23.4% ± 4.8 vs -19.6% ± 5.1, respectively; P = .005). New nonischemic LGE lesions were prevalent in two of 22 participants (9%). Compared with baseline, small pericardial effusions were more evident at follow-up (one of 22 participants [5%] vs 10 of 22 [45%]; P = .004). Conclusion In participants who received immune checkpoint inhibitor therapy for cancer treatment, follow-up cardiac MRI scans showed signs of systolic dysfunction and increased parameters of myocardial edema and inflammation. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Anton Faron
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Matthäus Reinert
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Katjana Schwab
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Judith Sirokay
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alois M Sprinkart
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franz-Georg Bauernfeind
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Darius Dabir
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C Pieper
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Annkristin Heine
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jennifer Landsberg
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- From the Department of Diagnostic and Interventional Radiology (A.F., A.I., N.M., M.R., A.M.S., D.D., C.C.P., D.K., U.A., J.A.L.), Quantitative Imaging Laboratory Bonn (QILaB) (A.F., A.I., N.M., A.M.S., D.K., J.A.L.), Department of Oncology, Hematology, and Rheumatology (K.S., F.G.B., A.H.), and Department of Dermatology and Allergology (J.S., J.L.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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5
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Barcena ML, Jeuthe S, Niehues MH, Pozdniakova S, Haritonow N, Kühl AA, Messroghli DR, Regitz-Zagrosek V. Sex-Specific Differences of the Inflammatory State in Experimental Autoimmune Myocarditis. Front Immunol 2021; 12:686384. [PMID: 34122450 PMCID: PMC8195335 DOI: 10.3389/fimmu.2021.686384] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022] Open
Abstract
Increasing evidence suggests male sex as a potential risk factor for a higher incidence of cardiac fibrosis, stronger cardiac inflammation, and dilated cardiomyopathy (DCM) in human myocarditis. Chronic activation of the immune response in myocarditis may trigger autoimmunity. The experimental autoimmune myocarditis (EAM) model has been well established for the study of autoimmune myocarditis, however the role of sex in this pathology has not been fully explored. In this study, we investigated sex differences in the inflammatory response in the EAM model. We analyzed the cardiac function, as well as the inflammatory stage and fibrosis formation in the heart of EAM male and female rats. 21 days after induction of EAM, male EAM rats showed a decreased ejection fraction, stroke volume and cardiac output, while females did not. A significantly elevated number of infiltrates was detected in myocardium in both sexes, indicating the activation of macrophages following EAM induction. The level of anti-inflammatory macrophages (CD68+ ArgI+) was only significantly increased in female hearts. The expression of Col3A1 and fibrosis formation were more prominent in males. Furthermore, prominent pro-inflammatory factors were increased only in male rats. These findings indicate sex-specific alterations in the inflammatory stage of EAM, with a pro-inflammatory phenotype appearing in males and an anti-inflammatory phenotype in females, which both significantly affect cardiac function in autoimmune myocarditis.
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Affiliation(s)
- Maria Luisa Barcena
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany
| | - Sarah Jeuthe
- DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany.,Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maximilian H Niehues
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sofya Pozdniakova
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Natalie Haritonow
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja A Kühl
- iPATH Berlin-Immunopathology for Experimental Models, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany.,Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Cardiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
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6
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Thavendiranathan P, Zhang L, Zafar A, Drobni ZD, Mahmood SS, Cabral M, Awadalla M, Nohria A, Zlotoff DA, Thuny F, Heinzerling LM, Barac A, Sullivan RJ, Chen CL, Gupta D, Kirchberger MC, Hartmann SE, Weinsaft JW, Gilman HK, Rizvi MA, Kovacina B, Michel C, Sahni G, González-Mansilla A, Calles A, Fernández-Avilés F, Mahmoudi M, Reynolds KL, Ganatra S, Gavira JJ, González NS, García de Yébenes Castro M, Kwong RY, Jerosch-Herold M, Coelho-Filho OR, Afilalo J, Zataraín-Nicolás E, Baksi AJ, Wintersperger BJ, Calvillo-Arguelles O, Ederhy S, Yang EH, Lyon AR, Fradley MG, Neilan TG. Myocardial T1 and T2 Mapping by Magnetic Resonance in Patients With Immune Checkpoint Inhibitor-Associated Myocarditis. J Am Coll Cardiol 2021; 77:1503-1516. [PMID: 33766256 DOI: 10.1016/j.jacc.2021.01.050] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Myocarditis is a potentially fatal complication of immune checkpoint inhibitor (ICI) therapy. Data on the utility of cardiovascular magnetic resonance (CMR) T1 and T2 mapping in ICI myocarditis are limited. OBJECTIVES This study sought to assess the value of CMR T1 and T2 mapping in patients with ICI myocarditis. METHODS In this retrospective study from an international registry of patients with ICI myocarditis, clinical and CMR findings (including T1 and T2 maps) were collected. Abnormal T1 and T2 were defined as 2 SD above site (vendor/field strength specific) reference values and a z-score was calculated for each patient. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. RESULTS Of 136 patients with ICI myocarditis with a CMR, 86 (63%) had T1 maps and 79 (58%) also had T2 maps. Among the 86 patients (66.3 ± 13.1 years of age), 36 (41.9%) had a left ventricular ejection fraction <55%. Across all patients, mean z-scores for T1 and T2 values were 2.9 ± 1.9 (p < 0.001) and 2.2 ± 2.1 (p < 0.001), respectively. On Siemens 1.5-T scanner (n = 67), native T1 (1,079.0 ± 55.5 ms vs. 1,000.3 ± 22.1 ms; p < 0.001) and T2 (56.2 ± 4.9 ms vs. 49.8 ± 2.2 ms; p < 0.001) values were elevated compared with reference values. Abnormal T1 and T2 values were seen in 78% and 43% of the patients, respectively. Applying the modified Lake Louise Criteria, 95% met the nonischemic myocardial injury criteria and 53% met the myocardial edema criteria. Native T1 values had excellent discriminatory value for subsequent MACE, with an area under the curve of 0.91 (95% confidence interval: 0.84 to 0.98). Native T1 values (for every 1-unit increase in z-score, hazard ratio: 1.44; 95% confidence interval: 1.12 to 1.84; p = 0.004) but not T2 values were independently associated with subsequent MACE. CONCLUSIONS The use of T1 mapping and application of the modified Lake Louise Criteria provides important diagnostic value, and T1 mapping provides prognostic value in patients with ICI myocarditis.
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Affiliation(s)
- Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Lili Zhang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amna Zafar
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zsofia D Drobni
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Syed S Mahmood
- Cardiology Division, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Marcella Cabral
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Magid Awadalla
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel A Zlotoff
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franck Thuny
- University Mediterranean Center of Cardio-Oncology, Nord Hospital, Aix-Marseille University, Marseille, France; Groupe Méditerranéen de Cardio-Oncologie, Marseille, France; Center for CardioVascular and Nutrition Research, INRA 1260, INSERM 1263, Aix-Marseille University, Marseille, France
| | - Lucie M Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ana Barac
- Cardio-Oncology Program, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Ryan J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carol L Chen
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Dipti Gupta
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah E Hartmann
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan W Weinsaft
- Cardiology Division, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA; Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York, USA
| | - Hannah K Gilman
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Muhammad A Rizvi
- Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA
| | - Bojan Kovacina
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Caroline Michel
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gagan Sahni
- Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
| | - Ana González-Mansilla
- Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Calles
- Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Fernández-Avilés
- Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Michael Mahmoudi
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kerry L Reynolds
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Juan José Gavira
- Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain
| | - Nahikari Salterain González
- Cardio-Oncology Program, Department of Cardiology, Clínica Universidad de Navarra, Pamplona and Madrid, Spain
| | | | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Jonathan Afilalo
- Department of Cardiology or Diagnostic Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Eduardo Zataraín-Nicolás
- Hospital General Universitario Gregorio Marañón, CIBERCV, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - A John Baksi
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Bernd J Wintersperger
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Oscar Calvillo-Arguelles
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephane Ederhy
- Cardio-Oncology Program, Division of Cardiology, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alexander R Lyon
- Cardio-Oncology Program, Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tomas G Neilan
- Cardiovascular Imaging Research Center, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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7
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Zhu J, Chen Y, Xu Z, Wang S, Wang L, Liu X, Gao F. Non-invasive assessment of early and acute myocarditis in a rat model using cardiac magnetic resonance tissue tracking analysis of myocardial strain. Quant Imaging Med Surg 2020; 10:2157-2167. [PMID: 33139995 DOI: 10.21037/qims-20-122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Myocardial strain analysis can provide diagnostic and prognostic information for myocarditis. The aim of the present study was to assess early and acute myocarditis in a rat model using cardiac magnetic resonance tissue tracking (CMR-TT) for myocardial strain analysis. We compared the strain's findings with the histological and immunohistochemical results. Methods Experimental autoimmune myocarditis (EAM) was induced by footpad injections of porcine cardiac myosin. The rats were examined by 7.0T preclinical CMR at day 14 (n=15) and day 21 (n=16) after EAM induction and the two control groups (each n=15) were also examined at day 14 and day 21, respectively. Using CMR-TT, we found a global peak systolic radial strain (ErrSAX) and a circumferential strain (EccSAX) from the short-axis cine views and a radial strain (ErrLAX) and a longitudinal strain (EllLAX) from the long-axis cine views, which were calculated by dedicated TT software. Subsequently, histological and immunohistochemical evaluations were performed. Results EllLAX significantly decreased in early myocarditis compared with the control (-23.40%±1.48% vs. -22.02%±0.81%, P<0.05). ErrSAX, EccSAX, ErrLAX, and EllLAX values significantly reduced in acute myocarditis compared with the controls (ErrSAX: 34.27%±9.80% vs. 49.76%±4.97%, EccSAX: -18.98%±3.69% vs. -24.13±1.23, ErrLAX: 33.21%±10.24% vs. 49.59%±5.69%, and EllLAX: -17.75%±3.58% vs. -23.39%±1.48%; P<0.001, respectively). The receiver operating characteristic curve showed that myocardial strain analysis had a good diagnostic performance in early and acute myocarditis. The pathological evaluation revealed that inflammatory lesions began to appear in early myocarditis and peaked in acute myocarditis. Conclusions The CMR-TT strain analysis allowed accurate and reliable evaluation of early and acute myocarditis in a rat model, and has the potential to serve as a diagnostic indicator for the assessment of myocardial dysfunction in myocarditis.
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Affiliation(s)
- Jing Zhu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yushu Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shiyu Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxin Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fabao Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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8
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Estimation of total collagen volume: a T1 mapping versus histological comparison study in healthy Landrace pigs. Int J Cardiovasc Imaging 2020; 36:1761-1769. [PMID: 32409978 PMCID: PMC7438377 DOI: 10.1007/s10554-020-01881-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
Right ventricular biopsy represents the gold standard for the assessment of myocardial fibrosis and collagen content. This invasive technique, however, is accompanied by perioperative complications and poor reproducibility. Extracellular volume (ECV) measured through cardiovascular magnetic resonance (CMR) has emerged as a valid surrogate method to assess fibrosis non-invasively. Nonetheless, ECV provides an overestimation of collagen concentration since it also considers interstitial space. Our study aims to investigate the feasibility of estimating total collagen volume (TCV) through CMR by comparing it with the TCV measured at histology. Seven healthy Landrace pigs were acutely instrumented closed-chest and transported to the MRI facility for measurements. For each protocol, CMR imaging at 3T was acquired. MEDIS software was used to analyze T1 mapping and ECV for both the left ventricular myocardium (LVmyo) and left ventricular septum (LVseptum). ECV was then used to estimate TCVCMR at LVmyo and LVseptum following previously published formulas. Tissues were prepared following an established protocol and stained with picrosirius red to analyze the TCVhisto in LVmyo and LVseptum. TCV measured at LVmyo and LVseptum with both histology (8 ± 5 ml and 7 ± 3 ml, respectively) and T1-Mapping (9 ± 5 ml and 8 ± 6 ml, respectively) did not show any regional differences. TCVhisto and TCVCMR showed a good level of data agreement by Bland–Altman analysis. Estimation of TCV through CMR may be a promising way to non-invasively assess myocardial collagen content and may be useful to track disease progression or treatment response.
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9
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Shao J, Zhou Z, Nguyen KL, Finn JP, Hu P. Accurate, precise, simultaneous myocardial T1 and T2 mapping using a radial sequence with inversion recovery and T2 preparation. NMR IN BIOMEDICINE 2019; 32:e4165. [PMID: 31461194 PMCID: PMC6817390 DOI: 10.1002/nbm.4165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 05/02/2023]
Abstract
We propose a simultaneous myocardial T1 and T2 mapping technique using a radial sequence with inversion recovery and T2 preparation, which achieves high accuracy and precision, with T1 and T2 reproducibility similar to the Modified Look-Locker Inversion recovery (MOLLI) sequence and the conventional bright blood T2 mapping technique, respectively. The sequence was developed by incorporating gold angle radial fast low angle shot (FLASH) readout combined with an inversion pulse and T2prep pulses. The extended Bloch equation simulation with slice profile correction (BLESSPC) algorithm was proposed to reconstruct T1 and T2 maps at the same time in a few seconds, while maintaining good T1 and T2 estimation accuracy. Accuracy and precision were compared among the proposed technique, MOLLI and conventional T2 mapping techniques using phantom studies, 10 healthy volunteers and three patients. In phantom studies, the proposed technique was more accurate than MOLLI (P < 0.05) while achieving similar precision (P = 0.3) in T1 estimation, and was more accurate (P < 0.05) and precise (P < 0.001) than conventional T2 mapping (two-parameter fitting) in T2 estimation. In vivo, the proposed technique achieved significantly higher T1 values (P < 0.001) and similar reproducibility (P = 0.3) compared with MOLLI, with significantly lower T2 values (P < 0.001) and similar reproducibility (P = 0.6) compared with the conventional T2 mapping technique. Thus, the proposed radial T1-T2 mapping technique allows for accurate, precise, simultaneous myocardial T1 and T2 mapping in an 11-heartbeat single breath-hold acquisition.
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Affiliation(s)
- Jiaxin Shao
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ziwu Zhou
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - J. Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, CA, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, CA, USA
- Correspondence to: Peng Hu, PhD, Department of Radiological Sciences, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095,
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10
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Gannon MP, Schaub E, Grines CL, Saba SG. State of the art: Evaluation and prognostication of myocarditis using cardiac MRI. J Magn Reson Imaging 2019; 49:e122-e131. [DOI: 10.1002/jmri.26611] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Michael P. Gannon
- National Heart, Lung, and Blood InstituteNational Institutes of Health Bethesda Maryland USA
| | - Ebe Schaub
- University of Heidelberg Heidelberg Germany
| | - Cindy L. Grines
- Department of CardiologyBarbara and Donald Zucker School of Medicine at Hofstra Northwell Manhasset New York USA
| | - Shahryar G. Saba
- Department of CardiologyBarbara and Donald Zucker School of Medicine at Hofstra Northwell Manhasset New York USA
- Department of RadiologyBarbara and Donald Zucker School of Medicine at Hofstra Northwell Manhasset New York USA
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11
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Manning WJ. Journal of Cardiovascular Magnetic Resonance 2017. J Cardiovasc Magn Reson 2018; 20:89. [PMID: 30593280 PMCID: PMC6309095 DOI: 10.1186/s12968-018-0518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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12
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Bohnen S, Radunski UK, Lund GK, Ojeda F, Looft Y, Senel M, Radziwolek L, Avanesov M, Tahir E, Stehning C, Schnackenburg B, Adam G, Blankenberg S, Muellerleile K. Tissue characterization by T1 and T2 mapping cardiovascular magnetic resonance imaging to monitor myocardial inflammation in healing myocarditis. Eur Heart J Cardiovasc Imaging 2018; 18:744-751. [PMID: 28329275 DOI: 10.1093/ehjci/jex007] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/16/2017] [Indexed: 12/18/2022] Open
Abstract
Aims Monitoring disease activity in myocarditis is important for tailored therapeutic strategies. This study evaluated the ability of T1 and T2 mapping cardiovascular magnetic resonance (CMR) to monitor the course of myocardial inflammation in healing myocarditis. Methods and Results Forty-eight patients with strictly defined acute myocarditis underwent CMR at 1.5 T in the acute stage, at 3-months (n = 39), and at 12-months follow-up (FU) (n = 21). Normal values were obtained in a control group of 27 healthy subjects. The CMR protocol included standard ('Lake-Louise') sequences as well as T1 (modified Look-Locker inversion recovery sequence, MOLLI) and T2 (gradient- and spin-echo sequence, GraSE) mapping. T1, T2, and extracellular volume (ECV) maps were generated using an OsiriX plug-in. Native myocardial T1, T2, and ECV values were increased in the acute stage, but declined with healing of myocarditis. The performances of global native T1 and T2 to differentiate acute from healed myocarditis stages were significantly better compared with all other global CMR parameters with AUCs of 0.85 (95% CI, 0.76-0.94) and 0.83 (95% CI, 0.73-0.93). Furthermore, regional native T1 and T2 in myocarditis lesions provided AUCs of 0.97 (95% CI, 0.93-1.02) and 0.93 (95% CI, 0.85-1.01), which were significantly superior to any other global or regional CMR parameter. Conclusion Healing of myocarditis can be monitored by native myocardial T1 and T2 measurements without the need for contrast media. Both native myocardial T1 and T2 provide an excellent performance for assessing the stage of myocarditis by CMR.
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Affiliation(s)
- S Bohnen
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - U K Radunski
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - G K Lund
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - F Ojeda
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Y Looft
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - M Senel
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - L Radziwolek
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - M Avanesov
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - E Tahir
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - C Stehning
- Philips GmbH Market DACH, Roentgenstr. 22, 22335 Hamburg
| | | | - G Adam
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg
| | - S Blankenberg
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - K Muellerleile
- Department of General and Interventional Cardiology, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, University Heart Center, Martinistrasse 52, 20246 Hamburg, Germany
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13
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Whitaker J, Tschabrunn CM, Jang J, Leshem E, O'Neill M, Manning WJ, Anter E, Nezafat R. Cardiac MR Characterization of left ventricular remodeling in a swine model of infarct followed by reperfusion. J Magn Reson Imaging 2018; 48:808-817. [PMID: 29522262 DOI: 10.1002/jmri.26005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/22/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) survivors are at risk of complications including heart failure and malignant arrhythmias. PURPOSE We undertook serial imaging of swine following MI with the aim of characterizing the longitudinal left ventricular (LV) remodeling in a translational model of ischemia-reperfusion-mediated MI. ANIMAL MODEL Eight Yorkshire swine underwent mid left anterior descending coronary artery balloon occlusion to create an ischemia-reperfusion experimental model of MI. FIELD STRENGTH/SEQUENCES 1.5T Philips Achieva scanner. Serial cardiac MRI was performed at 16, 33, and 62 days post-MI, including cine imaging, native and postcontrast T1 , T2 and dark-blood late gadolinium enhanced (DB-LGE) scar imaging. ASSESSMENT Regions of interest were selected on the parametric maps to assess native T1 and T2 in the infarct and in remote tissue. Volume of enhanced tissue, nonenhanced tissue, and gray zone were assessed from DB-LGE imaging. Volumes, cardiac function, and strain were calculated from cine imaging. STATISTICAL TESTS Parameters estimated at more than two timepoints were compared with a one-way repeated measures analysis of variance. Parametric mapping data were analyzed using a generalized linear mixed model corrected for multiple observations. A result was considered statistically significant at P < 0.05. RESULTS All animals developed anteroseptal akinesia and hyperenhancement on DB-LGE with a central core of nonenhancing tissue. Mean hyperenhancement volume did not change during the observation period, while the central core contracted from 2.2 ± 1.8 ml at 16 days to 0.08 ± 0.19 ml at 62 days (P = 0.008). Native T1 of ischemic myocardium increased from 1173 ± 93 msec at 16 days to 1309 ± 97 msec at 62 days (P < 0.001). Mean radial and circumferential strain rate magnitude in remote myocardium increased with time from the infarct (P < 0.05). DATE CONCLUSION In this swine model of MI, serial quantitative cardiac MR exams allow characterization of LV remodeling and scar formation. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- John Whitaker
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
| | - Cory M Tschabrunn
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jihye Jang
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eran Leshem
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College, London, UK
| | - Warren J Manning
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elad Anter
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Reza Nezafat
- Beth Israel Deaconess Medical Center (Cardiovascular Division) and Harvard Medical Schools, Boston, Massachusetts, USA, Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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14
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Shang Y, Zhang X, Zhou X, Greiser A, Zhou Z, Li D, Wang J. Blood T1* correction increases accuracy of extracellular volume measurements using 3T cardiovascular magnetic resonance: Comparison of T1 and T1* maps. Sci Rep 2018; 8:3361. [PMID: 29463828 PMCID: PMC5820253 DOI: 10.1038/s41598-018-21696-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
The goals were to compare the differences between ECVL (extracellular volume derived from myocardial T1 and blood T1), ECVc (combination of myocardial T1 and blood T1*), and ECVnL (derived from myocardium T1* and blood T1*), and to explore the diagnostic accuracy of these factors for discriminating between controls and patients. The Modified Look-Locker Inversion Recovery sequence was performed in 42 subjects to generate both T1 and T1* maps. Native and post-contrast T1 values for myocardium and blood pool were obtained, and ECVL, ECVc, and ECVnL were then calculated. The global ECVc values were smaller than the ECVL values (0.006, 2.11%, p < 0.001) and larger than the ECVnL values (0.06, 21.6%, p < 0.001) in all participants. The ECVc led to a 4–6% increase in the AUC value and a 24–32% reduction in the sample size to differentiate between the controls and other patients when compared with the ECVL. Blood T1* correction can improve the precision of blood T1 values and can consequently increase the accuracy of the extracellular volume fraction measurement. The ECVc can be used to improve diagnostic accuracy and reduce the sample size required for a clinical study.
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Affiliation(s)
- Yongning Shang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaochun Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthcare Ltd., Shanghai, China
| | | | - Zhengwei Zhou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
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15
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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von Knobelsdorff-Brenkenhoff F, Schüler J, Dogangüzel S, Dieringer MA, Rudolph A, Greiser A, Kellman P, Schulz-Menger J. Detection and Monitoring of Acute Myocarditis Applying Quantitative Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005242. [PMID: 28213448 DOI: 10.1161/circimaging.116.005242] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/15/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cardiovascular magnetic resonance based on the Lake Louise Criteria is used to make the diagnosis of acute myocarditis. Novel quantitative parametric mapping techniques promise to overcome some of its limitations. We aimed to evaluate quantitative cardiovascular magnetic resonance to detect and monitor acute myocarditis. METHODS AND RESULTS Eighteen patients with clinical diagnosis of acute myocarditis (25 years [23-38 years]; 78% males) were prospectively enrolled and repeatedly underwent cardiovascular magnetic resonance at 1.5 T seven days (5-10 days) after symptom onset (FU0), after 5 weeks (FU1), and after 6 months (FU2). Eighteen age- and sex-matched healthy subjects served as controls. Cardiovascular magnetic resonance included imaging of edema, hyperemia, necrosis, and fibrosis using semiquantitative T2-weighted spin echo, T2 mapping, and T1 mapping before and 3 and 10 minutes after gadobutrol administration. Extracellular volume for diffuse and late gadolinium enhancement for focal fibrosis were assessed. Compared with controls, patients had significantly higher global T2 times at FU0 (55.1 ms [53.3-57.2 ms] versus 50.2 ms [49.2-52.0 ms]; P<0.001) and at FU1 (52.0 ms [52.0-53.2 ms]; P=0.007), which normalized at FU2 (50.9 ms [49.6-53.3 ms]; P=0.323). Global native T1 times in patients were elevated acutely (1004 ms [988-1048 ms] versus 975 ms [957-1004 ms]; P=0.002) and remained elevated throughout the follow-up (FU1: 998 ms [990-1027 ms]; P=0.014; FU2: 1000 ms [972-1027 ms]; P=0.044). Global extracellular volume fraction was statistically not different between patients and controls (P=0.057). 77.8% (14/18) of patients had focal late gadolinium enhancement. T2 ratio was significantly elevated in patients with myocarditis at FU0 (2.2 [2.0-2.3] versus 1.6 [1.5-1.7]; P<0.001). The difference decreased during follow-up (FU1: 1.9 [1.7-1.9]; P=0.001 and FU2: 1.7 [1.7-1.8]; P=0.053). The diagnostic accuracy to discriminate between patients with acute myocarditis and healthy controls was 86% for T2>52 ms, 78% for native T1>981 ms, 74% for extracellular volume fraction >0.24, and 100% for T2 ratio >1.9. CONCLUSIONS Although both T2 and T1 mapping reliably detected acute myocarditis, only T2 mapping discriminated between acute and healed stages, underlining the incremental value of T2 mapping.
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Affiliation(s)
- Florian von Knobelsdorff-Brenkenhoff
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Johannes Schüler
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Serkan Dogangüzel
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Matthias A Dieringer
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Andre Rudolph
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Andreas Greiser
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Peter Kellman
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.)
| | - Jeanette Schulz-Menger
- From the 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; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Germany (F.v.K.-B., J.S., S.D., A.R., J.S.-M.); Clinic Agatharied, Department of Cardiology, Ludwig-Maximilians-University Munich, Hausham, Germany (F.v.K.-B.); Siemens Healthcare, Erlangen, Germany (M.A.D., A.G.); National Institute of Health, Bethesda, MD (P.K.); and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany (J.S.-M.).
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Mavrogeni SI, Schwitter J, Gargani L, Pepe A, Monti L, Allanore Y, Matucci-Cerinic M. Cardiovascular magnetic resonance in systemic sclerosis: "Pearls and pitfalls". Semin Arthritis Rheum 2017; 47:79-85. [PMID: 28522072 DOI: 10.1016/j.semarthrit.2017.03.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular dysfunction and excessive fibrosis, involving internal organs including the heart. The estimated prevalence of cardiac involvement in SSc is high and remains subclinical until the late stages. It is either primary, related to myocardial inflammation and fibrosis, or secondary, due to pulmonary arterial hypertension (SSc-PAH) or systemic hypertension, in those patients with renal involvement. Cardiovascular magnetic resonance (CMR) is a useful tool for the early assessment of cardiac involvement in SSc. It is the gold standard technique to assess ventricular volumes,ejection fraction, and in particular is very useful to reliably and non-invasively detect myocardial inflammation, early perfusion defects, and myocardial fibrosis. However, the CMR evaluation in SSc may be problematic, because of cardiac and respiratory artefacts, commonly found in these patients. Therefore, a high level of expertise is necessary for both acquisition and interpretation of CMR images in SSc.
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Affiliation(s)
- Sophie I Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, 50 Esperou St, 175-61, P. Faliro, Athens, Greece.
| | - Juerg Schwitter
- Cardiovascular Department, Cardiac MR Center of the CHUV, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland
| | - Luna Gargani
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R., Pisa, Italy
| | - Lorenzo Monti
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, AOUC, Florence, Italy
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Radunski UK, Bohnen S, Lund GK, Lindner D, Westermann D, Adam G, Blankenberg S, Muellerleile K. Advances in Quantitative Tissue Characterization in Myocarditis. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9398-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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