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Kuyama N, Takashio S, Oguni T, Yamamoto M, Hirakawa K, Ishii M, Hanatani S, Oda S, Matsuzawa Y, Usuku H, Yamamoto E, Hirai T, Ueda M, Tsujita K. Cardiac Biomarker Change at 1 Year After Tafamidis Treatment and Clinical Outcomes in Patients With Transthyretin Amyloid Cardiomyopathy. J Am Heart Assoc 2024; 13:e034518. [PMID: 38761073 PMCID: PMC11179818 DOI: 10.1161/jaha.124.034518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Although tafamidis treatment improves prognosis in patients with wild-type transthyretin amyloid cardiomyopathy, an optimal surrogate marker monitoring its therapeutic effect remains unclear. This study investigated the association between changes in cardiac biomarkers, high-sensitivity cardiac troponin T (hs-cTnT) and B-type natriuretic peptide (BNP) during the first year after tafamidis treatment and clinical outcomes. METHODS AND RESULTS In 101 patients with wild-type transthyretin amyloid cardiomyopathy receiving tafamidis at our institution, change in cardiac biomarkers from baseline to 1 year after tafamidis administration and its association with composite outcomes (composite of all-cause death and hospitalization attributable to heart failure) was assessed. During the follow-up period (median, 17 months), 16 (16%) patients experienced composite outcomes. The hs-cTnT level significantly decreased at 1 year after tafamidis treatment, unlike the BNP level. The frequencies of increased hs-cTnT and BNP levels were significantly higher in those with composite outcomes than in those without (44% versus 15%; P=0.01). Kaplan-Meier survival analysis showed that patients in whom both hs-cTnT and BNP levels increased at 1 year after tafamidis had a higher probability of composite outcomes compared with those with decreased hs-cTnT and BNP levels (log-rank P<0.01). Cox regression analysis identified increased hs-cTnT and BNP levels at 1 year after tafamidis administration as an independent predictor of higher cumulative risk of composite outcomes. CONCLUSIONS Deterioration in cardiac biomarkers during the first year after tafamidis treatment predicted a worse prognosis, suggesting the utility of serial assessment of cardiac biomarkers for monitoring the therapeutic response to tafamidis in patients with wild-type transthyretin amyloid cardiomyopathy.
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Affiliation(s)
- Naoto Kuyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Tetsuya Oguni
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Masahiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
- Department of Medical Information Science, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
- Faculty of Life Sciences, Center for Metabolic Regulation of Healthy Aging Kumamoto University Kumamoto Japan
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Li J, Zou L, Ma H, Zhao J, Wang C, Li J, Hu G, Yang H, Wang B, Xu D, Xia Y, Jiang Y, Jiang X, Li N. Interpretable machine learning based on CT-derived extracellular volume fraction to predict pathological grading of hepatocellular carcinoma. Abdom Radiol (NY) 2024:10.1007/s00261-024-04313-9. [PMID: 38703190 DOI: 10.1007/s00261-024-04313-9] [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: 02/07/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE To develop a non-invasive auxiliary assessment method based on CT-derived extracellular volume (ECV) to predict the pathological grading (PG) of hepatocellular carcinoma (HCC). METHODS The study retrospectively analyzed 238 patients who underwent HCC resection surgery between January 2013 and April 2023. Six machine learning algorithms were employed to construct predictive models for HCC PG: logistic regression, extreme gradient boosting, Light Gradient Boosting Machine (LightGBM), random forest, adaptive boosting, and Gaussian naive Bayes. Model performance was evaluated using receiver operating characteristic curve analysis, including area under the curve (AUC), sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and F1 score. Calibration plots were used for visual evaluation of model calibration. Clinical decision curve analysis was performed to assess potential clinical utility by calculating net benefit. RESULTS 166 patients from Hospital A were allocated to the training set, while 72 patients from Hospital B (constituting 30.25% of the total sample) were assigned to the test set. The model achieved an AUC of 1.000 (95%CI: 1.000-1.000) in the training set and 0.927 (95%CI: 0.837-0.999) in the validation set, respectively. Ultimately, the model achieved an AUC of 0.909 (95%CI: 0.837-0.980) in the test set, with an accuracy of 0.778, sensitivity of 0.906, specificity of 0.789, negative predictive value of 0.556, and F1 score of 0.908. CONCLUSION This study successfully developed and validated a non-invasive auxiliary assessment method based on CT-derived ECV to predict the HCC PG, providing important supplementary information for clinical decision-making.
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Affiliation(s)
- Jie Li
- Department of Radiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Bincheng District, Binzhou, 256600, China
| | - Linxuan Zou
- Department of Radiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Bincheng District, Binzhou, 256600, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, China
| | - Jifu Zhao
- Department of Radiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Bincheng District, Binzhou, 256600, China
| | - Chengyan Wang
- Department of Radiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Bincheng District, Binzhou, 256600, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264000, China
| | - Guangchao Hu
- School of Medical Imaging, Binzhou Medical University, No. 346 Guanhai Road, Laishan District, Yantai, 264003, China
| | - Haoran Yang
- School of Medical Imaging, Binzhou Medical University, No. 346 Guanhai Road, Laishan District, Yantai, 264003, China
| | - Beizhong Wang
- Department of Radiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Bincheng District, Binzhou, 256600, China
| | - Donghao Xu
- School of Medical Imaging, Binzhou Medical University, No. 346 Guanhai Road, Laishan District, Yantai, 264003, China
| | - Yuanhao Xia
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, China
- School of Medical Imaging, Binzhou Medical University, No. 346 Guanhai Road, Laishan District, Yantai, 264003, China
| | - Yi Jiang
- Department of Vascular Interventional Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264000, China
| | - Xingyue Jiang
- Department of Radiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Bincheng District, Binzhou, 256600, China.
| | - Naixuan Li
- Department of Vascular Interventional Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264000, China.
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Andresen K, Klæboe LG, Lie ØH, Broch K, Kvaslerud AB, Bosse G, Hopp E, de Lange C, Haugaa KH, Edvardsen T. No adverse association between exercise exposure and diffuse myocardial fibrosis in male endurance athletes. Sci Rep 2024; 14:6581. [PMID: 38503845 PMCID: PMC10951320 DOI: 10.1038/s41598-024-57233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
The potential association between endurance exercise and myocardial fibrosis is controversial. Data on exercise exposure and diffuse myocardial fibrosis in endurance athletes are scarce and conflicting. We aimed to investigate the association between exercise exposure and markers of diffuse myocardial fibrosis by cardiovascular magnetic resonance imaging (CMR) in endurance athletes. We examined 27 healthy adult male competitive endurance athletes aged 41 ± 9 years and 16 healthy controls in a cross sectional study using 3 Tesla CMR including late gadolinium enhancement and T1 mapping. Athletes reported detailed exercise history from 12 years of age. Left ventricular total mass, cellular mass and extracellular mass were higher in athletes than controls (86 vs. 58 g/m2, 67 vs. 44 g/m2 and 19 vs. 13 g/m2, all p < 0.01). Extracellular volume (ECV) was lower (21.5% vs. 23.8%, p = 0.03) and native T1 time was shorter (1214 ms vs. 1268 ms, p < 0.01) in the athletes. Increasing exercise dose was independently associated with shorter native T1 time (regression coefficient - 24.1, p < 0.05), but expressed no association with ECV. Our results indicate that diffuse myocardial fibrosis has a low prevalence in healthy male endurance athletes and do not indicate an adverse dose-response relationship between exercise and diffuse myocardial fibrosis in healthy athletes.
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Affiliation(s)
- Kristoffer Andresen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Haugen Lie
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
| | - Kaspar Broch
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anette Borger Kvaslerud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gerhard Bosse
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Charlotte de Lange
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Heart and Lung Diseases Unit, Department of Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Yin J, Qin J, Liu W, Zhu Y, Zhou X, Wang Y, Zhu X, Xu Y. A comparative study of synthetic and venous hematocrit for calculating cardiovascular magnetic resonance-derived extracellular volume. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-023-03044-0. [PMID: 38175388 DOI: 10.1007/s10554-023-03044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024]
Abstract
The extracellular volume (ECV) fraction derived from cardiac magnetic resonance (CMR) can reflect various pathologies. The application of ECVs was limited by the strict requirement that hematocrit (Hct0) should be obtained within 24 hours of CMR scan. The aim of this study was to obtain accurate and convenient ECV calculated from the venous Hct and synthetic Hct in CMR. A total of 839 subjects were retrospectively enrolled. The subjects were divided into derivation cohort for local sex-specific models and validation cohort for assessing the accuracy of different ECVs. In the validation cohort, venous Hcts from 7 days before the scan (Hct1 - 7), outside 7 days (Hct> 7), the closest day (Hctclosest), and Hctsyn were compared with Hct0. The agreement and correlation of the conventional ECV (ECV0) with the corresponding ECVs were analyzed. The factors affecting the accuracy of ECVsyn were assessed. ECV1-7 and ECVclosest had the best correlation and smallest bias with ECV0 (R = 0.959 and 0.951, bias = 0.02% and - 0.03%). When using an absolute 2% error as the standard, the performance of ECV1-7 was the best, with an accuracy of 81.0%, followed by ECVclosest (78.8%), ECV> 7 (77.2%) and ECVsyn (70.7%). Abnormally low and high Hcts and decreased left ventricular ejection fractions were associated with miscalculation of ECVsyn, especially patients with dilated cardiomyopathy. We recommend extending the time interval between a Hct and a CMR scan to 7 days for ECV calculation. The synthetic ECV should be used cautiously, especially for patients with extremely low or high Hcts, decreased cardiac function, and dilated cardiomyopathy.
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Affiliation(s)
- Jiani Yin
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Jie Qin
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Wangyan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, 200126, China
| | - Yunfei Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Nanjing, 210029, China.
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Zhang J, Xu Y, Li W, Zhang C, Liu W, Li D, Chen Y. The Predictive Value of Myocardial Native T1 Mapping Radiomics in Dilated Cardiomyopathy: A Study in a Chinese Population. J Magn Reson Imaging 2023; 58:772-779. [PMID: 36416613 DOI: 10.1002/jmri.28527] [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: 04/05/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Investigation of the factors influencing dilated cardiomyopathy (DCM) prognosis is important as it could facilitate risk stratification and guide clinical decision-making. PURPOSE To assess the prognostic value of magnetic resonance imaging (MRI) radiomics analysis of native T1 mapping in DCM. STUDY TYPE Prospective. SUBJECTS Three hundred and thirty consecutive patients with non-ischemic DCM (mean age 48.42 ± 14.20 years, 247 males). FIELD STRENGTH/SEQUENCE Balanced steady-state free precession and modified Look-Locker inversion recovery T1 mapping sequences at 3 T. ASSESSMENT Clinical characteristics, conventional MRI parameters (ventricular volumes, function, and mass), native myocardial T1, and radiomics features extracted from native T1 mapping were obtained. The study endpoint was defined as all-cause mortality or heart transplantation. Models were developed based on 1) clinical data; 2) radiomics data based on T1 mapping; 3) clinical and conventional MRI data; 4) clinical, conventional MRI, and native T1 data; and 5) clinical, conventional MRI, and radiomics T1 mapping data. Each prediction model was trained according to follow-up results with AdaBoost, random forest, and logistic regression classifiers. STATISTICAL TESTS The predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1 score by 5-fold cross-validation. RESULTS During a median follow-up of 53.5 months (interquartile range, 41.6-69.5 months), 77 patients with DCM experienced all-cause mortality or heart transplantation. The random forest model based on radiomics combined with clinical and conventional MRI parameters achieved the best performance, with AUC and F1 score of 0.95 and 0.89, respectively. DATA CONCLUSION A machine-learning framework based on radiomics analysis of T1 mapping prognosis prediction in DCM. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Wentao Liu
- Fundamental Technology Center of CCB Financial Technology Co., Ltd, Shanghai, China
| | - Dong Li
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Yucheng Chen
- Division of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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DiLorenzo MP, Grosse-Wortmann L. Myocardial Fibrosis in Congenital Heart Disease and the Role of MRI. Radiol Cardiothorac Imaging 2023; 5:e220255. [PMID: 37404787 PMCID: PMC10316299 DOI: 10.1148/ryct.220255] [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: 10/27/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
Progress in the field of congenital heart surgery over the last century can only be described as revolutionary. Recent improvements in patient outcomes have been achieved through refinements in perioperative care. In the current and future eras, the preservation and restoration of myocardial health, beginning with the monitoring of tissue remodeling, will be central to improving cardiac outcomes. Visualization and quantification of fibrotic myocardial remodeling is one of the greatest assets that cardiac MRI brings to the field of cardiology, and its clinical use within the field of congenital heart disease (CHD) has been an area of particular interest in the last few decades. This review summarizes the physical underpinnings of myocardial tissue characterization in CHD, with an emphasis on T1 parametric mapping and late gadolinium enhancement. It describes methods and suggestions for obtaining images, extracting quantitative and qualitative data, and interpreting the results for children and adults with CHD. The tissue characterization observed in different lesions is used to examine the causes and pathomechanisms of fibrotic remodeling in this population. Similarly, the clinical consequences of elevated imaging biomarkers of fibrosis on patient health and outcomes are explored. Keywords: Pediatrics, MR Imaging, Cardiac, Heart, Congenital, Tissue Characterization, Congenital Heart Disease, Cardiac MRI, Parametric Mapping, Fibrosis, Late Gadolinium Enhancement © RSNA, 2023.
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Morioka M, Takashio S, Nakashima N, Nishi M, Fujiyama A, Hirakawa K, Hanatani S, Usuku H, Yamamoto E, Kidoh M, Oda S, Matsushita K, Ueda M, Tsujita K. Correlation Between Cardiac Images, Biomarkers, and Amyloid Load in Wild-Type Transthyretin Amyloid Cardiomyopathy. J Am Heart Assoc 2022; 11:e024717. [PMID: 35699194 PMCID: PMC9238652 DOI: 10.1161/jaha.121.024717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Several imaging parameters and biomarkers provide diagnostic and prognostic information for wild-type transthyretin amyloid cardiomyopathy. However, the relevance of these parameters and their association with cardiac amyloid load requires further substantiation. We aimed to elucidate the association of imaging parameters obtained using 99mTc-labeled pyrophosphate scintigraphy, cardiovascular magnetic resonance imaging, global longitudinal strain (GLS), and cardiac biomarkers with cardiac amyloid load in patients with wild-type transthyretin amyloid cardiomyopathy. Methods and Results Eighty-eight patients with wild-type transthyretin amyloid cardiomyopathy who underwent 99mTc-labeled pyrophosphate scintigraphy and cardiovascular magnetic resonance were retrospectively evaluated. Quantitative cardiac amyloid load was obtained from 61 patients after myocardial biopsy. Correlations were assessed using Pearson's correlation coefficient applied to medical record data. The mean heart to contralateral ratio, native T1, extracellular volume, and GLS were 1.91±0.36, 1419.4±56.4 ms, 56.5±13.6%, and -9.4±2.5%, respectively. Median high-sensitivity cardiac troponin T (hs-cTnT) and BNP (B-type natriuretic peptide) levels were 0.0478 (0.0334-0.0691) ng/mL and 213.8 (125.8-392.7) pg/mL, respectively. The mean cardiac amyloid load was 22.9±15.0%. The heart to contralateral ratio correlated significantly with native T1 (r=0.397), extracellular volume (r=0.477), GLS (r=0.363), cardiac amyloid load (r=0.379), and Ln (hs-cTnT) (r=0.247). Further, cardiac amyloid load correlated significantly with native T1 (r=0.509), extracellular volume (r=0.310), GLS (r=0.446), and Ln (hs-cTnT) (r=0.354). Compared with BNP, hs-cTnT levels better correlated with several imaging parameters and cardiac amyloid load. Conclusions Increased cardiac amyloid load correlated with increased 99mTc-labeled pyrophosphate positivity, native T1, extracellular volume, and hs-cTnT levels, and an impaired GLS, suggesting that imaging parameters and cardiac biomarkers may reflect histological and functional changes attributable to amyloid deposition in the myocardium.
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Affiliation(s)
- Mami Morioka
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Seiji Takashio
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Naoya Nakashima
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Masato Nishi
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Akira Fujiyama
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kyoko Hirakawa
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Shinsuke Hanatani
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Hiroki Usuku
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Masafumi Kidoh
- Departments of Diagnostic Radiology Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Seitaro Oda
- Departments of Diagnostic Radiology Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Matsushita
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Mitsuharu Ueda
- Departments of Neurology Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Departments of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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Khanna S, Amarasekera AT, Li C, Bhat A, Chen HHL, Gan GCH, Ugander M, Tan TC. The utility of cardiac magnetic resonance imaging in the diagnosis of adult patients with acute myocarditis: A systematic review and meta-analysis. Int J Cardiol 2022; 363:225-239. [PMID: 35724801 DOI: 10.1016/j.ijcard.2022.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The presence of myocardial late gadolinium enhancement (LGE) indicates myocyte necrosis, and assists with the diagnosis of acute myocarditis (AM). Cardiac magnetic resonance (CMR) measures other than LGE i.e. tissue characterization and myocardial structural and functional parameters, play an important diagnostic role in assessment for inflammation, as seen in AM. The aim of this systematic review was to appraise the evidence for the use of quantitative CMR measures to identify myocardial inflammation in order to diagnose of AM in adult patients. METHODS A systematic literature search of medical databases was performed using PRISMA principles to identify relevant CMR studies on AM in adults (2005-2020; English; PROSPERO registration CRD42020180605). Data for a range of quantitative CMR measures were extracted. Continuous variables with low heterogeneity were meta-analyzed using a random-effects model for overall effect size measured as the standard mean difference (SMD). RESULTS Available data from 25 studies reporting continuous quantitative 1.5 T CMR measures revealed that AM is most reliably differentiated from healthy controls using T1 mapping (SMD 1.80, p < 0.01) and T2 mapping (SMD 1.63, p < 0.01), respectively. All other measures examined including T2-weighted ratio, extracellular volume, early gadolinium enhancement ratio, right ventricular ejection fraction, and LV end-diastolic volume, mass, ejection fraction, longitudinal strain, circumferential strain, and radial strain also had discriminatory ability although with smaller standard mean difference values (|SMD| 0.32-0.96, p < 0.01 for all). CONCLUSIONS Meta-analysis shows that myocardial tissue characterization (T1 mapping>T2 mapping) followed by measures of left ventricular structure and function demonstrate diagnostic discriminatory ability in AM.
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Affiliation(s)
- Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anjalee T Amarasekera
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; Western Sydney University, Sydney. NSW, Australia
| | - Cindy Li
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Martin Ugander
- University of New South Wales, Sydney, NSW, Australia; Kolling Institute, Royal North Shore Hospital, University of Sydney, NSW, Australia; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Western Sydney University, Sydney. NSW, Australia.
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9
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Banks L, Altaha MA, Yan AT, Dorian P, Konieczny K, Deva DP, LA Gerche A, Akhavein F, Bentley RF, Connelly KA, Goodman JM. Left Ventricular Fibrosis in Middle-Age Athletes and Physically Active Adults. Med Sci Sports Exerc 2021; 52:2500-2507. [PMID: 32472930 DOI: 10.1249/mss.0000000000002411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) and T1 mapping techniques enable the quantification of focal and diffuse myocardial LGE, respectively. Studies have shown evidence of fibrosis in middle-age athletes, but not relative to physically active (PA) adults who perform recommended physical activity levels. Therefore, we examined cardiac remodeling and presence of left ventricular (LV) LGE and T1 values in both recreational middle-age endurance athletes (EA) and PA adults. METHODS Healthy EA and PA adults (45-65 yr) completed a standardized 3-T CMR protocol with ventricular volumetry, LV LGE, and T1 mapping. RESULTS Seventy-two EA and 20 PA participants (mean age, 53 ± 5 vs 56 ± 4 yr; P < 0.01; V˙O2peak = 50 ± 7 vs 37 ± 9 mL·kg·min, P < 0.0001) were examined, with CMR data available in 89/92 participants. Focal LV LGE was observed in 30% of participants (n = 27/89): 33% of EA (n = 23/69; 33%) and 20% of PA (n = 4/20; 20%). LGE was present at the right ventricular hinge point (n = 21/89; 23.5%) or identified as ischemic (n = 2/89; 2%) or nonischemic (n = 4/89; 4%). Focal LV LGE was observed similarly in both EA and PA (P = 0.25). EA had larger LV chamber sizes and T1 native values (1169 ± 35 vs 1190 ± 26, P = 0.02) compared with PA, with similar LV ejection fraction. Global extracellular volume (ECV) was similar in both EA and PA (22.6% ± 3.5% vs 21.5% ± 2.6%, P = 0.26), with no relationship between global ECV and LV mass (r = -0.16, P = 0.19). CONCLUSIONS Focal LGE at the right ventricular hinge point was detected at the same frequency in both groups, was unrelated to demographic or clinical indices, and was found without evidence of global ECV expansion in EA, suggesting a physiologic remodeling response. The long-term clinical implications of hinge-point LGE require clarification using prospective, long-term follow-up studies.
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Affiliation(s)
- Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, CANADA
| | | | | | | | | | | | | | - Farhad Akhavein
- Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, CANADA
| | - Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, CANADA
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10
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Censi S, Cimaglia P, Barbieri A, Naldi M, Ruggerini S, Brogneri S, Tonet E, Rapezzi C, Squeri A. Performance of Synthetic Extracellular Volume Fraction in Different Cardiac Phenotypes From a Prospective Cohort of Patients Referred for Cardiac Magnetic Resonance. J Magn Reson Imaging 2021; 54:429-439. [PMID: 33590584 DOI: 10.1002/jmri.27556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A synthetic myocardial extracellular volume fraction (sECV) can be obtained without blood hematocrit (Hct) by using the linear relationship between Hct and the longitudinal relaxation time of blood. Concerns have been raised about the widespread clinical application of this approach. PURPOSE To assess the relationship between measured ECV (m-ECV) and sECV, using both a published model and a locally derived one. STUDY TYPE Single-center, prospective. FIELD STRENGTH/SEQUENCE A 1.5 T/modified Look Locker (MOLLI) sequence. SUBJECTS Fifty-two healthy subjects and 113 patients (76 with and 37 without a hypertrophic cardiac phenotype). ASSESSMENT Three ECV values were obtained for each patient: 1) measured ECV (m-ECV), using Hct from a venous blood sample; 2) Fent-synthetic ECV (F-sECV), using the equation proposed by Fent et al; and 3) Local-synthetic ECV (L-sECV), using the equation obtained from a local derivation cohort comprising 83 subjects. STATISTICAL TESTS Shapiro-Wilk test, analysis of variance, Kruskal Wallis test, Pearson correlation, Bland-Altman analysis, univariate and multivariable regression analysis. RESULTS In the validation cohort (N = 82), Bland-Altmann analysis revealed an excellent agreement between m-ECV and L-sECV with a statistically insignificant bias (-0.1%, limits of agreement: -2.8% and 2.6%; P = 0.528), while in the overall population (N = 165), the mean bias between m-ECV and F-sECV was small but significant (1.2%, limits of agreement: -1.5% and 3.9%, P < 0.05). F-sECV bias was significantly higher for measured Hct (m-Hct) values <0.372 (2.3% vs. 1.0%, P < 0.05). Among the phenotype subgroups, amyloidotic patients showed a higher bias compared to others, both with F-sECV and L-sECV (2.3% vs. 1.1%, P < 0.05 and 1.1% vs. 0.2%, P < 0.05, respectively). DATA CONCLUSION Although synthetic ECV performs well in an external cohort, the use of a local formula further improves the accuracy of ECV estimate over a broad spectrum of cardiac phenotypes. Local sECV performs better for a wider range of Hct values, compared to the published model. Amyloidosis is the only group associated with a lower accuracy. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Stefano Censi
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Paolo Cimaglia
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | - Monica Naldi
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Sara Ruggerini
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Simona Brogneri
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Claudio Rapezzi
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.,University Cardiological Center, University of Ferrara, Ferrara, Italy
| | - Angelo Squeri
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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11
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Nicholls SJ, Nerlekar N. Can CMR Elucidate the Cardiovascular Benefit of SGLT2 Inhibitors? JACC Cardiovasc Imaging 2021; 14:1174-1176. [PMID: 33454271 DOI: 10.1016/j.jcmg.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia.
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
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12
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CMR-derived ECVs vary with myocardial region and associate with the regional wall thickness. Sci Rep 2020; 10:20965. [PMID: 33262487 PMCID: PMC7708504 DOI: 10.1038/s41598-020-78043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 11/02/2020] [Indexed: 12/01/2022] Open
Abstract
This study was designed to identify whether the position and size of the
region of interest (ROI) influence extracellular volume fraction (ECV) measurements.
Patients with localized (n = 203) or infiltrative (n = 215) cardiomyopathies and 36
normal controls were enrolled in this study. ECV measurements at 4 different regions,
including the anterior, septal, posterior and lateral wall regions, were measured, and
all groups were compared. Regional ECV was correlated with the corresponding regional
wall thickness. The diagnostic power to differentiate the myocardial abnormalities was
evaluated for each myocardial region. ECVs measured using five different ROI sizes
within each myocardial region were compared. Our results showed that ECVs varied among
the myocardial regions, and this variation was significantly associated with regional
wall thicknesses. For the detection of myocardial abnormalities, regional ECV revealed
similar results as ECV derived from the whole region except for the anterior region. No
significant difference was found in the ECVs measured using the five different ROI
sizes. In conclusion, CMR-derived ECVs vary with myocardial region, and this variation
is significantly associated with the regional wall thickness. In contrast, the measured
size of the ROI has less of an effect on the ECV.
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13
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Luetkens JA, Voigt M, Faron A, Isaak A, Mesropyan N, Dabir D, Sprinkart AM, Pieper CC, Chang J, Attenberger U, Kuetting D, Thomas D. Influence of hydration status on cardiovascular magnetic resonance myocardial T1 and T2 relaxation time assessment: an intraindividual study in healthy subjects. J Cardiovasc Magn Reson 2020; 22:63. [PMID: 32892751 PMCID: PMC7487526 DOI: 10.1186/s12968-020-00661-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/07/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Myocardial native T1 and T2 relaxation time mapping are sensitive to pathological increase of myocardial water content (e.g. myocardial edema). However, the influence of physiological hydration changes as a possible confounder of relaxation time assessment has not been studied. The purpose of this study was to evaluate, whether changes in myocardial water content due to dehydration and hydration might alter myocardial relaxation times in healthy subjects. METHODS A total of 36 cardiovascular magnetic resonance (CMR) scans were performed in 12 healthy subjects (5 men, 25.8 ± 3.2 years). Subjects underwent three successive CMR scans: (1) baseline scan, (2) dehydration scan after 12 h of fasting (no food or water), (3) hydration scan after hydration. CMR scans were performed for the assessment of myocardial native T1 and T2 relaxation times and cardiac function. For multiple comparisons, repeated measures ANOVA or the Friedman test was used. RESULTS There was no change in systolic blood pressure or left ventricular ejection fraction between CMR scans (P > 0.05, respectively). T1 relaxation times were significantly reduced with dehydration (987 ± 27 ms [baseline] vs. 968 ± 29 ms [dehydration] vs. 986 ± 28 ms [hydration]; P = 0.006). Similar results were observed for T2 relaxation times (52.9 ± 1.8 ms [baseline] vs. 51.5 ± 2.0 ms [dehydration] vs. 52.2 ± 1.9 ms [hydration]; P = 0.020). CONCLUSIONS Dehydration may lead to significant alterations in relaxation times and thereby may influence precise, repeatable and comparable assessment of native T1 and T2 relaxation times. Hydration status should be recognized as new potential confounder of native T1 and T2 relaxation time assessment in clinical routine.
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Affiliation(s)
- Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
| | - Marilia Voigt
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Alois M Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Daniel Thomas
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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14
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Habert P, Capron T, Hubert S, Bentatou Z, Bartoli A, Tradi F, Renard S, Rapacchi S, Guye M, Bernard M, Habib G, Jacquier A. Quantification of right ventricular extracellular volume in pulmonary hypertension using cardiac magnetic resonance imaging. Diagn Interv Imaging 2020; 101:311-320. [DOI: 10.1016/j.diii.2019.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/30/2022]
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15
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Manning WJ. Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review. J Cardiovasc Magn Reson 2019; 21:79. [PMID: 31884956 PMCID: PMC6936125 DOI: 10.1186/s12968-019-0594-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
There were 89 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 76 original research papers, 4 reviews, 5 technical notes, 1 guideline, and 3 corrections. The volume was down slightly from 2017 with a corresponding 15% decrease in manuscript submissions from 405 to 346 and thus reflects a slight increase in the acceptance rate from 25 to 26%. The decrease in submissions for the year followed the initiation of the increased author processing charge (APC) for Society for Cardiovascular Magnetic Resonance (SCMR) members for manuscripts submitted after June 30, 2018. The quality of the submissions continues to be high. The 2018 JCMR Impact Factor (which is published in June 2019) was slightly lower at 5.1 (vs. 5.46 for 2017; as published in June 2018. The 2018 impact factor means that on average, each JCMR published in 2016 and 2017 was cited 5.1 times in 2018. Our 5 year impact factor was 5.82.In accordance with Open-Access publishing guidelines of BMC, the JCMR articles are published on-line in a continuus fashion 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 for the JCMR audience 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 contemporaneous JCMR publications. 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, as in the past two years, I have used this publication to also convey information regarding the editorial process and as a "State of our JCMR."This is the 12th year of JCMR as an open-access publication with BMC (formerly known as Biomed Central). The timing of the JCMR transition to the open access platform was "ahead of the curve" and a tribute to the vision of Dr. Matthias Friedrich, the SCMR Publications Committee Chair and Dr. Dudley Pennell, the JCMR editor-in-chief at the time. The open-access system has dramatically increased the reading and citation of JCMR publications and I hope that you, our authors, will continue to send your very best, high quality manuscripts to JCMR for consideration. It takes a village to run a journal and I thank our very dedicated Associate Editors, Guest Editors, Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner. These efforts have allowed the JCMR to continue as the premier journal of our field. This entire process would also not be possible without the dedication and efforts of our managing editor, Diana Gethers. Finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 4th year as your editor-in-chief. It has been a tremendous 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, Boston, Massachusetts, USA.
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16
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Robinson AA, Chow K, Salerno M. Myocardial T1 and ECV Measurement: Underlying Concepts and Technical Considerations. JACC Cardiovasc Imaging 2019; 12:2332-2344. [PMID: 31542529 PMCID: PMC7008718 DOI: 10.1016/j.jcmg.2019.06.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/31/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022]
Abstract
Myocardial native T1 and extracellular volume fraction (ECV) mapping have emerged as cardiac magnetic resonance biomarkers providing unique insight into cardiac pathophysiology. Single breath-hold acquisition techniques, available on clinical scanners across multiple vendor platforms, have made clinical T1 and ECV mapping a reality. Although the relationship between changes in native T1 and alterations in cardiac microstructure is complex, an understanding of how edema, blood volume, myocyte and interstitial expansion, lipids, and paramagnetic substances affect T1 and ECV can provide insight into how and why these parameters change in various cardiac pathologies. The goals of this state-of-the-art review will be to review factors influencing native T1 and ECV, to describe how native T1 and ECV are measured, to discuss potential challenges and pitfalls in clinical practice, and to describe new T1 mapping techniques on the horizon.
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Affiliation(s)
- Austin A Robinson
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, Illinois
| | - Michael Salerno
- Department of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia; Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia.
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17
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Nordlund D, Xanthis C, Bidhult S, Jablonowski R, Kanski M, Kopic S, Carlsson M, Engblom H, Aletras AH, Arheden H. Measuring extracellular volume fraction by MRI: First verification of values given by clinical sequences. Magn Reson Med 2019; 83:662-672. [PMID: 31418490 PMCID: PMC6900009 DOI: 10.1002/mrm.27938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
Purpose To verify MR measurements of myocardial extracellular volume fraction (ECV) based on clinically applicable T1‐mapping sequences against ECV measurements by radioisotope tracer in pigs and to relate the results to those obtained in volunteers. Methods Between May 2016 and March 2017, 8 volunteers (25 ± 4 years, 3 female) and 8 pigs (4 female) underwent ECV assessment with SASHA, MOLLI5(3b)3, MOLLI5(3s)3, and MOLLI5s(3s)3s. Myocardial ECV was measured independently in pigs using a radioisotope tracer method. Results In pigs, ECV in normal myocardium was not different between radioisotope (average ± standard deviation; 19 ± 2%) and SASHA (21 ± 2%; P = 0.086). ECV was higher by MOLLI5(3b)3 (26 ± 2%), MOLLI5(3s)3 (25 ± 2%), and MOLLI5s(3s)3s (25 ± 2%) compared with SASHA or radioisotope (P ≤ 0.001 for all). ECV in volunteers was higher by MOLLI5(3b)3 (26 ± 3%) and MOLLI5(3s)3 (26 ± 3%) than by SASHA (22 ± 3%; P = 0.022 and P = 0.033). No difference was found between MOLLI5s(3s)3s (25 ± 3%) and SASHA (P = 0.225). Native T1 of blood and myocardium as well as postcontrast T1 of myocardium was consistently lower using MOLLI compared with SASHA. ECV increased over time as measured by MOLLI5(3b)3 and MOLLI5(3s)3 for pigs (0.08% and 0.07%/min; P = 0.004 and P = 0.013) and by MOLLI5s(3s)3s for volunteers (0.07%/min; P = 0.032) but did not increase as measured by SASHA. Conclusion Clinically available MOLLI and SASHA techniques can be used to accurately estimate ECV in normal myocardium where MOLLI‐sequences show minor overestimation driven by underestimation of postcontrast T1 when compared with SASHA. The timing of imaging after contrast administration affected the measurement of ECV using some variants of the MOLLI sequence.
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Affiliation(s)
- David Nordlund
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Christos Xanthis
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.,Laboratory of Computing and Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sebastian Bidhult
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Robert Jablonowski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Sascha Kopic
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Anthony H Aletras
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden.,Laboratory of Computing and Medical Informatics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
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18
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Goldfarb JW, Hsu B, Cao JJ. Effects of supplemental oxygen on cardiovascular magnetic resonance water proton relaxation time constant measurements (T 1, T 2 and T 2*). Magn Reson Imaging 2019; 61:124-130. [PMID: 31082495 DOI: 10.1016/j.mri.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/08/2019] [Accepted: 05/04/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study, the effects of supplemental oxygen on the measurement of native cardiovascular water proton relaxation time constants using commercially available protocols. METHODS T1, T2 and T2* relaxation time constant mapping were performed in twelve volunteers at 1.5 T breathing room air and supplemental oxygen supplied by nasal cannula and a non-rebreather mask. Regions-of-interest were drawn for quantitative measurements in the bloodpool of each ventricle and atria as well as septal myocardium. The effects of supplemental oxygen were investigated statistically using a mixed model analysis of variance. Intra- and inter-observer reproducibility were assessed using the Intraclass Correlation Coefficient and Coefficient of Variation. RESULTS Blood T1 relaxation time constants in the left ventricle (T1 change = -241.0 ms) and left atrium (T1 change = -247.0 ms) decreased significantly in every subject after oxygen inhalation with a non-rebreather mask (p < 0.001). No significant changes of T1 in the right side of the heart were detected after oxygen inhalation with the non-rebreather mask (p = 0.345). Oxygen inhalation with nasal cannula did not significantly change blood T1 in the study (p = 0.497). No significant changes in myocardial T1 (p = 0.390), T2 (p = 0.960) or T2* (p = 0.438) were observed with supplemental oxygen supplied by nasal cannula or the non-rebreather mask. Results were similar in mid-short-axis and horizontal long-axis acquisitions. CONCLUSION Supplemental oxygen does not affect myocardial relaxation time constant measurements with current protocols. On the other hand, blood T1 measurements with the inhalation of supplemental oxygen supplied by a non-rebreather mask change significantly and could affect myocardial tissue characterization if used for the calculation of extracellular volume. Additionally, current relaxation time constant mapping protocols do not reproducibly detect myocardial T1 changes with supplemental oxygen inhalation.
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Affiliation(s)
- James W Goldfarb
- Department of Research and Education, Saint Francis Hospital Roslyn, NY, USA.
| | - Brittany Hsu
- Department of Research and Education, Saint Francis Hospital Roslyn, NY, USA.
| | - Jie J Cao
- Department of Research and Education, Saint Francis Hospital Roslyn, NY, USA.
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19
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Lott J, Platt T, Niesporek SC, Paech D, G. R. Behl N, Niendorf T, Bachert P, Ladd ME, Nagel AM. Corrections of myocardial tissue sodium concentration measurements in human cardiac
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Na MRI at 7 Tesla. Magn Reson Med 2019; 82:159-173. [DOI: 10.1002/mrm.27703] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Johanna Lott
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- University of Heidelberg, Faculty of Physics and Astronomy Heidelberg Germany
| | - Tanja Platt
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
| | | | - Daniel Paech
- German Cancer Research Center (DKFZ) Radiology, Heidelberg Germany
| | - Nicolas G. R. Behl
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
| | - Thoralf Niendorf
- Max Delbrueck Center for Molecular Medicine in the Helmholtz Association Berlin Germany
- MRI. TOOLS GmbH Berlin Germany
| | - Peter Bachert
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- University of Heidelberg, Faculty of Physics and Astronomy Heidelberg Germany
| | - Mark E. Ladd
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- University of Heidelberg, Faculty of Physics and Astronomy Heidelberg Germany
- University of Heidelberg Faculty of Medicine Heidelberg Germany
| | - Armin M. Nagel
- German Cancer Research Center (DKFZ), Medical Physics in Radiology Heidelberg Germany
- Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU), University Hospital Erlangen Institute of Radiology Erlangen Germany
- Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU) Institute of Medical Physics Erlangen Germany
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20
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Dodd JD, Dewey M. Quantification of Normal Parametric Values: A Prerequisite for Routine Cardiac MRI. Radiology 2019; 290:327-328. [DOI: 10.1148/radiol.2018182300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan D. Dodd
- From the Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland (J.D.D.); and Department of Radiology, Charité, Berlin, Germany (M.D.)
| | - Marc Dewey
- From the Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland (J.D.D.); and Department of Radiology, Charité, Berlin, Germany (M.D.)
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