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Wang K, Zhang Y, Zhang W, Jin H, An J, Cheng J, Zheng J. Role of endogenous T1ρ and its dispersion imaging in differential diagnosis of cardiac amyloidosis. J Cardiovasc Magn Reson 2024:101080. [PMID: 39127261 DOI: 10.1016/j.jocmr.2024.101080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 07/08/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) has demonstrated excellent performance in the diagnosis of cardiac amyloidosis (CA). However, misdiagnosis occasionally occurs because the morphological and functional features of CA are non-specific. This study was performed to determine the value of non-contrast CMR T1ρ in the diagnosis of CA. METHODS This prospective study included 45 patients with CA, 30 patients with hypertrophic cardiomyopathy (HCM), and 10 healthy controls (HCs). All participants underwent cine (whole heart), T1ρ mapping, pre- and post-contrast T1 mapping imaging (three slices), and late gadolinium enhancement using a 3T whole-body MRI system. All participants underwent T1ρ at two spin-locking frequencies: 0Hz and 298Hz. ECV maps were obtained using pre- and post-contrast T1 maps. The myocardial T1ρ dispersion map, termed myocardial dispersion index (MDI), was also calculated. All parameters were measured in the left ventricular myocardial wall. Participants in the HC group were scanned twice on different days to assess the reproducibility of T1ρ measurements. RESULTS Excellent reproducibility was observed upon evaluation of the coefficient of variation between two scans (T1ρ [298Hz]: 3.1%; T1ρ [0Hz], 2.5%). The ECV (HC: 27.4 ± 2.8% vs. HCM: 32.6 ± 5.8% vs. CA: 46 ± 8.9%; p < 0.0001), T1ρ [0Hz] (HC: 35.8 ± 1.7 ms vs. HCM: 40.0 ± 4.5 ms vs. CA: 51.4 ± 4.4 ms; p < 0.0001) and T1ρ [298Hz] (HC: 41.9 ± 1.6 ms vs. HCM: 48.8 ± 6.2 ms vs. CA: 54.4 ± 5.2 ms; p < 0.0001) progressively increased from the HC group to the HCM group, and then the CA group. The MDI progressively decreased from the HCM group to the HC group, and then the CA group (HCM: 8.8 ± 2.8 ms vs. HC: 6.1 ± 0.9 ms vs. CA: 3.4 ± 2.1 ms; p < 0.0001). For differential diagnosis, the combination of MDI and T1ρ [298Hz] showed the greatest sensitivity (98.3%) and specificity (95.5%) between CA and HCM, compared with the native T1 and ECV. CONCLUSIONS The T1ρ and MDI approaches can be used as non-contrast CMR imaging biomarkers to improve the differential diagnosis of patients with CA.
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Affiliation(s)
- Keyan Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenbo Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongrui Jin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Jingliang Cheng
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA.
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Grazzini G, Pradella S, Bani R, Fornaciari C, Cappelli F, Perfetto F, Cozzi D, Giovannelli S, Sica G, Miele V. The Role of T2 Mapping in Cardiac Amyloidosis. Diagnostics (Basel) 2024; 14:1048. [PMID: 38786346 PMCID: PMC11120592 DOI: 10.3390/diagnostics14101048] [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: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy divided into two types: light-chain (LA) and transthyretin (ATTR) CA. Cardiac magnetic resonance (CMR) has emerged as an important diagnostic tool in CA. While late gadolinium enhancement (LGE), T1 mapping and extracellular volume (ECV) have a consolidate role in the assessment of CA, T2 mapping has been less often evaluated. We aimed to test the value of T2 mapping in the evaluation of CA. This study recruited 70 patients with CA (51 ATTR, 19 AL). All the subjects underwent 1.5 T CMR with T1 and T2 mapping and cine and LGE imaging. Their QALE scores were evaluated. The myocardial T2 values were significantly (p < 0.001) increased in both types of CA compared to the controls. In the AL-CA group, increased T2 values were associated with a higher QALE score. The myocardial native T1 values and ECV were significantly (p < 0.001) higher in the CA patients than in the healthy subjects. Left ventricular (LV) mass, QALE score and ECV were higher in ATTR amyloidosis compared with AL amyloidosis, while the LV ejection fraction was lower (p < 0.001). These results support the concept of the presence of myocardial edema in CA. Therefore, a CMR evaluation including not only myocardial T1 imaging but also myocardial T2 imaging allows for more comprehensive tissue characterization in CA.
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Affiliation(s)
- Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Rossella Bani
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Chiara Fornaciari
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesco Cappelli
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Largo Piero Palagi 1, 50134 Florence, Italy
| | - Federico Perfetto
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Largo Piero Palagi 1, 50134 Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Simona Giovannelli
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
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3
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Cai S, Haghbayan H, Chan KKW, Deva DP, Jimenez-Juan L, Connelly KA, Ng MY, Yan RT, Yan AT. Tissue mapping by cardiac magnetic resonance imaging for the prognostication of cardiac amyloidosis: A systematic review and meta-analysis. Int J Cardiol 2024; 403:131892. [PMID: 38382853 DOI: 10.1016/j.ijcard.2024.131892] [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: 10/26/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cardiac amyloidosis is increasingly recognized as a significant contributor to cardiovascular morbidity and mortality. With the emergence of novel therapies, there is a growing interest in prognostication of patients with cardiac amyloidosis using cardiac magnetic resonance imaging (CMR). In this systematic review and meta-analysis, we aimed to examine the prognostic significance of myocardial native T1 and T2, and extracellular volume (ECV). METHODS Observational cohort studies or single arms of clinical trials were eligible. MEDLINE, EMBASE and CENTRAL were systematically searched from their respective dates of inception to January 2023. No exclusions were made based on date of publication, study outcomes, or study language. The study populations composed of adult patients (≥18 years old) with amyloid cardiomyopathy. All studies included the use of CMR with and without intravenous gadolinium contrast administration to assess myocardial native T1 mapping, T2 mapping, and ECV in association with the pre-specified primary outcome of all-cause mortality. Data were extracted from eligible primary studies by two independent reviewers and pooled via the inverse variance method using random effects models for meta-analysis. RESULTS A total of 3852 citations were reviewed. A final nine studies including a total of 955 patients (mean age 65 ± 10 years old, 32% female, mean left ventricular ejection fraction (LVEF) 59 ± 12% and 24% had NYHA class III or IV symptoms) with cardiac amyloidosis [light chain amyloidosis (AL) 50%, transthyretin amyloidosis (ATTR) 49%, other 1%] were eligible for inclusion and suitable for data extraction. All included studies were single centered (seven with 1.5 T MRI scanners, two with 3.0 T MRI scanners) and non-randomized in design, with follow-up spanning from 8 to 64 months (median follow-up = 25 months); 320 patients died during follow-up, rendering a weighted mortality rate of 33% across studies. Compared with patients with AL amyloid, patients with ATTR amyloid had significantly higher mean left ventricular mass index (LVMi) (102 ± 34 g/m2 vs 127 ± 37 g/m2, p = 0.02). N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin T levels, mean native T1 values, ECV and T2 values did not differ between patients with ATTR amyloid and AL amyloid (all p > 0.25). Overall, the hazard ratios for mortality were 1.33 (95% CI = [1.10, 1.60]; p = 0.003; I2 = 29%) for every 60 ms higher T1 time, 1.16 (95% CI = [1.09, 1.23], p < 0.0001; I2 = 76%) for every 3% higher ECV, and 5.23 (95% CI = [2.27, 12.02]; p < 0.0001; I2 = 0%) for myocardial-to-skeletal T2 ratio below the mean (vs above the mean). CONCLUSION Higher native T1 time and ECV, and lower myocardial to skeletal T2 ratio, on CMR are associated with worse mortality in patients with cardiac amyloidosis. Therefore, tissue mapping using CMR may offer a useful non-invasive technique to monitor disease progression and determine prognosis in patients with cardiac amyloidosis.
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Affiliation(s)
- Sean Cai
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Medical Oncology, Sunnybrook Hospital, Toronto, Canada
| | - Djeven P Deva
- Department of Medical Imaging, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, University of Toronto, Toronto, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, HKU-Shenzhen Hospital, China
| | - Raymond T Yan
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Medical Imaging, University of Toronto, Toronto, Canada; Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, Toronto, Canada.
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4
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Maggialetti N, Torrente A, Lorusso G, Villanova I, Ficco M, Gravina M, Ferrari C, Giordano L, Granata V, Rubini D, Lucarelli NM, Stabile Ianora AA, Scardapane A. Role of Cardiovascular Magnetic Resonance in Cardiac Amyloidosis: A Narrative Review. J Pers Med 2024; 14:407. [PMID: 38673034 PMCID: PMC11051560 DOI: 10.3390/jpm14040407] [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: 03/17/2024] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Amyloidosis is a rare infiltrative condition resulting from the extracellular accumulation of amyloid fibrils at the cardiac level. It can be an acquired condition or due to genetic mutations. With the progression of imaging technologies, a non-invasive diagnosis was proposed. In this study, we discuss the role of CMR in cardiac amyloidosis, focusing on the two most common subtypes (AL and ATTR), waiting for evidence-based guidelines to be published.
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Affiliation(s)
- Nicola Maggialetti
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Andrea Torrente
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giovanni Lorusso
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Ilaria Villanova
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Michele Ficco
- U.O.C. Radiologia, P.O. San Paolo, ASL Bari, 70123 Bari, Italy
| | - Matteo Gravina
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Cristina Ferrari
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Luca Giordano
- U.O.C. Radiodiagnostica, Ospedaliera Vito Fazzi, 73100 Lecce, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Dino Rubini
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Nicola Maria Lucarelli
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Amato Antonio Stabile Ianora
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Arnaldo Scardapane
- Sperimental Medicine Department, University of Salento, 73100 Lecce, Italy
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5
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Yamaguchi S, Oda S, Kidoh M, Hayashi H, Takashio S, Usuku H, Nagayama Y, Nakaura T, Tsujita K, Hirai T, Aoki T. Cardiac MRI T1 and T2 Mapping as a Quantitative Imaging Biomarker in Transthyretin Amyloid Cardiomyopathy. Acad Radiol 2024; 31:514-522. [PMID: 37775448 DOI: 10.1016/j.acra.2023.08.045] [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: 06/12/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to assess the utility of cardiac magnetic resonance imaging (MRI) T1 and T2 mapping as quantitative imaging biomarkers in transthyretin amyloid cardiomyopathy (ATTR-CM). MATERIALS AND METHODS This study retrospectively evaluated 74 patients with confirmed wild-type ATTR-CM who underwent cardiac MRI, 99mTc-labeled pyrophosphate (99mTc-PYP) scintigraphy, and echocardiography. We assessed the quantitative disease parameters, for example, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) by echocardiography, native T1, extracellular volume fraction (ECV), and native T2 value by cardiac MRI, heart-to-contralateral ratio (H/CL) by 99mTc-PYP, and high-sensitive cardiac troponin T. Myocardial native T2 of ≥50 ms was defined as myocardial edema. Correlations between the disease's quantitative parameters were evaluated, and the ECV was compared to other parameters in ATTR-CM with/without myocardial edema. RESULTS ECV in all patients with ATTR-CM revealed a strong correlation with native T1 (r = 0.62), a moderate correlation with hs-TnT (r = 0.59), LVEF (r = -0.48), GLS (r = 0.58), and H/CL (r = 0.48). Correlations between ECV and other quantitative parameters decreased in ATTR-CM with myocardial edema except for H/CL. Meanwhile, the correlations increased in ATTR-CM without myocardial edema. CONCLUSION The presence of myocardial edema affected the interpretation of ECV assessment, although ECV can be a comprehensive imaging biomarker for ATTR-CM. ECV showed a significant correlation with various quantitative disease parameters and can be a reliable disease monitoring marker in patients with ATTR-CM when myocardial edema was excluded.
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Affiliation(s)
- Shinpei Yamaguchi
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan (S.Y., T.A.); Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.).
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan (S.T., H.U., K.T.)
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan (S.T., H.U., K.T.)
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan (S.T., H.U., K.T.)
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan (S.Y., T.A.)
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6
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Zhou XY, Tang CX, Guo YK, Chen WC, Guo JZ, Ren GS, Li X, Li JH, Lu GM, Huang XH, Wang YN, Zhang LJ, Yang GF. Late gadolinium enhanced cardiac MR derived radiomics approach for predicting all-cause mortality in cardiac amyloidosis: a multicenter study. Eur Radiol 2024; 34:402-410. [PMID: 37552255 DOI: 10.1007/s00330-023-09999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/03/2023] [Accepted: 06/05/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of radiomics features based on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) images in patients with cardiac amyloidosis (CA). METHODS This retrospective study included 120 CA patients undergoing CMR at three institutions. Radiomics features were extracted from global and three different segments (base, mid-ventricular, and apex) of left ventricular (LV) on short-axis LGE images. Primary endpoint was all-cause mortality. The predictive performance of the radiomics features and semi-quantitative and quantitative LGE parameters were compared by ROC. The AUC was used to observe whether Rad-score had an incremental value for clinical stage. The Kaplan-Meier curve was used to further stratify the risk of CA patients. RESULTS During a median follow-up of 12.9 months, 30% (40/120) patients died. There was no significant difference in the predictive performance of the radiomics model in different LV sections in the validation set (AUCs of the global, basal, middle, and apical radiomics model were 0.75, 0.77, 0.76, and 0.77, respectively; all p > 0.05). The predictive performance of the Rad-score of the base-LV was better than that of the LGE total enhancement mass (AUC:0.77 vs. 0.54, p < 0.001) and LGE extent (AUC: 0.77 vs. 0.53, p = 0.004). Rad-score combined with Mayo stage had better predictive performance than Mayo stage alone (AUC: 0.86 vs. 0.81, p = 0.03). Rad-score (≥ 0.66) contributed to the risk stratification of all-cause mortality in CA. CONCLUSIONS Compared to quantitative LGE parameters, radiomics can better predict all-cause mortality in CA, while the combination of radiomics and Mayo stage could provide higher predictive accuracy. CLINICAL RELEVANCE STATEMENT Radiomics analysis provides incremental value and improved risk stratification for all-cause mortality in patients with cardiac amyloidosis. KEY POINTS • Radiomics in LV-base was superior to LGE semi-quantitative and quantitative parameters for predicting all-cause mortality in CA. • Rad-score combined with Mayo stage had better predictive performance than Mayo stage alone or radiomics alone. • Rad-score ≥ 0.66 was associated with a significantly increased risk of all-cause mortality in CA patients.
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Affiliation(s)
- Xi Yang Zhou
- Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Ying Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Wen Cui Chen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Jin Zhou Guo
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Gui Sheng Ren
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Xiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jun Hao Li
- Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Guang Ming Lu
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiang Hua Huang
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, Jiangsu, China
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Gui Fen Yang
- Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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7
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Boretto P, Patel NH, Patel K, Rana M, Saglietto A, Soni M, Ahmad M, Sin Ying Ho J, De Filippo O, Providencia RA, Hyett Bray JJ, D’Ascenzo F. Prognosis prediction in cardiac amyloidosis by cardiac magnetic resonance imaging: a systematic review with meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead092. [PMID: 37840586 PMCID: PMC10575621 DOI: 10.1093/ehjopen/oead092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58-67] were included. Median follow-up was 24 months (IQR 20-32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01-5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07-3.49) elevated native T1 (HR 2.19, 95% CI 1.12-4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52-2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17-1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51-22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6-2.69), RVEF (HR 1.13, 95% CI 1.05-1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02-1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality.
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Affiliation(s)
- Paolo Boretto
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Neal Hitesh Patel
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Keval Patel
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Mannat Rana
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Andrea Saglietto
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Manas Soni
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS
Foundation Trust, 10 Pond St, NW3 2PS London,
UK
| | - Jamie Sin Ying Ho
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS
Foundation Trust, 10 Pond St, NW3 2PS London,
UK
| | - Ovidio De Filippo
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Rui Andre Providencia
- Institute of Health Informatics Research, University College
London, 222 Euston Road, NW1 2DA London, UK
| | - Jonathan James Hyett Bray
- Institute of Health Informatics Research, University College
London, 222 Euston Road, NW1 2DA London, UK
- Institute of Life Sciences-2, Swansea Bay University Health Board and
Swansea University Medical School, Swansea University, 4
Mumbles Rd, Sketty, SA3 5AU Swansea, UK
| | - Fabrizio D’Ascenzo
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
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8
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Li Z, Yan C, Hu GX, Zhao R, Jin H, Yun H, Wei Z, Pan CZ, Shu XH, Zeng MS. Layer-specific strain in patients with cardiac amyloidosis using tissue tracking MR. FRONTIERS IN RADIOLOGY 2023; 3:1115527. [PMID: 37601532 PMCID: PMC10435886 DOI: 10.3389/fradi.2023.1115527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/04/2023] [Indexed: 08/22/2023]
Abstract
Background Cardiac infiltration is the major predictor of poor prognosis in patients with systemic amyloidosis, thus it becomes of great importance to evaluate cardiac involvement. Purpose We aimed to evaluate left ventricular myocardial deformation alteration in patients with cardiac amyloidosis (CA) using layer-specific tissue tracking MR. Material and Methods Thirty-nine patients with CA were enrolled. Thirty-nine normal controls were also recruited. Layer-specific tissue tracking analysis was done based on cine MR images. Results Compared with the control group, a significant reduction in LV whole layer strain values (GLS, GCS, and GRS) and layer-specific strain values was found in patients with CA (all P < 0.01). In addition, GRS and GLS, as well as subendocardial and subepicardial GLS, GRS, and GCS, were all diminished in patients with CA and reduced LVEF, when compared to those with preserved or mid-range LVEF (all P < 0.05). GCS showed the largest AUC (0.9952, P = 0.0001) with a sensitivity of 93.1% and specificity of 90% to predict reduced LVEF (<40%). Moreover, GCS was the only independent predictor of LV systolic dysfunction (Odds Ratio: 3.30, 95% CI:1.341-8.12, and P = 0.009). Conclusion Layer-specific tissue tracking MR could be a useful method to assess left ventricular myocardial deformation in patients with CA.
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Affiliation(s)
- Zheng Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Cheng Yan
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Xiang Hu
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rui Zhao
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
| | - Hang Jin
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Yun
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zheng Wei
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cui-Zhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xian-Hong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Meng-Su Zeng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Sinigiani G, De Michieli L, De Conti G, Ricci F, De Lazzari M, Migliore F, Perazzolo Marra M, Zorzi A, Corrado D, Cipriani A. Cardiac Magnetic Resonance-Detected Acute Myocardial Edema as Predictor of Favourable Prognosis: A Comprehensive Review. J Cardiovasc Dev Dis 2023; 10:319. [PMID: 37623332 PMCID: PMC10455433 DOI: 10.3390/jcdd10080319] [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: 06/25/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Acute myocardial edema (AME) is increased water content in the myocardium and represents the first and transient pathophysiological response to an acute myocardial injury. In-vivo and non-invasive evaluation is feasible with cardiac magnetic resonance (CMR), which is a powerful imaging technique capable of tissue characterization. In the clinical setting, early demonstration of AME has a recognized diagnostic value for acute coronary syndromes and acute myocarditis, although its prognostic value is not well established. This article provides a comprehensive narrative review on the clinical meaning of AME in heart diseases. In particular, the available evidence of a possible favourable prognostic value in several clinical scenarios is addressed.
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Affiliation(s)
- Giulio Sinigiani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Laura De Michieli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua, 35128 Padua, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
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10
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Topriceanu CC, Fornasiero M, Seo H, Webber M, Keenan KE, Stupic KF, Bruehl R, Ittermann B, Price K, McGrath L, Pang W, Hughes AD, Nezafat R, Kellman P, Pierce I, Moon JC, Captur G. Developing a medical device-grade T 2 phantom optimized for myocardial T 2 mapping by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:19. [PMID: 36935515 PMCID: PMC10026458 DOI: 10.1186/s12968-023-00926-z] [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: 08/19/2022] [Accepted: 01/26/2023] [Indexed: 03/21/2023] Open
Abstract
INTRODUCTION A long T2 relaxation time can reflect oedema, and myocardial inflammation when combined with increased plasma troponin levels. Cardiovascular magnetic resonance (CMR) T2 mapping therefore has potential to provide a key diagnostic and prognostic biomarkers. However, T2 varies by scanner, software, and sequence, highlighting the need for standardization and for a quality assurance system for T2 mapping in CMR. AIM To fabricate and assess a phantom dedicated to the quality assurance of T2 mapping in CMR. METHOD A T2 mapping phantom was manufactured to contain 9 T1 and T2 (T1|T2) tubes to mimic clinically relevant native and post-contrast T2 in myocardium across the health to inflammation spectrum (i.e., 43-74 ms) and across both field strengths (1.5 and 3 T). We evaluated the phantom's structural integrity, B0 and B1 uniformity using field maps, and temperature dependence. Baseline reference T1|T2 were measured using inversion recovery gradient echo and single-echo spin echo (SE) sequences respectively, both with long repetition times (10 s). Long-term reproducibility of T1|T2 was determined by repeated T1|T2 mapping of the phantom at baseline and at 12 months. RESULTS The phantom embodies 9 internal agarose-containing T1|T2 tubes doped with nickel di-chloride (NiCl2) as the paramagnetic relaxation modifier to cover the clinically relevant spectrum of myocardial T2. The tubes are surrounded by an agarose-gel matrix which is doped with NiCl2 and packed with high-density polyethylene (HDPE) beads. All tubes at both field strengths, showed measurement errors up to ≤ 7.2 ms [< 14.7%] for estimated T2 by balanced steady-state free precession T2 mapping compared to reference SE T2 with the exception of the post-contrast tube of ultra-low T1 where the deviance was up to 16 ms [40.0%]. At 12 months, the phantom remained free of air bubbles, susceptibility, and off-resonance artifacts. The inclusion of HDPE beads effectively flattened the B0 and B1 magnetic fields in the imaged slice. Independent temperature dependency experiments over the 13-38 °C range confirmed the greater stability of shorter vs longer T1|T2 tubes. Excellent long-term (12-month) reproducibility of measured T1|T2 was demonstrated across both field strengths (all coefficients of variation < 1.38%). CONCLUSION The T2 mapping phantom demonstrates excellent structural integrity, B0 and B1 uniformity, and reproducibility of its internal tube T1|T2 out to 1 year. This device may now be mass-produced to support the quality assurance of T2 mapping in CMR.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Han Seo
- Department of Cardiology, Center for Inherited Heart Muscle Conditions, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Matthew Webber
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Department of Cardiology, Center for Inherited Heart Muscle Conditions, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kathryn E Keenan
- National Institute of Standards and Technology (NIST), 325 Broadway, Boulder, CO, 80305, USA
| | - Karl F Stupic
- National Institute of Standards and Technology (NIST), 325 Broadway, Boulder, CO, 80305, USA
| | - Rüdiger Bruehl
- Physikalisch-Technische Bundesanstalt (PTB), Abbestraße 2-12, 10587, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Abbestraße 2-12, 10587, Berlin, Germany
| | - Kirsty Price
- UCL Bloomsbury Center for Clinical Phenotyping, London, WC1E 6HX, UK
| | - Louise McGrath
- UCL Bloomsbury Center for Clinical Phenotyping, London, WC1E 6HX, UK
| | - Wenjie Pang
- Resonance Health (RH), 141 Burswood Road, Burswood, WA, 6100, Australia
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health (NIH), Rockville Pike, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - James C Moon
- Barts Heart Center, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Department of Cardiology, Center for Inherited Heart Muscle Conditions, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
- Institute of Cardiovascular Science, Consultant Cardiologist in Inherited Heart Muscle Conditions, University College London, Gower Street, London, WC1E 6BT, UK.
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11
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Eck BL, Yim M, Hamilton JI, da Cruz GJL, Li X, Flamm SD, Tang WHW, Prieto C, Seiberlich N, Kwon DH. Cardiac Magnetic Resonance Fingerprinting: Potential Clinical Applications. Curr Cardiol Rep 2023; 25:119-131. [PMID: 36805913 PMCID: PMC10134477 DOI: 10.1007/s11886-022-01836-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/21/2023]
Abstract
PURPOSE OF REVIEW Cardiac magnetic resonance fingerprinting (cMRF) has developed as a technique for rapid, multi-parametric tissue property mapping that has potential to both improve cardiac MRI exam efficiency and expand the information captured. In this review, we describe the cMRF technique, summarize technical developments and in vivo reports, and highlight potential clinical applications. RECENT FINDINGS Technical developments in cMRF continue to progress rapidly, including motion compensated reconstruction, additional tissue property quantification, signal time course analysis, and synthetic LGE image generation. Such technical developments can enable simplified CMR protocols by combining multiple evaluations into a single protocol and reducing the number of breath-held scans. cMRF continues to be reported for use in a range of pathologies; however barriers to clinical implementation remain. Technical developments are described in this review, followed by a focus on potential clinical applications that they may support. Clinical translation of cMRF could shorten protocols, improve CMR accessibility, and provide additional information as compared to conventional cardiac parametric mapping methods. Current needs for clinical implementation are discussed, as well as how those needs may be met in order to bring cMRF from its current research setting to become a viable tool for patient care.
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Affiliation(s)
- Brendan L Eck
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Yim
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse I Hamilton
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Gastao José Lima da Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, England, UK
| | - Xiaojuan Li
- Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott D Flamm
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, England, UK
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Deborah H Kwon
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
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12
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Deep Learning to Classify AL versus ATTR Cardiac Amyloidosis MR Images. Biomedicines 2023; 11:biomedicines11010193. [PMID: 36672702 PMCID: PMC9855341 DOI: 10.3390/biomedicines11010193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
The aim of this work was to compare the classification of cardiac MR-images of AL versus ATTR amyloidosis by neural networks and by experienced human readers. Cine-MR images and late gadolinium enhancement (LGE) images of 120 patients were studied (70 AL and 50 TTR). A VGG16 convolutional neural network (CNN) was trained with a 5-fold cross validation process, taking care to strictly distribute images of a given patient in either the training group or the test group. The analysis was performed at the patient level by averaging the predictions obtained for each image. The classification accuracy obtained between AL and ATTR amyloidosis was 0.750 for cine-CNN, 0.611 for Gado-CNN and between 0.617 and 0.675 for human readers. The corresponding AUC of the ROC curve was 0.839 for cine-CNN, 0.679 for gado-CNN (p < 0.004 vs. cine) and 0.714 for the best human reader (p < 0.007 vs. cine). Logistic regression with cine-CNN and gado-CNN, as well as analysis focused on the specific orientation plane, did not change the overall results. We conclude that cine-CNN leads to significantly better discrimination between AL and ATTR amyloidosis as compared to gado-CNN or human readers, but with lower performance than reported in studies where visual diagnosis is easy, and is currently suboptimal for clinical practice.
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13
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Kreiniz N, Gertz MA. Bad players in AL amyloidosis in the current era of treatment. Expert Rev Hematol 2023; 16:33-49. [PMID: 36620914 PMCID: PMC9905376 DOI: 10.1080/17474086.2023.2166924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Systemic AL amyloidosis (ALA) is a clonal plasma cell (PC) disease characterized by deposition of amyloid fibrils in different organs and tissues. Traditionally, the prognosis of ALA is poor and is primarily defined by cardiac involvement. The modern prognostic models are based on cardiac markers and free light chain difference (dFLC). Cardiac biomarkers have low specificity and are dependent on renal function, volume status, and cardiac diseases other than ALA. New therapies significantly improved the prognosis of the disease. The advancements in technologies - cardiac echocardiography (ECHO) and cardiac MRI (CMR), as well as new biological markers, relying on cardiac injury, inflammation, endothelial damage, and clonal and non-clonal PC markers are promising. AREAS COVERED An update on the prognostic significance of cardiac ALA, number of involved organs, response to treatment, including minimal residual disease (MRD), ECHO, MRI, and new biological markers will be discussed. The literature search was done in PubMed and Google Scholar, and the most recent and relevant data are included. EXPERT OPINION Prospective multicenter trials, evaluating multiple clinical and laboratory parameters, should be done to improve the risk assessment models in ALA in the modern era of therapy.
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Affiliation(s)
- Natalia Kreiniz
- Division of Hematology, Bnai Zion Medical Centre, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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14
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Matsuda N, Otsuka H, Otani T, Azane S, Kunikane Y, Otomi Y, Ueki Y, Kubota M, Amano M, Yagi S, Sata M, Harada M. New quantitative indices of cardiac amyloidosis with 99mTc-pyrophosphate scintigraphy. Jpn J Radiol 2022; 41:428-436. [PMID: 36449252 DOI: 10.1007/s11604-022-01364-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Amyloid light chain (AL) and transthyretin (ATTR) are the major subtypes of cardiac amyloidosis (CA). 99mTc-pyrophosphate (PYP) scintigraphy is used to differentiate ATTR from other CA subtypes. We adapted the standardized uptake value (SUV) for 99mTc-PYP and proposed two quantitative indices, amyloid deposition volume (AmyDV) and total amyloid uptake (TAU). This study aimed to evaluate the utility of these quantitative indices in differentiating ATTR from non-ATTRs. MATERIALS AND METHODS Before the SUV measurement, the Becquerel calibration factor (BCF) of 99mTc was obtained by a phantom experiment. Thirty-two patients who had undergone hybrid SPECT/CT imaging 3 h after injection of 99mTc-PYP (370 MBq) were studied. CT attenuation correction for image reconstruction was applied in all. We calculated SUV, AmyDV, and TAU using a quantitative analysis software program for bone SPECT (GI-BONE) and analyzed AmyDV using two methods: threshold method (set 40%); and constant value method (average SUVmax of ribs). We assessed the diagnostic ability of heart-to-contralateral lung (H/CL) ratio, SUV, AmyDV, and TAU to differentiate ATTR from non-ATTR using receiver operating characteristic (ROC) analysis. RESULTS Statistically significant differences in all quantitative indices were observed between ATTR and non-ATTR. The area under the curve of each quantitative index for discriminating between ATTR and non-ATTR were as follows: H/CL, 0.997; SUVmax, 0.953; SUVmean (M1), 0.964; SUVmean (M2), 0.969; AmyDV (M1), 0.875; AmyDV (M2), 0.974; and TAU, 0.974. The AmyDV (M2) had higher diagnostic ability than AmyDV (M1). Thus, TAU was calculated as AmyDV (M2) × SUVmean (M2). In the ROC curve, SUV, AmyDV, and TAU had almost the same diagnostic ability as H/CL in distinguishing ATTR from non-ATTRs. CONCLUSIONS We propose two novel 3D-based quantitative parameters (AmyDV and TAU) that have almost equal ability to discriminate ATTR from non-ATTR.
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Affiliation(s)
- Noritake Matsuda
- Department of Radiology, Tokushima University Hospital, Kuramoto-Cho 2-50-1, Tokushima, 770-8503, Japan
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Tamaki Otani
- Advance Radiation Research, Education and Management Center, Tokushima University, Tokushima, Japan
| | - Shota Azane
- Department of Radiology, Tokushima University Hospital, Kuramoto-Cho 2-50-1, Tokushima, 770-8503, Japan
| | - Yamato Kunikane
- Department of Radiology, Tokushima University Hospital, Kuramoto-Cho 2-50-1, Tokushima, 770-8503, Japan
| | - Yoichi Otomi
- Department of Radiology and Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yuya Ueki
- Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masahiro Kubota
- Department of Radiology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Masafumi Amano
- Department of Radiology, Tokushima University Hospital, Kuramoto-Cho 2-50-1, Tokushima, 770-8503, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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15
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Guo Y, Li X, Wang Y. State of the Art: Quantitative Cardiac MRI in Cardiac Amyloidosis. J Magn Reson Imaging 2022; 56:1287-1301. [PMID: 35770942 DOI: 10.1002/jmri.28314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
Cardiac amyloidosis (CA) is characterized by amyloid infiltration in the myocardial extracellular space, causing heart failure. Patients with CA are currently underdiagnosed. Cardiac involvement is significantly associated with the prognosis and treatment decision-making for CA. Early identification and accurate stratification are the crucial first step in patient management. Comprehensive cardiac MRI-based evaluation of the cardiac structure, function, and myocardial tissue characterization assesses cardiac involvement by tracing disease processes. Emerging quantitative tissue characterization techniques have introduced new measures that can identify early staged CA and monitor disease progression or response after treatment. Quantitative cardiac MRI is becoming an instrumental tool in understanding CA, which leads to changes in individualized patient care. This review aimed to discuss the quantitative cardiac MRI-based assessment of CA using established and emerging techniques. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Yubo Guo
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Li
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yining Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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16
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Topriceanu CC, Pierce I, Moon JC, Captur G. T 2 and T 2⁎ mapping and weighted imaging in cardiac MRI. Magn Reson Imaging 2022; 93:15-32. [PMID: 35914654 DOI: 10.1016/j.mri.2022.07.012] [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: 03/07/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
Cardiac imaging is progressing from simple imaging of heart structure and function to techniques visualizing and measuring underlying tissue biological changes that can potentially define disease and therapeutic options. These techniques exploit underlying tissue magnetic relaxation times: T1, T2 and T2*. Initial weighting methods showed myocardial heterogeneity, detecting regional disease. Current methods are now fully quantitative generating intuitive color maps that do not only expose regionality, but also diffuse changes - meaning that between-scan comparisons can be made to define disease (compared to normal) and to monitor interval change (compared to old scans). T1 is now familiar and used clinically in multiple scenarios, yet some technical challenges remain. T2 is elevated with increased tissue water - oedema. Should there also be blood troponin elevation, this oedema likely reflects inflammation, a key biological process. T2* falls in the presence of magnetic/paramagnetic materials - practically, this means it measures tissue iron, either after myocardial hemorrhage or in myocardial iron overload. This review discusses how T2 and T2⁎ imaging work (underlying physics, innovations, dependencies, performance), current and emerging use cases, quality assurance processes for global delivery and future research directions.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Iain Pierce
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Cardiac MRI Unit, Barts Heart Centre, West Smithfield, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK; UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK; The Royal Free Hospital, Centre for Inherited Heart Muscle Conditions, Cardiology Department, Pond Street, Hampstead, London, UK.
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17
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O'Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM. T2 mapping in myocardial disease: a comprehensive review. J Cardiovasc Magn Reson 2022; 24:33. [PMID: 35659266 PMCID: PMC9167641 DOI: 10.1186/s12968-022-00866-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/27/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is considered the gold standard imaging modality for myocardial tissue characterization. Elevated transverse relaxation time (T2) is specific for increased myocardial water content, increased free water, and is used as an index of myocardial edema. The strengths of quantitative T2 mapping lie in the accurate characterization of myocardial edema, and the early detection of reversible myocardial disease without the use of contrast agents or ionizing radiation. Quantitative T2 mapping overcomes the limitations of T2-weighted imaging for reliable assessment of diffuse myocardial edema and can be used to diagnose, stage, and monitor myocardial injury. Strong evidence supports the clinical use of T2 mapping in acute myocardial infarction, myocarditis, heart transplant rejection, and dilated cardiomyopathy. Accumulating data support the utility of T2 mapping for the assessment of other cardiomyopathies, rheumatologic conditions with cardiac involvement, and monitoring for cancer therapy-related cardiac injury. Importantly, elevated T2 relaxation time may be the first sign of myocardial injury in many diseases and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. This comprehensive review discusses the technical considerations and clinical roles of myocardial T2 mapping with an emphasis on expanding the impact of this unique, noninvasive tissue parameter.
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Affiliation(s)
- Aaron T O'Brien
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Katarzyna E Gil
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| | - Karolina M Zareba
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.
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18
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Sozzi FB, Iacuzio L, Belmonte M, Schiavone M, Bursi F, Gherbesi E, Levy F, Canetta C, Carugo S. Early diagnosis of cardiomyopathies by cardiac magnetic resonance. Overview of the main criteria. Monaldi Arch Chest Dis 2022; 92. [PMID: 35416001 DOI: 10.4081/monaldi.2022.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/15/2022] [Indexed: 01/05/2023] Open
Abstract
Cardiomyopathies (CMPs) are diseases of the heart muscle. They include a variety of myocardial disorders that manifest with various structural and functional phenotypes and are frequently genetic. Myocardial disease caused by known cardiovascular causes (such as hypertension, ischemic heart disease, or valvular disease) should be distinguished from CMPs for classification and management purposes. Identification of various CMP phenotypes relies primarily upon echocardiographic evaluation. In selected cases, cardiac magnetic resonance imaging (CMR) or computed tomography may be useful to identify and localize fatty infiltration, inflammation, scar/fibrosis, focal hypertrophy, and better visualize the left ventricular apex and right ventricle. CMR imaging has emerged as a comprehensive tool for the diagnosis and follow-up of patients with CMPs. The accuracy and reproducibility in evaluating cardiac structures, the unique ability of non-invasive tissue characterization and the lack of ionizing radiation, make CMR very attractive as a potential "all-in-one technique". Indeed, it provides valuable data to confirm or establish the diagnosis, screen subclinical cases, identify aetiology, establish the prognosis. Additionally, it provides information for setting a risk stratification (based on evaluation of proved independent prognostic factors as ejection fraction, end-systolic-volume, myocardial fibrosis) and follow-up. Last, it helps to monitor the response to the therapy. In this review, the pivotal role of CMR in the comprehensive evaluation of patients with CMP is discussed, highlighting the key features guiding differential diagnosis and the assessment of prognosis.
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Affiliation(s)
- Fabiola B Sozzi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Marta Belmonte
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan.
| | - Elisa Gherbesi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Ciro Canetta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | - Stefano Carugo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
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19
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Yilmaz A. Interpretation of CMR-Based Mapping Findings in Cardiac Amyloidosis: Please Act With Caution! JACC Cardiovasc Imaging 2022; 15:604-606. [PMID: 35393064 DOI: 10.1016/j.jcmg.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/24/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Yilmaz
- Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Münster, Germany.
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20
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Cuddy SAM, Jerosch-Herold M, Falk RH, Kijewski MF, Singh V, Ruberg FL, Sanchorawala V, Landau H, Maurer MS, Yee AJ, Bianchi G, Di Carli MF, Liao R, Kwong RY, Dorbala S. Myocardial Composition in Light-Chain Cardiac Amyloidosis More Than 1 Year After Successful Therapy. JACC Cardiovasc Imaging 2022; 15:594-603. [PMID: 34922860 PMCID: PMC8995332 DOI: 10.1016/j.jcmg.2021.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The goals of this study were to characterize myocardial composition during the active and remission phases of light-chain (AL) cardiac amyloidosis. BACKGROUND Cardiac dysfunction in AL amyloidosis is characterized by dual insults to the myocardium from infiltration and toxicity from light chains during the active phase and by infiltration alone in the remission phase. METHODS Prospectively enrolled subjects with cardiac AL amyloidosis (21 remission AL amyloidosis; age: 63.4 ± 7.3 years; 47.6% male; and 48 active AL amyloidosis; age: 62.5 ± 7.4 years; 60.4% male) underwent contrast-enhanced cardiac magnetic resonance with T1 and T2 mapping and measurement of extracellular volume (ECV). By definition, serum free light-chain levels were normal for at least 1 year following successful AL therapy in the remission group and abnormal in the active group. RESULTS Myocardial ECV was similarly expanded in the remission and active AL amyloidosis groups (0.488 ± 0.082 vs 0.519 ± 0.083, respectively; P = 0.15). However, myocardial T2 relaxation times (47.7 ± 3.2 ms vs 45.5 ± 3.0 ms; P = 0.008) as well as native T1 times (1,368 ms [IQR: 1,290-1,422 ms] vs 1,264 ms [IQR: 1,203-1,380 ms]; P = 0.024) were significantly higher in the remission compared to the active AL amyloidosis group. CONCLUSIONS Myocardial ECV is substantially expanded in the active AL and remission AL cardiac amyloidosis groups, but native T1 values were higher, suggesting a different myocardial composition. There is no evidence of myocardial edema in active AL cardiac amyloidosis. Future phenotyping studies of AL cardiac amyloidosis need to consider complementary myocardial markers that define the interstitial milieu in addition to changes in extracellular volume. (Molecular Imaging of Primary Amyloid Cardiomyopathy; NCT02641145).
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Affiliation(s)
- Sarah A M Cuddy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; 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
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marie Foley Kijewski
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vasvi Singh
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vaishali Sanchorawala
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Landau
- Division of Medical Oncology, Memorial Sloan Kettering Medical Center, New York, New York, USA
| | - Matthew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew J Yee
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Giada Bianchi
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ronglih Liao
- Amyloidosis Program, Stanford University, Stanford, California, USA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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21
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Eck BL, Seiberlich N, Flamm SD, Hamilton JI, Suresh A, Kumar Y, Hanna M, Houston A, Tew D, Tang WHW, Kwon DH. Characterization of cardiac amyloidosis using cardiac magnetic resonance fingerprinting. Int J Cardiol 2022; 351:107-110. [PMID: 34963645 PMCID: PMC8857016 DOI: 10.1016/j.ijcard.2021.12.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/26/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy with poor prognosis absent appropriate treatment. Elevated native myocardial T1 and T2 have been reported for CA, and tissue characterization by cardiac MRI may expedite diagnosis and treatment. Cardiac Magnetic Resonance Fingerprinting (cMRF) has the potential to enable tissue characterization for CA through rapid, simultaneous T1 and T2 mapping. Furthermore, cMRF signal timecourses may provide additional information beyond myocardial T1 and T2. METHODS Nine CA patients and five controls were scanned at 3 T using a prospectively gated cMRF acquisition. Two cMRF-based analysis approaches were examined: (1) relaxometric-based linear discriminant analysis (LDA) using native T1 and T2, and (2) signal timecourse-based LDA. The Fisher coefficient was used to compare the separability of patient and control groups from both approaches. Leave-two-out cross-validation was employed to evaluate the classification error rates of both approaches. RESULTS Elevated myocardial T1 and T2 was observed in patients vs controls (T1: 1395 ± 121 vs 1240 ± 36.4 ms, p < 0.05; T2: 36.8 ± 3.3 vs 31.8 ± 2.6 ms, p < 0.05). LDA scores were elevated in patients for relaxometric-based LDA (0.56 ± 0.28 vs 0.18 ± 0.13, p < 0.05) and timecourse-based LDA (0.97 ± 0.02 vs 0.02 ± 0.02, p < 0.05). The Fisher coefficient was greater for timecourse-based LDA (60.8) vs relaxometric-based LDA (1.6). Classification error rates were lower for timecourse-based LDA vs relaxometric-based LDA (12.6 ± 24.3 vs 22.5 ± 30.1%, p < 0.05). CONCLUSIONS These findings suggest that cMRF may be a valuable technique for the detection and characterization of CA. Analysis of cMRF signal timecourse data may improve tissue characterization as compared to analysis of native T1 and T2 alone.
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Affiliation(s)
- Brendan L Eck
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Nicole Seiberlich
- Department of Radiology, Department of Biomedical Engineering, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Scott D Flamm
- Imaging Institute, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jesse I Hamilton
- Department of Radiology, Department of Biomedical Engineering, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Abhilash Suresh
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yash Kumar
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mazen Hanna
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Angel Houston
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Derrek Tew
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - W H Wilson Tang
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Deborah H Kwon
- Imaging Institute, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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22
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Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J 2022; 43:1157-1172. [PMID: 35176758 PMCID: PMC8903393 DOI: 10.1093/eurheartj/ehac031] [Citation(s) in RCA: 284] [Impact Index Per Article: 142.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Emerging as a new epidemic, long COVID or post-acute sequelae of coronavirus disease 2019 (COVID-19), a condition characterized by the persistence of COVID-19 symptoms beyond 3 months, is anticipated to substantially alter the lives of millions of people globally. Cardiopulmonary symptoms including chest pain, shortness of breath, fatigue, and autonomic manifestations such as postural orthostatic tachycardia are common and associated with significant disability, heightened anxiety, and public awareness. A range of cardiovascular (CV) abnormalities has been reported among patients beyond the acute phase and include myocardial inflammation, myocardial infarction, right ventricular dysfunction, and arrhythmias. Pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiac diseases which are abundant in those at risk of severe disease. In this review, we discuss the definition of long COVID and its epidemiology, with an emphasis on cardiopulmonary symptoms. We further review the pathophysiological mechanisms underlying acute and chronic CV injury, the range of post-acute CV sequelae, and impact of COVID-19 on multiorgan health. We propose a possible model for referral of post-COVID-19 patients to cardiac services and discuss future directions including research priorities and clinical trials that are currently underway to evaluate the efficacy of treatment strategies for long COVID and associated CV sequelae.
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Affiliation(s)
- Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 3252 Clinical Science Center, 600 Highland Ave, Madison, WI 53792, USA
| | - Thomas F. Lüscher
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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23
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Pfirman KS, Newton W, Garst C, Patel S, Dawson Dowe J. A Late Diagnosis of Transthyretin Amyloidosis. Cureus 2022; 14:e21481. [PMID: 35223261 PMCID: PMC8858644 DOI: 10.7759/cureus.21481] [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] [Accepted: 01/20/2022] [Indexed: 12/05/2022] Open
Abstract
Cardiac amyloidosis is a rare disease caused by the accumulation of protein-based fibrils that deposit into the myocardium, causing disease. The accumulation of amyloid in the heart tissue causes the heart to become increasingly stiff, reducing compliance, with the eventual decline of the heart’s systolic function over time as the disease progresses. The restrictive physiology of the disease usually prompts investigation; however, if allowed to progress, the systolic function becomes affected in the later stages of the disease. We present a case of late-stage transthyretin-related amyloidosis (ATTR).
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24
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Ionescu TM, Jalloul W, Stolniceanu CR, Iacob R, Grecu LP, Stătescu AM, Grierosu I, Guțu M, Gavrilescu A, Daniela C, Petriș A, Ciocoiu M, Ungureanu C, Ștefănescu C. Transthyretin cardiac amyloidosis: a review of the nuclear imaging findings with emphasis on the radiotracers mechanisms. Ann Nucl Med 2021; 35:967-993. [PMID: 34275068 DOI: 10.1007/s12149-021-01650-3] [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: 12/29/2020] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
Cardiac amyloidosis is a protein deposition disease characterized by the infiltration of the myocardium and coronary arteries resulting in a progressive thickening of both ventricles, interatrial septum and atrioventricular valves, eventually leading to organ failure. It is a disease hard to diagnose, due to the lack of diagnostic investigations. However, development of new and more accurate examinations is undergoing. Endomyocardial biopsy is the gold standard investigation for this disease, but it has its limitations (invasive and not widely available). Other investigations may be able to detect the presence of cardiac amyloidosis but cannot specify the type involved. To that end, nuclear medicine through bone scanning offers a simple, non-invasive solution to detect, differentiate and diagnose transthyretin cardiac amyloidosis (ATTR) from other types of cardiac amyloidosis. In order to demonstrate the importance of bone scanning we will present a few methods of image processing based on literature and a personalized method, followed by a few important examples of positive cases. The aim of this review was to present the current methods of ATTR detection with emphasis on nuclear medicine bone scanning and its important place in the decision algorithm of the cardiologist for a personalized approach to this pathology.
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Affiliation(s)
- Teodor M Ionescu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania.
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania.
| | - Wael Jalloul
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Cati R Stolniceanu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Roxana Iacob
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Laura P Grecu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Ana-Maria Stătescu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Irena Grierosu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Mihai Guțu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Adrian Gavrilescu
- Cardiology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Crișu Daniela
- Cardiology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Antoniu Petriș
- Cardiology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Manuela Ciocoiu
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Cristina Ungureanu
- Endocrinology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Cipriana Ștefănescu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
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25
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Abulizi M, Sifaoui I, Wuliya-Gariepy M, Kharoubi M, Israël JM, Emsen B, Bodez D, Monnet A, Didierlaurent D, Tacher V, Luciani A, Damy T, Deux JF, Itti E. 18F-sodium fluoride PET/MRI myocardial imaging in patients with suspected cardiac amyloidosis. J Nucl Cardiol 2021; 28:1586-1595. [PMID: 31512197 DOI: 10.1007/s12350-019-01885-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We evaluated the diagnostic performance of 18F-NaF PET/MRI in patients with suspected cardiac amyloidosis (CA). METHODS Twenty-seven consecutive patients underwent myocardial PET 1 hour after injection of 4 MBq/kg 18F-NaF with simultaneous MRI including cine-MRI, T1 and T2 mapping, first-pass and late gadolinium enhancement (LGE). 18F-NaF uptake was measured visually and semi-quantitatively by calculating myocardium-to-blood pool (M/B) ratios. CA was confirmed histologically. RESULTS Transthyretin (TTR)-CA was diagnosed in 16 patients, light-chain (AL)-CA in 7, and no-CA in 4. Visual interpretation of 18F-NaF images revealed a relative increase in myocardial uptake in only 3 patients, all with TTR CA, and a relative decrease in 13, including 7 AL CA, 3 no-CA, and 3 TTR CA. M/B ratios were significantly higher in TTR CA (1.00 ± 0.12) than in AL CA (0.81 ± 0.06, P = 0.001) or in no-CA (0.73 ± 0.16, P = 0.006). The optimal M/B cut-off to distinguish TTR CA from AL CA was ≥ 0.90 (Fischer, P = 0.0005). By comparison, classification of patients using 99mTc-HMDP heart-to-mediastinum ratios with the previously published cut-off ≥ 1.21 reached higher significance (P < 0.0001). Among MRI parameters, myocardial T1, LGE score, and extracellular volume were higher in CA than in no-CA patients, 1409 ± 76 vs 1278 ± 35 ms (P = 0.004), 10.35 ± 5.30 vs 3.50 ± 3.42 (P = 0.03), and 46 ± 10 vs 33 ± 8 % (P = 0.01), respectively. CONCLUSION 18F-NaF PET/MRI shows good diagnostic performance when semi-quantification is used. However, contrast is low and visual interpretation may be challenging in routine. PET/MRI could constitute a one-stop-shop evaluation of amyloid load and cardiac function in patients needing rapid work-up.
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Affiliation(s)
- Mukedaisi Abulizi
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
| | - Islem Sifaoui
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
| | - Mijiti Wuliya-Gariepy
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- Department of Cardiology, CHU Henri Mondor, AP-HP/U-PEC, 94010, Créteil, France
| | - Mounira Kharoubi
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
- Department of Cardiology, CHU Henri Mondor, AP-HP/U-PEC, 94010, Créteil, France
| | - Jean-Marc Israël
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Berivan Emsen
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Diane Bodez
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
- Department of Cardiology, CHU Henri Mondor, AP-HP/U-PEC, 94010, Créteil, France
| | | | | | - Vania Tacher
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
| | - Alain Luciani
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Thibaud Damy
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
- Department of Cardiology, CHU Henri Mondor, AP-HP/U-PEC, 94010, Créteil, France
| | - Jean-François Deux
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France
| | - Emmanuel Itti
- SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France.
- Amyloid Research Institute, IMRB U955, U-PEC, 94010, Créteil, France.
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26
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Agha AM, Palaskas N, Patel AR, DeCara J, Parwani P, Iliescu C, Durand JB, Kim P, Hassan S, Gladish G, Lee HC, Kaufman GP, Lopez-Mattei JC. Cardiac Magnetic Resonance Predicting Outcomes Among Patients at Risk for Cardiac AL Amyloidosis. Front Cardiovasc Med 2021; 8:626414. [PMID: 34268341 PMCID: PMC8276072 DOI: 10.3389/fcvm.2021.626414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patients with systemic AL amyloidosis (AL) should be evaluated for cardiac amyloidosis (CA), as prognosis is strongly related to cardiac involvement. We assessed the characteristics of patients referred to cardiac magnetic resonance (CMR) with suspected CA from a cancer center and determine predictors of mortality/heart failure hospitalizations (HFH). Methods: Forty-four consecutive patients referred for CMR with suspected CA were retrospectively included. Variables collected included cardiac biomarkers, in addition to echocardiographic and CMR variables. Survival analyses were performed to determine which variables were more predictive of mortality and HFH. Results: Of the 44 patients included, 55% were females. 73% of patients were diagnosed with CA by CMR; 56% of them had an established diagnosis of AL. Patients with CA by CMR had higher native T1, higher extracellular volume (ECV) fraction, higher T2, less negative GLS by Echo, and higher troponin I and B-type natriuretic peptide (BNP). Kaplan-Meier survival analysis revealed that the following were predictive of mortality: an ECV ≥ 0.50 (p = 0.0098), CMR LVEF < 50% (p = 0.0010), T2/ECV ≤ 100 (p = 0.0001), and troponin I > 0.03 (p = 0.0025). In a stepwise conditional Cox logistic regression model, the only variable predictive of a composite of mortality and HFH was ECV (HR: 1.17, 95% CI = 1.02–1.34 p = 0.030). Conclusion: ECV seems to be an important biomarker that could be a predictor of outcomes in cardiac AL amyloidosis. In combination, CMR and serum cardiac biomarkers might help to establish prognosis in patients with CA.
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Affiliation(s)
- Ali M Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX, United States
| | - Nicolas Palaskas
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Amit R Patel
- Cardiology Section, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jeanne DeCara
- Cardiology Section, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, United States
| | - Cezar Iliescu
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean B Durand
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Kim
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory Gladish
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hans C Lee
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gregory P Kaufman
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Juan C Lopez-Mattei
- Division of Internal Medicine, Department Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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27
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Abstract
Purpose of Review The purpose of this review is to summarize the application of cardiac magnetic resonance (CMR) in the diagnostic and prognostic evaluation of patients with heart failure (HF). Recent Findings CMR is an important non-invasive imaging modality in the assessment of ventricular volumes and function and in the analysis of myocardial tissue characteristics. The information derived from CMR provides a comprehensive evaluation of HF. Its unique ability of tissue characterization not only helps to reveal the underlying etiologies of HF but also offers incremental prognostic information. Summary CMR is a useful non-invasive tool for the diagnosis and assessment of prognosis in patients suffering from heart failure.
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Affiliation(s)
- Chuanfen Liu
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Victor A. Ferrari
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
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28
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Eck BL, Flamm SD, Kwon DH, Tang WHW, Vasquez CP, Seiberlich N. Cardiac magnetic resonance fingerprinting: Trends in technical development and potential clinical applications. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2021; 122:11-22. [PMID: 33632415 PMCID: PMC8366914 DOI: 10.1016/j.pnmrs.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 05/02/2023]
Abstract
Quantitative cardiac magnetic resonance has emerged in recent years as an approach for evaluating a range of cardiovascular conditions, with T1 and T2 mapping at the forefront of these developments. Cardiac Magnetic Resonance Fingerprinting (cMRF) provides a rapid and robust framework for simultaneous quantification of myocardial T1 and T2 in addition to other tissue properties. Since the advent of cMRF, a number of technical developments and clinical validation studies have been reported. This review provides an overview of cMRF, recent technical developments, healthy subject and patient studies, anticipated technical improvements, and potential clinical applications. Recent technical developments include slice profile and pulse efficiency corrections, improvements in image reconstruction, simultaneous multislice imaging, 3D whole-ventricle imaging, motion-resolved imaging, fat-water separation, and machine learning for rapid dictionary generation. Future technical developments in cMRF, such as B0 and B1 field mapping, acceleration of acquisition and reconstruction, imaging of patients with implanted devices, and quantification of additional tissue properties are also described. Potential clinical applications include characterization of infiltrative, inflammatory, and ischemic cardiomyopathies, tissue characterization in the left atrium and right ventricle, post-cardiac transplantation assessment, reduction of contrast material, pre-procedural planning for electrophysiology interventions, and imaging of patients with implanted devices.
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Affiliation(s)
- Brendan L Eck
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Scott D Flamm
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Deborah H Kwon
- Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - W H Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Claudia Prieto Vasquez
- School of Biomedical Engineering and Imaging Sciences, King's College London, Westminster Bridge Road, London, UK.
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
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29
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Bistola V, Parissis J, Foukarakis E, Valsamaki PN, Anastasakis A, Koutsis G, Efthimiadis G, Kastritis E. Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis. Heart Fail Rev 2021; 26:861-879. [PMID: 33452596 DOI: 10.1007/s10741-020-10062-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by accumulation in the heart interstitium of amyloid fibrils formed by misfolded proteins. Most common CA types are light chain amyloidosis (AL) caused by monoclonal immunoglobulin light chains and transthyretin amyloidosis (ATTR) caused by either mutated or wild-type transthyretin aggregates. Previously considered a rare disease, CA is increasingly recognized among patients who may be misdiagnosed as undifferentiated heart failure with preserved ejection fraction (HFPEF), paradoxical low-flow/low-gradient aortic stenosis, or otherwise unexplained left ventricular hypertrophy. Progress in diagnosis has been due to the refinement of cardiac echocardiographic techniques (speckle tracking imaging) and magnetic resonance (T1 mapping) and mostly due to the advent of bone scintigraphy that has enabled noninvasive diagnosis of ATTR, limiting the need for endomyocardial biopsy. Importantly, proper management of CA starts from early recognition of suspected cases among high prevalence populations, followed by advanced diagnostic evaluation to confirm diagnosis and typing, preferentially in experienced amyloidosis centers. Differentiating ATTR from other types of amyloidosis, especially AL, is critical. Emerging targeted ATTR therapies offer the potential to improve outcomes of these patients previously treated only palliatively.
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Affiliation(s)
- Vasiliki Bistola
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - John Parissis
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Emmanouil Foukarakis
- Cardiology Department, Venizeleion General Hospital of Heraklion, Heraklion, Greece
| | - Pipitsa N Valsamaki
- Nuclear Medicine Department, "Alexandra" University General Hospital, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition University Hospital, Athens, Greece
| | - Georgios Efthimiadis
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.
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30
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Son J, Hong YJ. Treatment Response Evaluation of Cardiac Amyloidosis Using Serial T1- and T2-Mapping Cardiovascular Magnetic Resonance Imaging. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:429-434. [PMID: 36238733 PMCID: PMC9431940 DOI: 10.3348/jksr.2020.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
Amyloidosis is a multisystemic disease characterized by the accumulation of abnormal proteins in extracellular spaces in various organs, with frequent involvement of the myocardium. We report a case of a patient who had cardiac amyloidosis with a trend of reduction in native T1 and T2 values and extracellular volume fraction on serial cardiac magnetic resonance imaging after chemotherapy and stem cell transplantation. The native T1 value and the extracellular volume fraction are closely associated with tissue amyloid burden in amyloidosis patients. This case demonstrated that cardiac magnetic resonance imaging may be used as a non-invasive and quantitative biomarker in the treatment monitoring of amyloidosis.
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Affiliation(s)
- Jinwoo Son
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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31
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Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B, Captur G, Francois CJ, Jerosch-Herold M, Salerno M, Teague SD, Valsangiacomo-Buechel E, van der Geest RJ, Bluemke DA. Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 2020; 22:87. [PMID: 33308262 PMCID: PMC7734766 DOI: 10.1186/s12968-020-00683-3] [Citation(s) in RCA: 258] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
- Institute for Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, InselspitalBern, Switzerland
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI, 53726, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Gabriella Captur
- MRC Unit of Lifelong Health and Ageing At UCL, 5-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK
- Inherited Heart Muscle Conditions Clinic, Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Shawn D Teague
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Emanuela Valsangiacomo-Buechel
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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32
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Wang TKM, Brizneda MV, Kwon DH, Popovic ZB, Flamm SD, Hanna M, Griffin BP, Xu B. Reference Ranges, Diagnostic and Prognostic Utility of Native
T1
Mapping and Extracellular Volume for Cardiac Amyloidosis: A Meta‐Analysis. J Magn Reson Imaging 2020; 53:1458-1468. [DOI: 10.1002/jmri.27459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Maria Vega Brizneda
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Deborah H. Kwon
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Zoran B. Popovic
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Scott D. Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Mazen Hanna
- Section of Heart Failure and Cardiac Transplantation, Sydell and Arnold Miller Family Heart and Vascular Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Brian P. Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland Ohio 44195 USA
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33
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Khanna S, Wen I, Bhat A, Chen HHL, Gan GCH, Pathan F, Tan TC. The Role of Multi-modality Imaging in the Diagnosis of Cardiac Amyloidosis: A Focused Update. Front Cardiovasc Med 2020; 7:590557. [PMID: 33195479 PMCID: PMC7661689 DOI: 10.3389/fcvm.2020.590557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/24/2020] [Indexed: 12/25/2022] Open
Abstract
Cardiac amyloidosis (CA) is a unique disease entity involving an infiltrative process, typically resulting in a restrictive cardiomyopathy with diastolic heart failure that ultimately progresses to systolic heart failure. The two most common subtypes are light-chain and transthyretin amyloidosis. Early diagnosis of this disease entity, especially light-chain CA subtype, is crucial, as it portends a poorer prognosis. This review focuses on the clinical utility of the various imaging modalities in the diagnosis and differentiation of CA subtypes. This review also aims to highlight the key advances in each of the imaging modalities in the diagnosis and prognostication of CA.
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Affiliation(s)
- Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Ivy Wen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Faraz Pathan
- Department of Cardiovascular Imaging, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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34
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Prognostic implications of pericardial and pleural effusion in patients with cardiac amyloidosis. Clin Res Cardiol 2020; 110:532-543. [PMID: 32914241 PMCID: PMC8055634 DOI: 10.1007/s00392-020-01698-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pericardial and pleural effusion are common findings in patients with cardiac amyloidosis (CA). It is not known, whether effusions correlate with right ventricular (RV) function in these patients. Furthermore, data on the prognostic significance of pleural and pericardial effusion in CA is scarce. METHODS Patients with transthyretin (ATTR) and light chain (AL) CA were included in a clinical registry. All patients underwent transthoracic echocardiography at baseline. The presence of pericardial and pleural effusion was determined in every patient. The clinical endpoint was defined as cardiac death or heart failure hospitalization. RESULTS In total, 143 patients were analysed. Of these, 85 patients were diagnosed with ATTR and 58 patients with AL. Twenty-four patients presented with isolated pericardial effusion and 35 with isolated pleural effusion. In 19 patients, both pericardial and pleural effusion were found and in 65 patients no effusion was present at baseline. The presence of pleural effusion correlated well with poor RV function, measured by global RV free-wall strain (p = 0.007) in patients with AL, but not in ATTR. No such correlation could be found for pericardial effusion in either amyloidosis subtype. Patients with AL presenting with pleural effusion had worse outcomes compared to patients with pericardial effusion alone or no effusion at baseline. In the ATTR group, there was no difference in outcomes according to presence and type of effusion. CONCLUSION More than 50% of patients with CA presented with pleural and/or pericardial effusions. While pleural effusion was clearly associated with poor RV function in AL, we were not able to detect this association with pericardial effusion.
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35
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Oda S, Kidoh M, Nagayama Y, Takashio S, Usuku H, Ueda M, Yamashita T, Ando Y, Tsujita K, Yamashita Y. Trends in Diagnostic Imaging of Cardiac Amyloidosis: Emerging Knowledge and Concepts. Radiographics 2020; 40:961-981. [DOI: 10.1148/rg.2020190069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Seitaro Oda
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masafumi Kidoh
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yasunori Nagayama
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seiji Takashio
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hiroki Usuku
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Mitsuharu Ueda
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Taro Yamashita
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yukio Ando
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Tsujita
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yasuyuki Yamashita
- From the Departments of Diagnostic Radiology (S.O., M.K., Y.N., Y.Y.), Cardiovascular Medicine (S.T., H.U., K.T.), Molecular Laboratory Medicine (H.U.), and Neurology (M.U., T.Y., Y.A.), Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto 860-8556, Japan
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36
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Blankstein R, Shaw L, Chandrashekhar Y. Amyloidosis Imaging. JACC Cardiovasc Imaging 2020; 13:1392-1394. [DOI: 10.1016/j.jcmg.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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37
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Snel GJH, van den Boomen M, Hernandez LM, Nguyen CT, Sosnovik DE, Velthuis BK, Slart RHJA, Borra RJH, Prakken NHJ. Cardiovascular magnetic resonance native T 2 and T 2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2020; 22:34. [PMID: 32393281 PMCID: PMC7212597 DOI: 10.1186/s12968-020-00627-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The clinical application of cardiovascular magnetic resonance (CMR) T2 and T2* mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T2 and T2* mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated. METHODS The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T2 or T2* values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data. RESULTS One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T2 values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with controls. T2 values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T2* values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P < 0.01) compared with controls. T2* values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies. CONCLUSIONS The clinical utility of T2 and T2* mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T2 and T2* values of most cardiomyopathies are similar.
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Affiliation(s)
- G J H Snel
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - M van den Boomen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - L M Hernandez
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C T Nguyen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - D E Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Division of Health Sciences and Technology, Harvard-MIT, 7 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Dienstweg 1, 7522 ND, Enschede, The Netherlands
| | - R J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Diagnostic Performance of Abnormal Nulling on Cardiac Magnetic Resonance Imaging Look Locker Inversion Time Sequence in Differentiating Cardiac Amyloidosis Types. J Thorac Imaging 2020; 35:334-339. [DOI: 10.1097/rti.0000000000000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Fukushima K, Nakano S, Matsunari I. Cardiac Amyloidosis: Current Diagnostic Strategies Using Multimodality Imaging. ANNALS OF NUCLEAR CARDIOLOGY 2020; 6:67-73. [PMID: 37123486 PMCID: PMC10133936 DOI: 10.17996/anc.20-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 05/02/2023]
Abstract
Amyloidosis is a systemic disorder in which abnormal amyloid proteins deposit in body organs, leading to organ dysfunction and death. Cardiac amyloid deposition, causing a sort of restrictive cardiomyopathy and associated with increased risk of mortality. Most cases of cardiac amyloidosis are of either light chain or transthyretin type. Early and accurate diagnosis of cardiac amyloidosis may improve outcomes. However, diagnosis requires systematic approach including electrocardiography and biomarkers when encountered suspicious candidate. Diagnosis by multimodality noninvasive imaging have been substantially studied and established for differentiation from subtypes. Recent advance in the treatment of amyloidosis offers therapeutic monitoring and prognosis.
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Affiliation(s)
- Kenji Fukushima
- Department of Nuclear Medicine, Heart Center, Saitama Medical University International Medical Center, Saitama, Japan
- Department of Cardiology, Heart Center, Saitama Medical University International Medical Center, Saitama, Japan
- Reprint requests and correspondence: Kenji Fukushima, MD, PhD, Department of Nuclear Medicine, Heart Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350–1298, Japan / E-mail:
| | - Shintaro Nakano
- Department of Cardiology, Heart Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ichiro Matsunari
- Department of Nuclear Medicine, Saitama Medical University, Saitama, Japan
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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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Vajapey R, Eck B, Tang W, Kwon DH. Advances in MRI Applications to Diagnose and Manage Cardiomyopathies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:74. [PMID: 31773390 DOI: 10.1007/s11936-019-0762-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The prevalence of heart failure continues to rise, and imaging characterization of the cardiomyopathic process is important for identifying myocardial disease, initiating appropriate treatment, and improving outcomes. We aimed to summarize recent advances in cardiac magnetic resonance imaging (CMR) applications for the diagnosis, characterization, and implications on management of various cardiomyopathies. RECENT FINDINGS Parametric mapping by CMR has emerged as an important advancement in quantification of myocardial fibrosis, increased extracellular space, and myocardial edema. In addition, improved assessment of myocardial function with myocardial strain assessment may provide early identification of patients at risk and determining responsiveness to therapeutic interventions. Novel MRI techniques and the advent of artificial intelligence may help to uncover important mechanistic insights into the cardiomyopathic process. Innovative CMR techniques continue to evolve, and it will be of interest to determine how these advances can be incorporated into clinical practice to improve diagnosis, treatment, and management of patients with cardiomyopathies.
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Affiliation(s)
- Ramya Vajapey
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Brendan Eck
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Wilson Tang
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Deborah H Kwon
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA. .,Department of Cardiovascular Medicine, Cleveland Clinic, Imaging Institute, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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Yamamoto H, Yokochi T. Transthyretin cardiac amyloidosis: an update on diagnosis and treatment. ESC Heart Fail 2019; 6:1128-1139. [PMID: 31553132 PMCID: PMC6989279 DOI: 10.1002/ehf2.12518] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/19/2019] [Accepted: 08/25/2019] [Indexed: 12/14/2022] Open
Abstract
Transthyretin cardiac amyloidosis (ATTR‐CA) demonstrates progressive, potentially fatal, and infiltrative cardiomyopathy caused by extracellular deposition of transthyretin‐derived insoluble amyloid fibrils in the myocardium. Two distinct types of transthyretin (wild type or variant) become unstable, and misfolding forms aggregate, resulting in amyloid fibrils. ATTR‐CA, which has previously been underrecognized and considered to be rare, has been increasingly recognized as a cause of heart failure with preserved ejection fraction among elderly persons. With the advanced technology, the diagnostic tools have been improving for cardiac amyloidosis. Recently, the efficacy of several disease‐modifying agents focusing on the amyloidogenic process has been demonstrated. ATTR‐CA has been changing from incurable to treatable. Nevertheless, there are still no prognostic improvements due to diagnostic delay or misdiagnosis because of phenotypic heterogeneity and co‐morbidities. Thus, it is crucial for clinicians to be aware of this clinical entity for early diagnosis and proper treatment. In this mini‐review, we focus on recent advances in diagnosis and treatment of ATTR‐CA.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, 1-1-1 Hiyoshidai, Tomisato, Chiba, 286-0201, Japan
| | - Tomoki Yokochi
- Department of Clinical Research, Chiba Tokushukai Hospital, Chiba, Japan
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Manolis AS, Manolis AA, Manolis TA, Melita H. Cardiac amyloidosis: An underdiagnosed/underappreciated disease. Eur J Intern Med 2019; 67:1-13. [PMID: 31375251 DOI: 10.1016/j.ejim.2019.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
Cardiac amyloidosis or amyloid cardiomyopathy (ACM), commonly resulting from extracellular deposition of amyloid fibrils consisted of misfolded immunoglobulin light chain (AL) or transthyretin (TTR) protein, is an underestimated cause of heart failure and cardiac arrhythmias. Among the three types of cardiac amyloidosis (wild-type or familial TTR and light-chain), the wild-type (Wt) TTR-related amyloidosis (ATTR) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF), and amyloidosis should be considered in the differential diagnosis of this heart failure group of patients. Recent advances in the diagnosis and drug treatment of ACM have ushered in a new era in early disease detection and better management of these patients. Certain clues in cardiac and extracardiac manifestations of ACM may heighten clinical suspicion and guide further confirmatory testing. Newer noninvasive imaging methods (strain echocardiography, cardiac magnetic resonance and bone scintigraphy) may obviate the need for endomyocardial biopsy in ATTR patients, while newer targeted therapies may alter the adverse prognosis in these patients. Early recognition of ACM is crucial in halting the disease process before irreversible organ damage occurs. Chemotherapy and stem-cell transplantation combined with immunomodulatory therapy may also favorably affect the course and prognosis of light chain ACM. Finally, in select patients with end-stage disease, heart transplantation may render results comparable to non-ACM patients. All these issues are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Qin J, Zhan C, Li H, Han Y, Wang H, Li R, Ma F, Yan J. Noninvasive diagnosis of hereditary transthyretin-related cardiac amyloidosis: A case report. Medicine (Baltimore) 2019; 98:e16566. [PMID: 31348283 PMCID: PMC6709038 DOI: 10.1097/md.0000000000016566] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation. PATIENT CONCERNS A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb. DIAGNOSIS The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), -technetium pyrophosphate (Tc-PYP) scintigraphy and genetic testing. INTERVENTIONS The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital. OUTCOMES A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis. LESSONS While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.
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Affiliation(s)
- Jin Qin
- Division of Cardiology, Department of Internal Medicine
| | | | | | | | - Hong Wang
- Genetic Diagnostic Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Rui Li
- Division of Cardiology, Department of Internal Medicine
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine
| | - Jiangtao Yan
- Division of Cardiology, Department of Internal Medicine
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Seraphim A, Knott KD, Augusto J, Bhuva AN, Manisty C, Moon JC. Quantitative cardiac MRI. J Magn Reson Imaging 2019; 51:693-711. [PMID: 31111616 DOI: 10.1002/jmri.26789] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Cardiac MRI has become an indispensable imaging modality in the investigation of patients with suspected heart disease. It has emerged as the gold standard test for cardiac function, volumes, and mass and allows noninvasive tissue characterization and the assessment of myocardial perfusion. Quantitative MRI already has a key role in the development and incorporation of machine learning in clinical imaging, potentially offering major improvements in both workflow efficiency and diagnostic accuracy. As the clinical applications of a wide range of quantitative cardiac MRI techniques are being explored and validated, we are expanding our capabilities for earlier detection, monitoring, and risk stratification of disease, potentially guiding personalized management decisions in various cardiac disease models. In this article we review established and emerging quantitative techniques, their clinical applications, highlight novel advances, and appraise their clinical diagnostic potential. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:693-711.
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Affiliation(s)
- Andreas Seraphim
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kristopher D Knott
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Joao Augusto
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anish N Bhuva
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Charlotte Manisty
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - James C Moon
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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