1
|
Petersen A, Nagel SN, Hamm B, Elgeti T, Schaafs LA. Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging. Front Cardiovasc Med 2022; 9:977414. [PMID: 36337885 PMCID: PMC9631472 DOI: 10.3389/fcvm.2022.977414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Left bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images. Materials and methods Fifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash). Results Thirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44–20.44%); LBBB without artefact: 6.82% (-2.18–15.83%); controls: 4.38% (1.38–7.38%); p < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; p < 0.05). Conclusion Patients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.
Collapse
|
2
|
Krittayaphong R, Zhang S, Tanapibunpon P, Kaolawanich Y, Nakyen S. Dark-blood late gadolinium-enhancement cardiac magnetic resonance imaging for myocardial scar detection based on simplified timing scheme: single-center experience in patients with suspected coronary artery disease. Quant Imaging Med Surg 2022; 12:1037-1050. [PMID: 35111603 DOI: 10.21037/qims-21-704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to examine scar detectability using dark-blood late gadolinium enhancement (LGE) with simplified timing scheme and fixed parameters comparing to two conventional bright-blood approaches in patients with known or suspected coronary artery disease. Methods Three LGE techniques were performed in all patients with known or suspected coronary artery disease at 3 T: dark blood two-dimensional (2D) phase-sensitive inversion recovery (PSIR) preceded with a T2-preparation pulse (DB-LGE), conventional three-dimensional (3D) gradient-echo inversion recovery (3D-IR) and conventional 2D PSIR. Timing parameters in DB-LGE were tested in five clinically confirmed coronary artery disease patients with scars and fixed for the rest of the study. Two independent readers evaluated images at both patient and segment levels. Image quality and contrast ratio between scar and adjacent tissues were assessed. Concordance between the three techniques and detection rate based on expert consensus were reported. Results Forty-six patients were recruited in the study (average age 66.8 years, 69.6% male). DB-LGE demonstrated superior image quality (P=0.001 vs. 3D-IR) and scar-to-blood contrast ratio (P<0.001 vs. 3D-IR and PSIR). Among 41 patients with suspected coronary artery disease, myocardial scar was present in 30 patients (73.2%), all detected by DB-LGE, yielding a detection rate of 100% compared to 93.3% and 96.7% for bright-blood 3D-IR and PSIR. For subendocardial scar detection among 656 segments, DB-LGE had a detection rate of 99.4% compared to 57.8% for 3D-IR and 61.0% for PSIR (both P<0.001). Conclusions DB-LGE improves detection of myocardial scar compared with conventional bright-blood LGE techniques, particularly of subendocardial scar.
Collapse
Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shuo Zhang
- Philips Healthcare, Singapore.,Philips Healthcare, Hamburg, Germany
| | - Prajak Tanapibunpon
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Nakyen
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
3
|
Toia P, Maffei E, Mantini C, Runza G, La Grutta L, Grassedonio E, Guaricci A, Punzo B, Cavaliere C, Cademartiri F. Cardiac Magnetic Resonance with Delayed Enhancement of the Right Ventricle in patients with Left Ventricle primary involvement: diagnosis and evaluation of functional parameters. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022023. [PMID: 35546038 PMCID: PMC9171872 DOI: 10.23750/abm.v93i2.10765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022]
Abstract
Cardiac Magnetic Resonance (CMR) allows an accurate Right Ventricle (RV) assessment that could be of great relevance in diseases causing inflammation or fibrosis. The aim of this study was to evaluate the concomitant involvement of the RV in patients with delayed enhancement (DE) of the Left Ventricle (LV-DE) using CMR. We retrospectively enrolled 95 (male n. 66; age 55±18years; BMI 26±5kg/m2) consecutive patients with LV-DE who underwent a CMR (Achieva 1.5 T, Philips) for different indications: post-ischemic dilated cardiopathy (PDM), hypertrophic cardiomyopathy (HCM), myocardial infarction (MI), myocarditis/pericarditis (MP) and congenital heart disease (CD). We assessed the presence and extension of DE and functional parameters such as ventricular end-diastolic (EDV), end-systolic volumes (ESV) and ejection fraction (EF) of both LV and RV. Prevalence of RV-DE was 30.5% (29/95): 75% (3/4) for CD, 44% (4/9) for PDM, 36% (17/47) for MI, 27.8% (5/18) for MP and 0% (0/17) for HCM. LV-EF and RV-EF were 53±15mL and 51±13mL, respectively, for patients without RV-DE (RV-DE-), and 40±19 mL and 42±15 mL, respectively, for patients with RV-DE (RV-DE+) (p<0.05), while LV-EDV and LV-ESV were 80±28 mL and 40±26 mL, respectively, for RV-DE- and 100±45 mL and 65±49 mL, respectively, for RV-DE+ (p<0.05). The prevalence of RV-DE in patients with LV primary involvement is not negligible and it is found mainly in patients with CD and PDM and then in patients with MI and MP. It is more often associated with LV-EF and RV-EF reduction and increase in LV volumes.
Collapse
Affiliation(s)
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Italy
| | - Giuseppe Runza
- Department of Radiology, P.O. Umberto I, ASP 8, Siracusa, Italy
| | | | | | - Andrea Guaricci
- Department of Cardiology, University Hospital of Bari, Bari, Italy
| | | | | | - Filippo Cademartiri
- Department of Radiology, Fondazione Toscana Gabriele Monasterio/CNR, Pisa, Italy
| |
Collapse
|
4
|
Lee JH, Uhm JS, Suh YJ, Kim M, Kim IS, Jin MN, Cho MS, Yu HT, Kim TH, Hong YJ, Lee HJ, Shim CY, Kim YJ, Kim J, Kim JY, Joung B, Hong GR, Pak HN, Nam GB, Choi KJ, Kim YH, Lee MH. Usefulness of cardiac magnetic resonance images for prediction of sudden cardiac arrest in patients with mitral valve prolapse: a multicenter retrospective cohort study. BMC Cardiovasc Disord 2021; 21:546. [PMID: 34789163 PMCID: PMC8600905 DOI: 10.1186/s12872-021-02362-2] [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: 08/30/2020] [Accepted: 11/03/2021] [Indexed: 12/07/2022] Open
Abstract
Background An association has been identified between mitral valve prolapse (MVP) and sudden cardiac arrest (SCA), and ventricular arrhythmias (VA). This study aimed to elucidate predictive factors for SCA or VA in MVP patients. Methods MVP patients who underwent cardiac magnetic resonance (CMR) were retrospectively included. Patients with other structural heart disease or causes of aborted SCA were excluded. Clinical characteristics (sex, age, body mass index, histories of diabetes, hypertension, and dyslipidemia) and electrocardiographic (PR interval, QRS duration, corrected QT interval, inverted T wave in the inferior leads, bundle branch block, and atrial fibrillation), echocardiographic [mitral regurgitation grade, prolapsing mitral leaflet, and right ventricular systolic pressure (RVSP)], and CMR [left atrial volume index, both ventricular ejection fractions, both ventricular end-diastolic and systolic volume indexes, prolapse distance, mitral annular disjunction, systolic curling motion, presence of late gadolinium enhancement (LGE), LGE volume and proportion] parameters were analyzed. Results Of the 85 patients [age, 54.0 (41.0–65.0) years; 46 men], seven experienced SCA or VA. Younger age and wide QRS complex were observed more often in the SCA/VA group than in the no-SCA/VA group. The SCA/VA group exhibited lower RVSP, more systolic curling motion and LGE, greater LGE volume, and higher LGE proportion. The presence of LGE [hazard ratio (HR), 19.8; 95% confidence interval (CI) 2.65–148.15; P = 0.004], LGE volume (HR 1.08; 95% CI 1.02–1.14; P = 0.006) and LGE proportion (HR 1.32; 95% CI 1.08–1.60; P = 0.006) were independently associated with higher risk of SCA or VA in MVP patients together with systolic curling motion in each model. Conclusions The presence of systolic curling motion, high LGE volume and proportion, and the presence of LGE on CMR were independent predictive factors for SCA or VA in MVP patients.
Collapse
Affiliation(s)
- Jae-Hyuk Lee
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae-Sun Uhm
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Joo Suh
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Min Kim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - In-Soo Kim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo-Nyun Jin
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Tae-Hoon Kim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yoo Jin Hong
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Chi Young Shim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Jin Kim
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Youn Kim
- Department of Cardiology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Boyoung Joung
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Geu-Ru Hong
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hui-Nam Pak
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Ho Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
5
|
Fahmy AS, Rowin EJ, Chan RH, Manning WJ, Maron MS, Nezafat R. Improved Quantification of Myocardium Scar in Late Gadolinium Enhancement Images: Deep Learning Based Image Fusion Approach. J Magn Reson Imaging 2021; 54:303-312. [PMID: 33599043 PMCID: PMC8359184 DOI: 10.1002/jmri.27555] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quantification of myocardium scarring in late gadolinium enhanced (LGE) cardiac magnetic resonance imaging can be challenging due to low scar-to-background contrast and low image quality. To resolve ambiguous LGE regions, experienced readers often use conventional cine sequences to accurately identify the myocardium borders. PURPOSE To develop a deep learning model for combining LGE and cine images to improve the robustness and accuracy of LGE scar quantification. STUDY TYPE Retrospective. POPULATION A total of 191 hypertrophic cardiomyopathy patients: 1) 162 patients from two sites randomly split into training (50%; 81 patients), validation (25%, 40 patients), and testing (25%; 41 patients); and 2) an external testing dataset (29 patients) from a third site. FIELD STRENGTH/SEQUENCE 1.5T, inversion-recovery segmented gradient-echo LGE and balanced steady-state free-precession cine sequences ASSESSMENT: Two convolutional neural networks (CNN) were trained for myocardium and scar segmentation, one with and one without LGE-Cine fusion. For CNN with fusion, the input was two aligned LGE and cine images at matched cardiac phase and anatomical location. For CNN without fusion, only LGE images were used as input. Manual segmentation of the datasets was used as reference standard. STATISTICAL TESTS Manual and CNN-based quantifications of LGE scar burden and of myocardial volume were assessed using Pearson linear correlation coefficients (r) and Bland-Altman analysis. RESULTS Both CNN models showed strong agreement with manual quantification of LGE scar burden and myocardium volume. CNN with LGE-Cine fusion was more robust than CNN without LGE-Cine fusion, allowing for successful segmentation of significantly more slices (603 [95%] vs. 562 (89%) of 635 slices; P < 0.001). Also, CNN with LGE-Cine fusion showed better agreement with manual quantification of LGE scar burden than CNN without LGE-Cine fusion (%ScarLGE-cine = 0.82 × %Scarmanual , r = 0.84 vs. %ScarLGE = 0.47 × %Scarmanual , r = 0.81) and myocardium volume (VolumeLGE-cine = 1.03 × Volumemanual , r = 0.96 vs. VolumeLGE = 0.91 × Volumemanual , r = 0.91). DATA CONCLUSION CNN based LGE-Cine fusion can improve the robustness and accuracy of automated scar quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: 1.
Collapse
Affiliation(s)
- Ahmed S. Fahmy
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Ethan J. Rowin
- Hypertrophic Cardiomyopathy Center, Division of CardiologyTufts Medical CenterBostonMassachusettsUSA
| | - Raymond H. Chan
- Toronto General HospitalUniversity Health NetworkTorontoCanada
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
- RadiologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Center, Division of CardiologyTufts Medical CenterBostonMassachusettsUSA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division)Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
6
|
Ota S, Hozumi T, Tanimoto T, Takemoto K, Wada T, Kashiwagi M, Shimamura K, Shiono Y, Kuroi A, Matsuo Y, Kitabata H, Ino Y, Kubo T, Tanaka A, Akasaka T. Global longitudinal strain evaluated by speckle-tracking echocardiography as a surrogate marker for predicting replacement fibrosis detected by magnetic resonance-late gadolinium enhancement in patients with nonischemic cardiomyopathy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:479-487. [PMID: 33527434 DOI: 10.1002/jcu.22983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/12/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE This study aimed to investigate whether left ventricular (LV) global longitudinal strain (GLS) evaluated by speckle-tracking echocardiography (STE) can be used as a surrogate marker for the detection of replacement fibrosis by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with nonischemic cardiomyopathy (NICM). METHODS This study analyzed 41 NICM patients who successfully underwent both STE and CMR, and were divided into those with (Group A, n = 18) and those without CMR-LGE (Group B, n = 23). Echocardiographic indexes, including GLS, were compared between the two groups. RESULTS No significant differences were observed in LV end-diastolic and end-systolic volume indexes, LV ejection fraction, mitral E/A, deceleration time, E/e', left atrial volume index, and the systolic trans-tricuspid pressure gradient between Groups A and B. STE-GLS was significantly worse in Group A than in Group B (-7.6% ± 3.0% vs -9.9% ± 3.2%, P = .01). Receiver operating characteristic curve analysis showed that STE-GLS of -7.9% was the best cut-off value for detection of CMR-LGE (sensitivity, 78%; specificity, 74%; and area under the curve, 0.74). CONCLUSIONS STE-GLS may be a potential surrogate marker for the detection of CMR-LGE-derived replacement fibrosis in patients with NICM.
Collapse
Affiliation(s)
- Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
7
|
Ota S, Orii M, Nishiguchi T, Yokoyama M, Matsushita R, Takemoto K, Tanimoto T, Hirata K, Hozumi T, Akasaka T. Implications of multiple late gadolinium enhancement lesions on the frequency of left ventricular reverse remodeling and prognosis in patients with non-ischemic cardiomyopathy. J Cardiovasc Magn Reson 2021; 23:32. [PMID: 33761955 PMCID: PMC7992777 DOI: 10.1186/s12968-021-00734-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-ischemic cardiomyopathy (NICM) is a heterogeneous disease, and its prognosis varies. Although late gadolinium enhancement (LGE)-cardiovascular magnetic resonance (CMR) demonstrates a linear pattern in the mid-wall of the septum or multiple LGE lesions in patients with NICM, the therapeutic response and prognosis of multiple LGE lesions have not been elucidated. This study aimed to investigate the frequency of left ventricular (LV) reverse remodeling (LVRR) and prognosis in patients with NICM who have multiple LGE lesions. METHODS This single-center retrospective study included 101 consecutive patients with NICM who were divided into 3 groups according to LGE-CMR results: patients without LGE (no LGE group = 48 patients), patients with a typical mid-wall LGE pattern (n = 29 patients), and patients with multiple LGE lesions (n = 24 patients). LVRR was defined as an increase in LV ejection fraction (LVEF) ≥ 10 % and a final value of LVEF > 35 %, which was accompanied by a decrease in LV end-systolic volume ≥ 15 % at 12-month follow-up using echocardiography. The frequency of composite cardiac events, defined as sudden cardiac death (SCD), aborted SCD (non-fatal ventricular fibrillation, sustained ventricular tachycardia, or adequate implantable cardioverter-defibrillator therapies), and heart failure death or hospitalization for worsening heart failure, were summarized and compared between the groups. RESULTS Among the 3 groups, the frequency of LVRR was significantly lower in the multiple lesions group than in the no LGE and mid-wall groups (no LGE vs. mid-wall vs. multiple lesions: 49 % vs. 52 % vs. 19 %, p = 0.03). There were 24 composite cardiac events among the patients: 2 in patients without LGE (hospitalization for worsening heart failure; 2), 7 in patients of the mid-wall group (SCD; 1, aborted SCD; 1 and hospitalization for worsening heart failure; 5), and 15 in patients of the multiple lesions group (SCD; 1, aborted SCD; 8 and hospitalization for worsening heart failure; 6). The multiple LGE lesions was an independent predictor of composite cardiac events (hazard ratio: 11.40 [95 % confidence intervals: 1.49-92.01], p = 0.020). CONCLUSIONS Patients with multiple LGE lesions have a higher risk of cardiac events and poorer LVRR. The LGE pattern may be useful for an improved risk stratification in patients with NICM.
Collapse
Affiliation(s)
- Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Makoto Orii
- Department of Radiology, Iwate Medical University, 1-1, Idaidori, Yahaba, 028-3695, Iwate, Japan.
| | - Tsuyoshi Nishiguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mao Yokoyama
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryoko Matsushita
- Clinical Laboratory, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kumiko Hirata
- Department of Education, Division of medical science, Osaka Educational University, Osaka, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
8
|
Kolluru L, Srikala J, Rao HN, Maheen S, Rao BH. Incremental value of Late Gadolinium Enhancement by Cardiac MRI in risk stratification of heart failure patients with moderate and severe LV dysfunction. Indian Heart J 2020; 73:49-55. [PMID: 33714409 PMCID: PMC7961248 DOI: 10.1016/j.ihj.2020.11.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/10/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022] Open
Abstract
Objective This is a prospective study of patients with LVEF ≤40%, with the objective of correlating CV events to LGE detected and quantified by CMRI. Methods Heart Failure (HF) patients with LVEF <40% who underwent CMRI were included. LGE volume of ≥6% of the myocardial volume was considered significant. Data of appropriate ICD shocks, CV hospitalizations and mortality were recorded. Results There were 133 HF (72 ICM & 62 NIDCM) patients with a mean age of 54 ± 12 years, mean LVEF of 34 ± 6% and a follow up of 24 ± 3 months. Totally 46 CV events were recorded in 30 patients, 44 in LGE +ve & 2 in LGE -ve groups (HR 17.8, 95% CI-8.03-39.3, P = 0.000095). All the 7 deaths were in LGE +ve group. CV events were 22 (30.5%) in ICM group and 8 (13.1%) in NIDCM group (p = 0.03). All the 22 ICM patients and 6 of the 8 NIDCM with CV events were LGE +ve. The distribution of CV events amongst LGE +ve and LGE -ve were 35 vs 0 (ICM) and 9 vs 2 (NIDCM); p < 0.005.CV events in LVEF ≤ 30% group, were seen in 19 (47.5%) vs 1 (5.8%) in LGE +ve vs LGE -ve and no of events were 29 vs 1 (p = 0.003). In those with LVEF >30% the corresponding figures were 9 (22.5%) vs 1 (2.8%) and 15 vs 1 respectively (p = 0.02). Conclusion Demonstration of significant LGE by CMRI indicates high risk occurrence of CV events (CV hospitalization, appropriate shocks and total mortality) in NIDCM & ICM patients with LVEF < 40%.
Collapse
Affiliation(s)
- Laxman Kolluru
- Department of Cardiology, KIMS Hospitals, Hyderabad, India
| | - Jwala Srikala
- Department of Radiology, KIMS Hospitals, Hyderabad, India
| | - H Nagaraj Rao
- Department of Cardiology, KIMS Hospitals, Nellore, India
| | - Sania Maheen
- Department of Radiology, KIMS Hospitals, Hyderabad, India
| | - B Hygriv Rao
- Department of Cardiology, KIMS Hospitals, Hyderabad, India; Arrhythmia Research & Training Society(ARTS), Hyderabad, India.
| |
Collapse
|
9
|
Implanted Monitor Alerting to Reduce Treatment Delay in Patients With Acute Coronary Syndrome Events. J Am Coll Cardiol 2020; 74:2047-2055. [PMID: 31623762 DOI: 10.1016/j.jacc.2019.07.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/16/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increased pre-hospital delay during acute coronary syndrome (ACS) events contributes to worse outcome. OBJECTIVES The purpose of this study was to assess the effectiveness of an implanted cardiac monitor with real-time alarms for abnormal ST-segment shifts to reduce pre-hospital delay during ACS events. METHODS In the ALERTS (AngeLmed Early Recognition and Treatment of STEMI) pivotal study, subjects at high risk for recurrent ACS events (n = 907) were randomized to control (Alarms OFF) or treatment groups for 6 months, after which alarms were activated in all subjects (Alarms ON). Emergency department (ED) visits with standard-of-care cardiac test results were independently adjudicated as true- or false-positive ACS events. Alarm-to-door (A2D) and symptom-to-door (S2D) times were calculated for true-positive ACS ED visits triggered by 3 possible prompts: alarm only, alarms + symptoms, or symptoms only. RESULTS The Alarms ON group showed reduced delays, with 55% (95% confidence interval [CI]: 46% to 63%) of ED visits for ACS events <2 h compared with 10% (95% CI: 2% to 27%) in the Alarms OFF group (p < 0.0001). Results were similar when restricted to myocardial infarction (MI) events. Median pre-hospital delay for MI was 12.7 h for Alarms OFF and 1.6 h in Alarms ON subjects (p < 0.0089). Median A2D delay was 1.4 h for asymptomatic MI. Median S2D delay for symptoms-only MI (no alarm) in Alarms ON was 4.3 h. CONCLUSIONS Intracardiac monitoring with real-time alarms for ST-segment shift that exceeds a subject's self-normative ischemia threshold level significantly reduced the proportion of pre-hospital delays >2 h for ACS events, including asymptomatic MI, compared with symptoms-only ED visits in Alarms OFF. (AngeLmed for Early Recognition and Treatment of STEMI [ALERTS]; NCT00781118).
Collapse
|
10
|
Yi JE, Park J, Lee HJ, Shin DG, Kim Y, Kim M, Kwon K, Pyun WB, Kim YJ, Joung B. Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study. PLoS One 2018; 13:e0208100. [PMID: 30485353 PMCID: PMC6261623 DOI: 10.1371/journal.pone.0208100] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction The presence of late gadolinium enhancement (LGE) at the right ventricular insertion point (RVIP) on cardiac magnetic resonance (CMR) is generally believed to be nonspecific, but the clinical implication of this unique LGE pattern in patients with non-ischemic dilated cardiomyopathy (NICM) has not been elucidated. Objectives We investigated the prognostic significance of RVIP-LGE in NICM patients. Methods A total of 360 consecutive NICM patients referred for CMR (102 with no LGE, 50 with RVIP-LGE, 121 with left ventricular [LV]-LGE, and 87 with both an LV and RVIP-LGE) were studied. The primary endpoint was a composite of the all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events. Results During a mean follow-up of 45.2 ± 36.5 months, 149 (41.4%) patients (22 [21.6%] no LGE vs. 16 [32.0%] RVIP-LGE vs. 62 [51.2%] LV-LGE vs. 49 [56.3%] both LV and RVIP-LGE, P < 0.0001) reached the primary endpoint. A Kaplan Meier curve demonstrated that RVIP-LGE patients had an intermediate trend of an event free survival rate for the composite endpoint (log-rank P < 0.0001). In a multivariable Cox regression model, LV-LGE (P = 0.008) and both LV and RVIP-LGE (P = 0.003) were significantly associated with a worse outcome, whereas RVIP-LGE was not (P = 0.101). In addition, RVIP-LGE patients (n = 32) had a more favorable outcome compared to LV-LGE patients (n = 32) even after matching the extent of the LGE (median 3.4% [interquartile range, 3.1–3.8], 8 [25.0%] RVIP-LGE vs. 20 [62.5%] LV-LGE, P = 0.002). Conclusions LGE confined to the RVIP among NICM patients did not significantly increase the risk of adverse cardiac events, and also showed a better outcome than the same extent of LGE located in the LV. Identification of this unique LGE distribution may help refine the current risk stratification.
Collapse
Affiliation(s)
- Jeong-Eun Yi
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Geum Shin
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Minsuk Kim
- Department of Pharmacology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kihwan Kwon
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail: (BYJ); (YJK)
| | - Boyoung Joung
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: (BYJ); (YJK)
| |
Collapse
|
11
|
Myocardial Fibrosis in Patients With Primary Mitral Regurgitation With and Without Prolapse. J Am Coll Cardiol 2018; 72:823-834. [DOI: 10.1016/j.jacc.2018.06.048] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 11/20/2022]
|
12
|
Souto ALM, Souto RM, Teixeira ICR, Nacif MS. Myocardial Viability on Cardiac Magnetic Resonance. Arq Bras Cardiol 2017; 108:458-469. [PMID: 28591322 PMCID: PMC5444893 DOI: 10.5935/abc.20170056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022] Open
Abstract
The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability. Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.
Collapse
Affiliation(s)
| | | | | | - Marcelo Souto Nacif
- Universidade Federal Fluminense, Niterói, RJ - Brazil.,Centro de Imagem Complexo Hospitalar de Niterói, Niterói, RJ - Brazil.,Unidade de Radiologia Clínica - Hospital Vivalle - Rede D´Or - São Luiz, São José dos Campo, SP - Brazil
| |
Collapse
|
13
|
Amano Y, Yanagisawa F, Tachi M, Asai K, Suzuki Y, Hashimoto H, Ishihara K, Kumita S. Three-dimensional Cardiac MR Imaging: Related Techniques and Clinical Applications. Magn Reson Med Sci 2017; 16:183-189. [PMID: 28202854 PMCID: PMC5600024 DOI: 10.2463/mrms.rev.2016-0116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Three-dimensional (3D) cardiac magnetic resonance (MR) imaging has several advantages, including the easy coverage of the entire heart without misregistration, reduction of breath-holding times, and availability for postprocessing reconstruction. These advantages are associated with some techniques such as breath-hold or navigator gating and parallel imaging. However, the image quality of 3D cardiac MR images is compromised by the use of a shorter repetition time and parallel imaging. Thus, a steady-state free precession sequence, contrast agent administration, and presaturation pulses are used to maintain the image quality. In this review, we introduce the MR imaging techniques used in 3D cardiac MR imaging and demonstrate the typical 3D cardiac MR images, followed by discussion about their advantages and disadvantages.
Collapse
Affiliation(s)
- Yasuo Amano
- Department of Radiology, Nihon University Hospital.,Department of Radiology, Nippon Medical School
| | - Fumi Yanagisawa
- Department of Radiology, Nihon University Hospital.,Department of Radiology, Nippon Medical School
| | | | - Kuniya Asai
- Department of Cardiology, Nippon Medical School
| | | | - Hidenobu Hashimoto
- Department of Radiology, Nihon University Hospital.,Department of Cardiology, Toho University Omori Medical Center
| | | | | |
Collapse
|
14
|
Karim R, Bhagirath P, Claus P, James Housden R, Chen Z, Karimaghaloo Z, Sohn HM, Lara Rodríguez L, Vera S, Albà X, Hennemuth A, Peitgen HO, Arbel T, Gonzàlez Ballester MA, Frangi AF, Götte M, Razavi R, Schaeffter T, Rhode K. Evaluation of state-of-the-art segmentation algorithms for left ventricle infarct from late Gadolinium enhancement MR images. Med Image Anal 2016; 30:95-107. [PMID: 26891066 DOI: 10.1016/j.media.2016.01.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 11/12/2015] [Accepted: 01/15/2016] [Indexed: 11/17/2022]
Abstract
Studies have demonstrated the feasibility of late Gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging for guiding the management of patients with sequelae to myocardial infarction, such as ventricular tachycardia and heart failure. Clinical implementation of these developments necessitates a reproducible and reliable segmentation of the infarcted regions. It is challenging to compare new algorithms for infarct segmentation in the left ventricle (LV) with existing algorithms. Benchmarking datasets with evaluation strategies are much needed to facilitate comparison. This manuscript presents a benchmarking evaluation framework for future algorithms that segment infarct from LGE CMR of the LV. The image database consists of 30 LGE CMR images of both humans and pigs that were acquired from two separate imaging centres. A consensus ground truth was obtained for all data using maximum likelihood estimation. Six widely-used fixed-thresholding methods and five recently developed algorithms are tested on the benchmarking framework. Results demonstrate that the algorithms have better overlap with the consensus ground truth than most of the n-SD fixed-thresholding methods, with the exception of the Full-Width-at-Half-Maximum (FWHM) fixed-thresholding method. Some of the pitfalls of fixed thresholding methods are demonstrated in this work. The benchmarking evaluation framework, which is a contribution of this work, can be used to test and benchmark future algorithms that detect and quantify infarct in LGE CMR images of the LV. The datasets, ground truth and evaluation code have been made publicly available through the website: https://www.cardiacatlas.org/web/guest/challenges.
Collapse
Affiliation(s)
- Rashed Karim
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK.
| | - Pranav Bhagirath
- Department of Cardiology, Haga Teaching Hospital, The Netherlands
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Universiteit Leuven, Belgium
| | - R James Housden
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Universiteit Leuven, Belgium
| | - Zhong Chen
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | | | - Hyon-Mok Sohn
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | | | | | - Xènia Albà
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anja Hennemuth
- Fraunhofer Institute for Medical Image Computing, Fraunhofer MEVIS, Germany
| | - Heinz-Otto Peitgen
- Fraunhofer Institute for Medical Image Computing, Fraunhofer MEVIS, Germany
| | - Tal Arbel
- The Centre for Intelligence Machines, McGill University, Canada
| | | | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic & Electrical Engineering, University of Sheffield, Sheffield, UK
| | - Marco Götte
- Department of Cardiology, Haga Teaching Hospital, The Netherlands
| | - Reza Razavi
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | - Tobias Schaeffter
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| | - Kawal Rhode
- Department of Imaging Sciences & Biomedical Engineering, King's College London, UK
| |
Collapse
|
15
|
|
16
|
Nguyen C, Fan Z, Xie Y, Dawkins J, Tseliou E, Bi X, Sharif B, Dharmakumar R, Marbán E, Li D. In vivo contrast free chronic myocardial infarction characterization using diffusion-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2014; 16:68. [PMID: 25230598 PMCID: PMC4167272 DOI: 10.1186/s12968-014-0068-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the established role of late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in characterizing chronic myocardial infarction (MI), a significant portion of chronic MI patients are contraindicative for the use of contrast agents. One promising alternative contrast free technique is diffusion weighted CMR (dwCMR), which has been shown ex vivo to be sensitive to myocardial fibrosis. We used a recently developed in vivo dwCMR in chronic MI pigs to compare apparent diffusion coefficient (ADC) maps with LGE imaging for infarct characterization. METHODS In eleven mini pigs, chronic MI was induced by complete occlusion of the left anterior descending artery for 150 minutes. LGE, cine, and dwCMR imaging was performed 8 weeks post MI. ADC maps were derived from three orthogonal diffusion directions (b = 400 s/mm2) and one non-diffusion weighted image. Two semi-automatic infarct classification methods, threshold and full width half max (FWHM), were performed in both LGE and ADC maps. Regional wall motion (RWM) analysis was performed and compared to ADC maps to determine if any observed ADC change was significantly influenced by bulk motion. RESULTS ADC of chronic MI territories was significantly increased (threshold: 2.4 ± 0.3 μm2/ms, FWHM: 2.4 ± 0.2 μm2/ms) compared to remote myocardium (1.4 ± 0.3 μm2/ms). RWM was significantly reduced (threshold: 1.0 ± 0.4 mm, FWHM: 0.9 ± 0.4 mm) in infarcted regions delineated by ADC compared to remote myocardium (8.3 ± 0.1 mm). ADC-derived infarct volume and location had excellent agreement with LGE. Both LGE and ADC were in complete agreement when identifying transmural infarcts. Additionally, ADC was able to detect LGE-delineated infarcted segments with high sensitivity, specificity, PPV, and NPV. (threshold: 0.88, 0.93, 0.87, and 0.94, FWHM: 0.98, 0.97, 0.93, and 0.99, respectively). CONCLUSIONS In vivo diffusion weighted CMR has potential as a contrast free alternative for LGE in characterizing chronic MI.
Collapse
Affiliation(s)
- Christopher Nguyen
- />Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Blvd Suite 800, Los Angeles, CA 90048 USA
- />Department of Bioengineering, University of California Los Angeles, 420 Westwood Plaza, Engineering V Room 5121, PO Box 951600, Los Angeles, CA 90095 USA
| | - Zhaoyang Fan
- />Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Blvd Suite 800, Los Angeles, CA 90048 USA
| | - Yibin Xie
- />Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Blvd Suite 800, Los Angeles, CA 90048 USA
- />Department of Bioengineering, University of California Los Angeles, 420 Westwood Plaza, Engineering V Room 5121, PO Box 951600, Los Angeles, CA 90095 USA
| | - James Dawkins
- />Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. Advanced Health Sciences Pavilion A3600, Los Angeles, CA 90048 USA
| | - Eleni Tseliou
- />Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. Advanced Health Sciences Pavilion A3600, Los Angeles, CA 90048 USA
| | - Xiaoming Bi
- />MR Research and Development, Siemens Healthcare, 116 N. Robertson Blvd Suite 800, Los Angeles, 90048 CA USA
| | - Behzad Sharif
- />Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Blvd Suite 800, Los Angeles, CA 90048 USA
| | - Rohan Dharmakumar
- />Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Blvd Suite 800, Los Angeles, CA 90048 USA
- />Department of Bioengineering, University of California Los Angeles, 420 Westwood Plaza, Engineering V Room 5121, PO Box 951600, Los Angeles, CA 90095 USA
- />Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. Advanced Health Sciences Pavilion A3600, Los Angeles, CA 90048 USA
| | - Eduardo Marbán
- />Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. Advanced Health Sciences Pavilion A3600, Los Angeles, CA 90048 USA
| | - Debiao Li
- />Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N. Robertson Blvd Suite 800, Los Angeles, CA 90048 USA
- />Department of Bioengineering, University of California Los Angeles, 420 Westwood Plaza, Engineering V Room 5121, PO Box 951600, Los Angeles, CA 90095 USA
| |
Collapse
|