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Goldie FC, Lee MMY, Coats CJ, Nordin S. Advances in Multi-Modality Imaging in Hypertrophic Cardiomyopathy. J Clin Med 2024; 13:842. [PMID: 38337535 PMCID: PMC10856479 DOI: 10.3390/jcm13030842] [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: 12/22/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by abnormal growth of the myocardium with myofilament disarray and myocardial hyper-contractility, leading to left ventricular hypertrophy and fibrosis. Where culprit genes are identified, they typically relate to cardiomyocyte sarcomere structure and function. Multi-modality imaging plays a crucial role in the diagnosis, monitoring, and risk stratification of HCM, as well as in screening those at risk. Following the recent publication of the first European Society of Cardiology (ESC) cardiomyopathy guidelines, we build on previous reviews and explore the roles of electrocardiography, echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging. We examine each modality's strengths along with their limitations in turn, and discuss how they can be used in isolation, or in combination, to facilitate a personalized approach to patient care, as well as providing key information and robust safety and efficacy evidence within new areas of research.
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Affiliation(s)
- Fraser C. Goldie
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
| | - Matthew M. Y. Lee
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
| | - Caroline J. Coats
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Sabrina Nordin
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; (F.C.G.); (M.M.Y.L.); (C.J.C.)
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
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Kim H, Kim IC, Choi SW, Chung JW, Kim JY. Clinical significance of early-diastolic tissue velocity imaging of lateral mitral annulus for prognosis of nonischemic left ventricular dysfunction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:160-167. [PMID: 31675137 DOI: 10.1002/jcu.22787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE We explored the potential of tissue velocity imaging (TVI) for prognosis of nonischemic left ventricular (LV) dysfunction (LVD). METHODS We reviewed 138 nonischemic LVD patients (58 ± 14 years) who underwent both cardiac magnetic resonance (CMR) and echocardiography. Septal and lateral mitral annular TVI data were compared with late gadolinium enhancement (LGE) on CMR. During a mean follow-up of 24 months, recovery (>15%) of LV ejection fraction and clinical outcomes (cardiovascular death and heart failure hospitalization) were assessed. RESULTS LGE was commonly observed in the basal anteroseptal, inferoseptal, and inferior segments, but infrequently observed in the anterolateral segment. LGE was associated with lower early diastolic, septal (Sep-e' = 5.2 ± 2.0 vs 6.9 ± 2.0 cm/s, P = .031) and lateral (Lat-e' = 7.3 ± 3.0 vs 9.5 ± 2.0 cm/s, P < .001) TVI. The relationship between Lat-e' and anterolateral LGE (area under the curve, AUC 0.834) was much better than that between Sep-e' and inferoseptal LGE (AUC 0.699). The 60 patients with LVD reversibility revealed higher Lat-e' (9.8 ± 2.0 vs 6.7 ± 2.2 cm/s, P < .001) and lower LGE burden (7.3 ± 9.0 vs 22 ± 10%, P < .001), while Lat-e' ≤ 7.8 cm/s appeared unfavorable for 31 events patients. On multivariate analyses, Lat-e' (HR 0.79, 95% CI 0.63-0.99, P = .044) and LVD reversibility (HR 0.53, 95% CI 0.16-0.90, P = .018) were still meaningful together with LGE segments and burden. CONCLUSION Lat-e' was related with LVD reversibility and a significant predictor of clinical outcomes.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Woong Choi
- Division of Cardiology, Department of Internal Medicine, Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Jin-Wook Chung
- Division of Cardiology, Department of Internal Medicine, Daegu Dongsan Hospital, Daegu, Republic of Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Abstract
PURPOSE OF REVIEW To describe new cardiac MRI (CMR) findings on cardiac structure and myocardial composition in hypertrophic cardiomyopathy (HCM). RECENT FINDINGS Quantitative CMR assessment of replacement fibrosis and interstitial fibrosis can risk stratify HCM patients for adverse outcomes. Patients with global LVH (increased LV mass index) have more adverse outcomes. The HCM phenotype with a spiral distribution of hypertrophy entails a good prognosis. Myocardial noncompaction can be associated with HCM, as are papillary muscle and mitral apparatus abnormalities. Genotype positive, phenotype negative relatives of HCM probands may be detected by myocardial motion abnormalities. Emerging CMR methods for myocardial fiber disarray and altered myocardial stiffness may shed more light on cardiac structure, function and outcomes in HCM in coming years. SUMMARY CMR structural features of HCM, including severity and distribution of hypertrophy and fibrosis, can augment clinical evaluation of HCM. New CMR phenotypes, associated papillary muscle, mitral leaflet and myocardial noncompaction abnormalities, role of left atrial enlargement, findings in genotype positive phenotype negative HCM, and emerging methods for the detection of myocardial fiber disarray and altered myocardial stiffness may shed light in coming years.
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Hamlin SA, Henry TS, Little BP, Lerakis S, Stillman AE. Mapping the future of cardiac MR imaging: case-based review of T1 and T2 mapping techniques. Radiographics 2015; 34:1594-611. [PMID: 25310419 DOI: 10.1148/rg.346140030] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardiac magnetic resonance (MR) imaging has grown over the past several decades into a validated, noninvasive diagnostic imaging tool with a pivotal role in cardiac morphologic and functional assessment and tissue characterization. With traditional cardiac MR imaging sequences, assessment of various pathologic conditions ranging from ischemic and nonischemic cardiomyopathy to cardiac involvement in systemic diseases (eg, amyloidosis and sarcoidosis) is possible; however, these sequences are most useful in focal myocardial disease, and image interpretation relies on subjective qualitative analysis of signal intensity. Newer T1 and T2 myocardial mapping techniques offer a quantitative assessment of the myocardium (by using T1 and T2 relaxation times), which can be helpful in focal disease, and demonstrate special utility in the evaluation of diffuse myocardial disease (eg, edema and fibrosis). Altered T1 and T2 relaxation times in disease states can be compared with published ranges of normal relaxation times in healthy patients. In conjunction with traditional cardiac MR imaging sequences, T1 and T2 mapping can limit the interpatient and interstudy variability that are common with qualitative analysis and may provide clinical markers for long-term follow-up.
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Affiliation(s)
- Scott A Hamlin
- From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (S.A.H., T.S.H., B.P.L., A.E.S.), and Department of Cardiology (S.L.), Emory University School of Medicine, 1364 Clifton Rd NE, Room D125A, Atlanta, GA 30322
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Peteiro J, Fernandez X, Bouzas-Mosquera A, Monserrat L, Méndez C, Rodriguez-Garcia E, Soler R, Couto D, Castro-Beiras A. Exercise echocardiography and cardiac magnetic resonance imaging to predict outcome in patients with hypertrophic cardiomyopathy†. Eur Heart J Cardiovasc Imaging 2015; 16:423-432. [DOI: 10.1093/ehjci/jeu225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Bogaert J, Olivotto I. MR Imaging in Hypertrophic Cardiomyopathy: From Magnet to Bedside. Radiology 2015; 273:329-48. [PMID: 25340269 DOI: 10.1148/radiol.14131626] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hypertrophic cardiomyopathy ( HCM hypertrophic cardiomyopathy ), the most common genetically transmitted cardiac disorder, has been the focus of extensive research over the past 50 years. HCM hypertrophic cardiomyopathy is a multifaceted disease with highly heterogeneous genetic background, phenotypic expression, clinical presentation, and long-term outcome. Though most patients have an indolent course with a life expectancy comparable to that of the general population, early diagnosis and accurate risk profiling are essential to identify the sizeable subset at increased risk of sudden cardiac death or disease progression and heart failure-related complications, requiring aggressive management options. Imaging has a central role in the diagnosis and prognostic assessment of HCM hypertrophic cardiomyopathy patients, as well as screening of potentially affected family members. In this context, magnetic resonance (MR) imaging has recently emerged as an ideal complement to transthoracic echocardiography. Its multiparametric approach, fusing spatial, contrast, and temporal resolution, provides the clinician with detailed characterization of the HCM hypertrophic cardiomyopathy phenotype and assessment of its functional consequences including causes and site of dynamic obstruction, presence and extent of myocardial perfusion abnormalities, and fibrosis. Moreover, MR is key in differentiating HCM hypertrophic cardiomyopathy from "phenocopies"-that is, hearts with similar morphology but profoundly different etiology, such as amyloid or Anderson-Fabry disease. Long term, the incremental information provided by MR is relevant to planning of septal reduction therapies, identification of the early stages of end-stage progression, and stratification of arrhythmic risk. The aim of this review is to depict the increasingly important role of MR imaging in relation to the complexity of HCM hypertrophic cardiomyopathy , highlighting its role in clinical decision making.
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Affiliation(s)
- Jan Bogaert
- From the Department of Radiology, Gasthuisberg University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium (J.B.); and Referral Center for Myocardial Diseases, Azienda Universitaria Careggi, Florence, Italy (I.O.)
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Weingärtner S, Akçakaya M, Roujol S, Basha T, Tschabrunn C, Berg S, Anter E, Nezafat R. Free-breathing combined three-dimensional phase sensitive late gadolinium enhancement and T1 mapping for myocardial tissue characterization. Magn Reson Med 2014; 74:1032-41. [PMID: 25324205 DOI: 10.1002/mrm.25495] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 08/29/2014] [Accepted: 09/20/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE To develop a novel MR sequence for combined three-dimensional (3D) phase-sensitive (PS) late gadolinium enhancement (LGE) and T1 mapping to allow for simultaneous assessment of focal and diffuse myocardial fibrosis. METHODS In the proposed sequence, four 3D imaging volumes are acquired with different T1 weightings using a combined saturation and inversion preparation, after administration of a gadolinium contrast agent. One image is acquired fully sampled with the inversion time selected to null the healthy myocardial signal (the LGE image). The other three images are three-fold under-sampled and reconstructed using compressed sensing. An acquisition scheme with two interleaved imaging cycles and joint navigator-gating of those cycles ensures spatial registration of the imaging volumes. T1 maps are generated using all four imaging volumes. The signal-polarity in the LGE image is restored using supplementary information from the T1 fit to generate PS-LGE images. The accuracy of the proposed method was assessed with respect to a inversion-recovery spin-echo sequence. In vivo T1 maps and LGE images were acquired with the proposed sequence and quantitatively compared with 2D multislice Modified Look-Locker inversion recovery (MOLLI) T1 maps. Exemplary images in a patient with focal scar were compared with conventional LGE imaging. RESULTS The deviation of the proposed method and the spin-echo reference was < 11 ms in phantom for T1 times between 250 and 600 ms, regardless of the inversion time selected in the LGE image. There was no significant difference in the in vivo T1 times of the proposed sequence and the 2D MOLLI technique (myocardium: 292 ± 75 ms versus 310 ± 49 ms, blood-pools: 191 ± 75 ms versus 182.0 ± 33). The LGE images showed proper nulling of the healthy myocardium in all subjects and clear depiction of scar in the patient. CONCLUSION The proposed sequence enables simultaneous acquisition of 3D PS-LGE images and spatially registered 3D T1 maps in a single scan.
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Affiliation(s)
- Sebastian Weingärtner
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Mehmet Akçakaya
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Sébastien Roujol
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Tamer Basha
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Cory Tschabrunn
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Sophie Berg
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Elad Anter
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Machann W, Geier O, Koeppe S, O’Donnell T, Greiser A, Breunig F, Sandstede J, Hahn D, Koestler H, Beer M. Reproducibility of manual and semi-automated late enhancement quantification in patients with Fabry disease. Acta Radiol 2014; 55:155-60. [PMID: 24078459 DOI: 10.1177/0284185113505275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late enhancement (LE) imaging is increasingly used for diagnosis of non-ischemic cardiomyopathy. However, the mostly patchy appearance of LE in this context may reduce the reproducibility of LE measurement. PURPOSE To report intra- and inter-observer variabilities of LE measurements in Fabry disease using manual and semi-automated quantification. MATERIAL AND METHODS Twenty MRI data-sets of male patients aged 44 ± 7 years were analyzed twice (interval 12 months) by one observer and additionally once by a second observer. Left ventricular (LV) parameters were determined using cine MRI. Gradient-echo LE images were analyzed by manual planimetry and by a semi-automatic prototype software. Variabilities were determined by Bland-Altman analyses and additionally intra-class correlation coefficient (ICC) values were calculated to survey intra- and inter-observer reproducibility. RESULTS The amount of LE was 5.2 ± 5.1 mL or 2.8 ± 2.6 % of LV mass (observer 2). LE was detected predominantly intramurally in a patchy pattern. All patients had LE restricted to the basal infero-lateral parts of the LV. The extent of LE correlated to LV mass (207 ± 70 g, P < 0.05, r = 0.6). The intra- and inter-observer variabilities were -0.6 to 1.0 mL and -0.7 to 1.6 mL, respectively (95% confidence intervals). ICC values were 0.981-0.999. The semi-automatic software allowed quantification of LE areas in all patients. The comparison of LE amount determined by semi-automatic software versus manual planimetry yielded an intra-observer variability ranging from -1.9 to 2.3 mL. CONCLUSION Semi-automatic planimetry of patchy LE in patients with Fabry disease is feasible. The determined intra- and inter-observer variabilities for manual and semi-automatic planimetry were in the range of 20-40% of LE amount with high ICC values.
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Affiliation(s)
- Wolfram Machann
- Institute of Radiology, University of Würzburg, Würzburg, Germany
| | - Oliver Geier
- The Intervention Centre, Oslo University Hospital, Norway
| | - Sabrina Koeppe
- Institute of Radiology, University of Würzburg, Würzburg, Germany
| | | | | | - Frank Breunig
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
| | - Joern Sandstede
- Institute of Radiology, University of Würzburg, Würzburg, Germany
| | - Dietbert Hahn
- Institute of Radiology, University of Würzburg, Würzburg, Germany
| | - Herbert Koestler
- Institute of Radiology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Meinrad Beer
- Institute of Radiology, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
- Department of Radiology, Medical University Graz, Graz, Austria
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Delcrè SDL, Di Donna P, Leuzzi S, Miceli S, Bisi M, Scaglione M, Caponi D, Conte MR, Cecchi F, Olivotto I, Gaita F. Relationship of ECG findings to phenotypic expression in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study. Int J Cardiol 2013; 167:1038-45. [DOI: 10.1016/j.ijcard.2012.03.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/01/2012] [Accepted: 03/03/2012] [Indexed: 01/21/2023]
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Tyan CC, Armstrong S, Scholl D, Stirrat J, Blackwood K, El-Sherif O, Thompson T, Wisenberg G, Prato FS, So A, Lee TY, Drangova M, White JA. Stress hypoperfusion and tissue injury in hypertrophic cardiomyopathy: spatial characterization using high-resolution 3-tesla magnetic resonance imaging. Circ Cardiovasc Imaging 2013; 6:229-38. [PMID: 23413422 DOI: 10.1161/circimaging.112.000170] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemia and tissue injury are common in patients with hypertrophic cardiomyopathy. Cardiovascular magnetic resonance imaging offers combined evaluations of each phenomenon at sufficiently high resolution to examine transmural spatial distribution. In this prospective cohort study, we examine the spatial distribution of stress perfusion abnormalities and tissue injury in patients with hypertrophic cardiomyopathy. METHODS AND RESULTS One hundred consecutive patients with hypertrophic cardiomyopathy underwent cardiovascular magnetic resonance imaging. Cine, stress perfusion, late gadolinium enhancement, and T2-weighted imaging techniques were used. Each was spatially coregistered according to predefined segmental and subsegmental models and was blindly analyzed for abnormalities using validated techniques. Spatial associations among stress perfusion, late gadolinium enhancement, and T2 imaging were made at segmental and subsegmental levels. Of the 100 patients studied, the phenotype was septal in 86 and apical in 14. Late gadolinium enhancement imaging was abnormal in 79 patients (79%). Eighty-six patients met prespecified safety criteria to undergo stress perfusion, and ischemia was identified in 46 patients (57%). T2 imaging was available in 81 patients and was abnormal in 19 (29%). The dominant distribution of all 3 findings was to segment with hypertrophy. Subsegmental analysis revealed geographic dominance of ischemia within the subendocardial zones. However, this zone was most commonly spared from late gadolinium enhancement and T2 abnormalities, typically seen in midwall and subepicardial zones. CONCLUSIONS Inducible hypoperfusion is a common finding in hypertrophic cardiomyopathy and is typically identified within segments exhibiting imaging markers of tissue injury. However, the respective transmural dominance of these phenomena seems distinct. Alternate factors contributing to a regional susceptibility to tissue injury are deserving of further study.
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Affiliation(s)
- Chung Chun Tyan
- Department of Medicine, Schulich School of Medicine and Dentistry, Imaging Research Laboratories, Robarts Research Institute, and Lawson Health Research Institute, University of Western Ontario, Ontario, Canada
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Intraindividual comparison of gadobutrol and gadopentetate dimeglumine for detection of myocardial late enhancement in cardiac MRI. AJR Am J Roentgenol 2012; 198:809-16. [PMID: 22451545 DOI: 10.2214/ajr.11.7118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Gadobutrol is an extracellular macrocyclic gadolinium chelate recently introduced in MRI, and it has already been used for cardiac late enhancement imaging; however, until now it has never been compared with gadopentetate dimeglumine. The purpose of our study was to compare 0.1 mmol/kg gadobutrol to 0.2 mmol/kg gadopentetate dimeglumine for the detection of myocardial late enhancement in the same group of patients. SUBJECTS AND METHODS This was an exploratory single-blind parallel group study comparing gadobutrol (0.1 mmol/kg) to gadopentetate dimeglumine (0.2 mmol/kg) in 20 adult patients scheduled for cardiac late enhancement MRI with gadopentetate dimeglumine and whose MR images showed late enhancement. MR images were acquired at 10, 15, and 20 minutes after peripheral injection of gadobutrol by using a 3D turbo field echo inversion recovery T1-weighted sequence. Volume and percentage of late enhancement, number of involved segments, late enhancement localization and pattern, and late enhancement signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared between contrast agents. RESULTS Late enhancement was not significantly different with gadobutrol and gadopentetate dimeglumine both in terms of total volume of myocardium (mean ± SD, 37.8 ± 56.1 and 35.1 ± 46.7 cm(3), respectively; p = 0.33) and percentage of myocardial wall involvement (22.5% ± 19.1% and 22.0% ± 17.2%, respectively; p = 0.67). The number of segments involved was not different (138 with gadobutrol vs 134 with gadopentetate dimeglumine). Furthermore, SNR and CNR were not different (gadopentetate dimeglumine, 123.8 ± 82.9 and gadobutrol, 117.2 ± 88.6, p = 0.58 and gadopentetate dimeglumine, 96.2 ± 68.9 and gadobutrol, 88.4 ± 72.9, p = 0.53, respectively). CONCLUSION A single dose of gadobutrol seems to be as effective as a double dose of gadopentetate dimeglumine for the detection of late enhancement.
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Noureldin RA, Liu S, Nacif MS, Judge DP, Halushka MK, Abraham TP, Ho C, Bluemke DA. The diagnosis of hypertrophic cardiomyopathy by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:17. [PMID: 22348519 PMCID: PMC3309929 DOI: 10.1186/1532-429x-14-17] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 02/20/2012] [Indexed: 12/31/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic disease of the heart. HCM is characterized by a wide range of clinical expression, ranging from asymptomatic mutation carriers to sudden cardiac death as the first manifestation of the disease. Over 1000 mutations have been identified, classically in genes encoding sarcomeric proteins. Noninvasive imaging is central to the diagnosis of HCM and cardiovascular magnetic resonance (CMR) is increasingly used to characterize morphologic, functional and tissue abnormalities associated with HCM. The purpose of this review is to provide an overview of the clinical, pathological and imaging features relevant to understanding the diagnosis of HCM. The early and overt phenotypic expression of disease that may be identified by CMR is reviewed. Diastolic dysfunction may be an early marker of the disease, present in mutation carriers prior to the development of left ventricular hypertrophy (LVH). Late gadolinium enhancement by CMR is present in approximately 60% of HCM patients with LVH and may provide novel information regarding risk stratification in HCM. It is likely that integrating genetic advances with enhanced phenotypic characterization of HCM with novel CMR techniques will importantly improve our understanding of this complex disease.
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MESH Headings
- Cardiomyopathy, Hypertrophic, Familial/complications
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Contrast Media
- Death, Sudden, Cardiac/etiology
- Disease Progression
- Fibrosis
- Genetic Predisposition to Disease
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/genetics
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging
- Myocardium/pathology
- Phenotype
- Predictive Value of Tests
- Prognosis
- Ventricular Function, Left
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Affiliation(s)
- Radwa A Noureldin
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Songtao Liu
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
| | - Marcelo S Nacif
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Theodore P Abraham
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
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Cardiomyopathies (hypertrophy and failure): what can offer cardiac magnetic resonance imaging? Presse Med 2011; 40:e425-36. [PMID: 21795013 DOI: 10.1016/j.lpm.2010.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/21/2010] [Indexed: 11/21/2022] Open
Abstract
In routine, cardiomyopathy, confirmed or not, is a frequent reason for cardiac MRI evaluation. Step by step, by using a wide panel of sequences, cardiac MRI is able to characterize cardiomyopathies by their morphologic and functional phenotype as well as by tissue characterization. Cardiac-MRI is also considered as the most appropriate technique for the follow-up of this disease. The purpose of this article is to browse an overview of the main MRI features of cardiomyopathy, focusing the purpose on hypertrophic forms and myocardial diseases leading to cardiac failure.
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Koeppe S, Neubauer H, Breunig F, Weidemann F, Wanner C, Sandstede J, Machann W, Hahn D, Köstler H, Beer M. MR-based analysis of regional cardiac function in relation to cellular integrity in Fabry disease. Int J Cardiol 2011; 160:53-8. [PMID: 21463907 DOI: 10.1016/j.ijcard.2011.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 03/10/2011] [Accepted: 03/12/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fabry cardiomyopathy is characterized by left ventricular (LV) hypertrophy and regional fibrosis. Recent high-end echocardiography studies of selected LV sections suggest an interrelation between regional fibrosis, impaired function, and hypertrophy possibly changing under specific enzyme replacement therapy (ERT). METHODS Magnetic resonance imaging (MRI) was used for a region dependent study of cardiac function, morphology and late enhancement (LE) in 25 Fabry patients before and after 12 months of ERT in comparison to 43 healthy volunteers. RESULTS Fabry patients presented with LV increased wall thickness (EDWT) and reduced wall thickening (WT) with a focus on basal and midventricular regions corresponding to areas of LE. The degree of hypertrophy and hypokinesia were the highest if LE was detectable. A significant decrease of the EDWT under ERT was observed in LE negative patients accompanied by a decline of hypokinesia with regional differences. CONCLUSIONS Regional differences of LV hypertrophy and wall motion were detected corresponding to the distribution of myocardial fibrosis (LE). Functional impairment was closely restricted to fibrotic regions while morphologic changes slightly exceeded the areas of fibrosis. ERT resulted in regional improvements whereby absence of fibrosis was connected to a better outcome.
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Affiliation(s)
- Sabrina Koeppe
- Institute of Radiology, Wuerzburg University, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
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Myocardial Fibrosis Attenuates the Effect of Cibenzoline on Left Ventricular Diastolic Function in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Pharmacol 2011; 57:207-12. [DOI: 10.1097/fjc.0b013e318203830d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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16
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Aquaro GD, Positano V, Pingitore A, Strata E, Di Bella G, Formisano F, Spirito P, Lombardi M. Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2010; 12:21. [PMID: 20374627 PMCID: PMC2867984 DOI: 10.1186/1532-429x-12-21] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 04/07/2010] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) with the late gadolinium enhancement (LGE) technique allows the detection of myocardial fibrosis in Hypertrophic cardiomyopathy (HCM). The aim of this study was to compare different methods of automatic quantification of LGE in HCM patients. METHODS Forty HCM patients (mean age 48 y, 30 males) and 20 normal subjects (mean age 38 y, 16 males) underwent CMR, and we compared 3 methods of quantification of LGE: 1) in the SD2 method a region of interest (ROI) was placed within the normal myocardium and enhanced myocardium was considered as having signal intensity >2 SD above the mean of ROI; 2) in the SD6 method enhanced myocardium was defined with a cut-off of 6 SD above mean of ROI; 3) in the RC method a ROI was placed in the background of image, a Rayleigh curve was created using the SD of that ROI and used as ideal curve of distribution of signal intensity of a perfectly nulled myocardium. The maximal signal intensity found in the Rayleigh curve was used as cut-off for enhanced myocardium. Parametric images depicting non enhanced and enhanced myocardium was created using each method. Three investigators assigned a score to each method by the comparison of the original LGE image to the respective parametric map generated. RESULTS Patients with HCM had lower concordance between the measured curve of distribution of signal intensity and the Rayleigh curve than controls (63.7 +/- 12.3% vs 92.2 +/- 2.3%, p < 0.0001).A cut off of concordance < 82.9% had a 97.1% sensitivity and 92.3% specificity to distinguish HCM from controls. The RC method had higher score than the other methods. The average extent of enhanced myocardium measured by SD6 and Rayleigh curve method was not significant different but SD6 method showed underestimation of enhancement in 12% and overestimation in 5% of patients with HCM. CONCLUSIONS Quantification of fibrosis in LGE images with a cut-off derived from the Rayleigh curve is more accurate than using a fixed cut-off.
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Affiliation(s)
| | - Vincenzo Positano
- MRI laboratory, Foundation G. Monasterio Regione Toscana/CNR, Pisa, Italy
| | | | | | - Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | | | - P Spirito
- Cardiology Department, Ospedali Galliera, Genova, Italy
| | - Massimo Lombardi
- MRI laboratory, Foundation G. Monasterio Regione Toscana/CNR, Pisa, Italy
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17
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Usefulness of delayed enhancement by magnetic resonance imaging in hypertrophic cardiomyopathy as a marker of disease and its severity. Am J Cardiol 2010; 105:392-7. [PMID: 20102955 DOI: 10.1016/j.amjcard.2009.09.045] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/20/2009] [Accepted: 09/20/2009] [Indexed: 12/17/2022]
Abstract
The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HC), the association between late gadolinium enhancement and clinical end points, such as nonsustained ventricular tachycardia, arrhythmic risk factors, New York Heart Association class, symptoms, and left ventricular functional parameters. A total of 20 normal subjects (mean age 38 years, 16 men) and 100 patients with HC (mean age 46 years, 70 men) were enrolled in the present study. In the late gadolinium enhancement images, the extent of unenhanced, mildly enhanced, and higher enhanced myocardium was measured. Higher enhancement was present in 80% of the HC population and was significantly greater in patients with a New York Heart Association class >1. Mild enhancement was present in all the patients with HC. Receiver operating characteristic analysis revealed that a cutoff of >4.9% of mild enhancement had 100% sensitivity and 86% specificity to predict the occurrence of nonsustained ventricular tachycardia, and a cutoff of >2.4% of hyperenhancement had 77% sensitivity and 96% specificity. In conclusion, late gadolinium enhancement was associated with nonsustained ventricular tachycardia, arrhythmic risk factors, and worse New York Heart Association class.
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18
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Amano Y, Takayama M, Kumita S. Contrast-enhanced myocardial T1-weighted scout (Look-Locker) imaging for the detection of myocardial damages in hypertrophic cardiomyopathy. J Magn Reson Imaging 2009; 30:778-84. [PMID: 19787718 DOI: 10.1002/jmri.21921] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To assess the myocardial damage in hypertrophic cardiomyopathy (HCM) using contrast-enhanced myocardial T1-weighted scout (Look-Locker) magnetic resonance imaging (MRI). MATERIALS AND METHODS Twenty-three patients with HCM and seven comparative patients without known HCM serving as controls underwent cine, contrast-enhanced myocardial T1-weighted scout and delayed-enhancement MRI using a 1.5T unit. Intervals of null points between myocardium and blood were compared among hyperenhancing and nullified myocardium of HCM and the normal myocardium. The relationship between these myocardial patterns and global cardiac functions was analyzed in HCM. RESULTS The hyperenhancing myocardium, dense myocardial fibrosis in HCM had null points significantly shorter than blood, normal myocardium, and nullified myocardium of HCM (P < 0.0001). The number of hyperenhancing myocardial segments correlated with the ejection fraction (P = 0.045). The nullified myocardium of HCM showed shorter intervals of the null points between myocardium and blood than did the normal myocardium, indicating the dispersed myocardial fibrosis (P = 0.0032). The interval of null points between the nullified myocardium and blood showed a significant correlation with the increase in myocardial mass in HCM (P = 0.034). CONCLUSION Contrast-enhanced myocardial T1-weighted scout imaging has the potential for showing dispersed myocardial damage leading to increased myocardial mass in HCM, while the dense myocardial fibrosis correlated with reduced ejection fraction.
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Affiliation(s)
- Yasuo Amano
- Department of Radiology, Nippon Medical School, Tokyo, Japan.
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19
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Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 2009; 54:1407-24. [PMID: 19796734 DOI: 10.1016/j.jacc.2009.04.094] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 04/14/2009] [Accepted: 04/28/2009] [Indexed: 01/08/2023]
Abstract
Noninvasive imaging plays a central role in the diagnosis of heart failure, assessment of prognosis, and monitoring of therapy. Cardiovascular magnetic resonance (CMR) offers a comprehensive assessment of heart failure patients and is now the gold standard imaging technique to assess myocardial anatomy, regional and global function, and viability. Furthermore, it allows assessment of perfusion and acute tissue injury (edema and necrosis), whereas in nonischemic heart failure, fibrosis, infiltration, and iron overload can be detected. The information derived from CMR often reveals the underlying etiology of heart failure, and its high measurement accuracy makes it an ideal technique for monitoring disease progression and the effects of treatment. Evidence on the prognostic value of CMR-derived parameters in heart failure is rapidly emerging. This review summarizes the advantages of CMR for patients with heart failure and its important role in key areas.
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Affiliation(s)
- Theodoros D Karamitsos
- University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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20
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Breuckmann F, Möhlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, Sievers B, Schlosser T, Jöckel KH, Heusch G, Erbel R, Barkhausen J. Myocardial Late Gadolinium Enhancement: Prevalence, Pattern, and Prognostic Relevance in Marathon Runners. Radiology 2009; 251:50-7. [DOI: 10.1148/radiol.2511081118] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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AJR Teaching File: Asymptomatic Man with Giant Negative T Waves on ECG. AJR Am J Roentgenol 2009; 192:S57-61. [DOI: 10.2214/ajr.07.7116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Satoh H, Matoh F, Shiraki K, Saitoh T, Odagiri K, Saotome M, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. Delayed enhancement on cardiac magnetic resonance and clinical, morphological, and electrocardiographical features in hypertrophic cardiomyopathy. J Card Fail 2009; 15:419-27. [PMID: 19477402 DOI: 10.1016/j.cardfail.2008.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/09/2008] [Accepted: 11/26/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND The clinical, morphological, and electrocardiographical relevance of delayed enhancement (DE) in cardiac magnetic resonance (CMR) was studied in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS A total of 56 patients underwent both gadolinium-enhanced CMR and 12-lead electrocardiogram. The CMR demonstrated DE at the left ventricular (LV) wall in 39 patients. The patients with DE included more cases with dilated phase of HCM, higher New York Heart Association (NYHA) classes and incidence of ventricular tachyarrhythmias (VT), lower LV ejection fraction (LVEF) and mean LV wall thickness (WT), and a larger ratio of maximum to minimum LVWT. The QRS duration was prolonged and the QRS axis deviated toward left with increases in the DE volume (r = 0.58 and r = 0.41, P < .01). Abnormal Q waves were present in 5 patients and the location coincided with the DE segments in 4 patients, but the concordance was not significant. The amplitude of T waves correlated with the ratio of the apex to basal LVWT (r = 0.38, P < .01) and was more negative in cases with DE at the apex. CONCLUSIONS In HCM, the DE was associated with higher NYHA classes and prevalence of VT, impaired global LV function and asymmetrical hypertrophy, and conduction disturbance, abnormal Q waves, and giant negative T waves.
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Affiliation(s)
- Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Japan.
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23
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Association Between Regional Ventricular Function and Myocardial Fibrosis in Hypertrophic Cardiomyopathy Assessed by Speckle Tracking Echocardiography and Delayed Hyperenhancement Magnetic Resonance Imaging. J Am Soc Echocardiogr 2008; 21:1299-305. [DOI: 10.1016/j.echo.2008.09.011] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Indexed: 02/07/2023]
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24
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Affiliation(s)
- Gisela C Mueller
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan 48109-2713, USA
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25
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Sotgia B, Sciagrà R, Olivotto I, Casolo G, Rega L, Betti I, Pupi A, Camici PG, Cecchi F. Spatial relationship between coronary microvascular dysfunction and delayed contrast enhancement in patients with hypertrophic cardiomyopathy. J Nucl Med 2008; 49:1090-6. [PMID: 18552138 DOI: 10.2967/jnumed.107.050138] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED To clarify the spatial relationship between coronary microvascular dysfunction and myocardial fibrosis in hypertrophic cardiomyopathy (HCM), we compared the measurement of hyperemic myocardial blood flow (hMBF) by PET with the extent of delayed contrast enhancement (DCE) detected by MRI. METHODS In 34 patients with HCM, PET was performed using (13)N-labeled ammonia during hyperemia induced by intravenous dipyridamole. DCE and systolic thickening were assessed by MRI. Left ventricular myocardial segments were classified as with DCE, either transmural (DCE-T) or nontransmural (DCE-NT), and without DCE, either contiguous to DCE segments (NoDCE-C) or remote from them (NoDCE-R). RESULTS In the group with DCE, hMBF was significantly lower than in the group without DCE (1.81 +/- 0.94 vs. 2.13 +/- 1.11 mL/min/g; P < 0.001). DCE-T segments had lower hMBF than did DCE-NT segments (1.43 +/- 0.52 vs. 1.91 +/- 1 mL/min/g, P < 0.001). Similarly, NoDCE-C segments had lower hMBF than did NoDCE-R (1.98 +/- 1.10 vs. 2.29 +/- 1.10 mL/min/g, P < 0.01) and had no significant difference from DCE-NT segments. Severe coronary microvascular dysfunction (hMBF in the lowest tertile of all segments) was more prevalent among NoDCE-C than NoDCE-R segments (33% vs. 24%, P < 0.05). Systolic thickening was inversely correlated with percentage transmurality of DCE (Spearman rho = -0.37, P < 0.0001) and directly correlated with hMBF (Spearman rho = 0.20, P < 0.0001). CONCLUSION In myocardial segments exhibiting DCE, hMBF is reduced. DCE extent is inversely correlated and hMBF directly correlated with systolic thickening. In segments without DCE but contiguous to DCE areas, hMBF is significantly lower than in those remote from DCE and is similar to the value obtained in nontransmural DCE segments. These results suggest that increasing degrees of coronary microvascular dysfunction might play a causative role for myocardial fibrosis in HCM.
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Affiliation(s)
- Barbara Sotgia
- Department of Clinical Physiopathology-Nuclear Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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26
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Payá E, Marín F, González J, Gimeno JR, Feliu E, Romero A, Ruiz-Espejo F, Roldán V, Climent V, de la Morena G, Valdés M. Variables Associated With Contrast-Enhanced Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy: Clinical Implications. J Card Fail 2008; 14:414-9. [DOI: 10.1016/j.cardfail.2008.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 02/01/2008] [Accepted: 02/06/2008] [Indexed: 12/26/2022]
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27
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Strach K, Sommer T, Grohé C, Meyer C, Fischer D, Walter MC, Vorgerd M, Reilich P, Bär H, Reimann J, Reuner U, Germing A, Goebel HH, Lochmüller H, Wintersperger B, Schröder R. Clinical, genetic, and cardiac magnetic resonance imaging findings in primary desminopathies. Neuromuscul Disord 2008; 18:475-82. [PMID: 18504128 DOI: 10.1016/j.nmd.2008.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 03/08/2008] [Accepted: 03/16/2008] [Indexed: 01/25/2023]
Abstract
We report the clinical, genetic and cardiac magnetic resonance imaging (MRI) findings in 11 German patients with heterozygous E245D, D339Y, R350P and L377P desmin mutations and without cardiac symptoms. Clinical evaluation revealed a marked variability of skeletal muscle, respiratory and cardiac involvement even between patients with identical mutations, ranging from asymptomatic to severely affected. While echocardiography did not show any pathological findings in all 11 patients, cine MRI revealed focal left ventricular hypertrophy in 2 patients and MR delayed enhancement imaging displayed intramyocardial fibrosis in the left ventricle in 4 patients indicating early myocardial involvement. Our data argue against distinct genotype-phenotype correlations and suggest that comprehensive cardiac MRI is superior to conventional echocardiography for the detection of early and clinically asymptomatic stages of cardiomyopathy in desminopathy patients. Therefore, cardiac MRI may serve as a screening tool to identify patients at risk, which might benefit from early pharmacological and/or interventional (e.g. implantable cardioverter-defibrillator devices) therapy.
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Affiliation(s)
- Katharina Strach
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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28
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Ordovás KG, Reddy GP, Higgins CB. MRI in nonischemic acquired heart disease. J Magn Reson Imaging 2008; 27:1195-213. [DOI: 10.1002/jmri.21172] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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29
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Andersen K, Hennersdorf M, Cohnen M, Blondin D, Mödder U, Poll LW. Myocardial delayed contrast enhancement in patients with arterial hypertension: initial results of cardiac MRI. Eur J Radiol 2008; 71:75-81. [PMID: 18434065 DOI: 10.1016/j.ejrad.2008.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Revised: 03/03/2008] [Accepted: 03/10/2008] [Indexed: 01/01/2023]
Abstract
PURPOSE In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. METHODS AND MATERIAL Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. RESULTS Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. CONCLUSION In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.
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Affiliation(s)
- Kjel Andersen
- Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
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30
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Magnetic Resonance Imaging of Apical Left Ventricular Aneurysm and Thinning Associated With Hypertrophic Cardiomyopathy. J Comput Assist Tomogr 2008; 32:259-64. [DOI: 10.1097/rct.0b013e318074fdbc] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Gorriño M, Arizaga E, Oleaga L, Gorriño O. [Focal hypertrophic cardiomyopathy]. RADIOLOGIA 2008; 50:28; discussion 87. [PMID: 18275785 DOI: 10.1016/s0033-8338(08)71936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Gorriño
- Servicio de Radiodiagnóstico. Hospital de Basurto. Bilbao. España.
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32
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Kim YJ, Choi BW, Hur J, Lee HJ, Seo JS, Kim TH, Choe KO, Ha JW. Delayed enhancement in hypertrophic cardiomyopathy: Comparison with myocardial tagging MRI. J Magn Reson Imaging 2008; 27:1054-60. [DOI: 10.1002/jmri.21366] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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33
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Abstract
OBJECTIVE We present a two-part review about the use of MRI in patients with hypertrophic cardiomyopathy (HCM). This article, Part 1, focuses on the MRI appearances of HCM. CONCLUSION MRI has proven to be an important tool for the evaluation of patients suspected of having HCM because it can readily diagnose those with phenotypic expression of the disorder and can potentially identify the subset of patients at risk of sudden cardiac death.
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34
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Dumont CA, Monserrat L, Soler R, Rodriguez E, Peteiro J, Fernández X, Rodríguez A, Pérez R, Bouzas B, Castro-Beiras A. Left Ventricular Asynchrony in Patients with Hypertrophic Cardiomyopathy: Its Determinants and its Relation to Left Ventricular Function. J Am Soc Echocardiogr 2007; 20:1247-52. [PMID: 17604956 DOI: 10.1016/j.echo.2007.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 11/15/2022]
Affiliation(s)
- Carlos A Dumont
- Division of Cardiology, Juan Canalejo Hospital, La Coruña, Spain
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35
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Matoh F, Satoh H, Shiraki K, Saitoh T, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. Usefulness of delayed enhancement magnetic resonance imaging to differentiate dilated phase of hypertrophic cardiomyopathy and dilated cardiomyopathy. J Card Fail 2007; 13:372-9. [PMID: 17602984 DOI: 10.1016/j.cardfail.2007.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 02/02/2007] [Accepted: 02/05/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND The dilated phase of hypertrophic cardiomyopathy (HCM) has a poor prognosis. For correct recognition of such patients, we compared the findings in cardiac delayed enhancement (DE)-magnetic resonance imaging (MRI) between HCM and dilated cardiomyopathy (DCM) patients. METHODS AND RESULTS Sixty-five patients (HCM 39, DCM 26) underwent gadolinium-DTPA-enhanced MRI. The HCM patients were divided into those with preserved (HCM-P, n = 30) and those with impaired systolic function (HCM-I, n = 9). DE-MRI demonstrated focal or diffuse DE at the left ventricular (LV) wall in 60% of HCM-P and 100% of HCM-I, but in only 12% of DCM. The DE distributed mainly septal to the anterior wall of LV, but the DE volume against whole LV muscle volume was much larger in HCM-I than in HCM-P and DCM (4.1 +/- 6.1% in HCM-P, 14.6 +/- 11.9% in HCM-I, and 0.8 +/- 2.4% in DCM, means +/- SD, P < .05). In HCM, there were weak but significant correlations between DE volume, and LV end-diastolic volume and LV end-systolic volume. In HCM-P, the percent of length shortening in the segments with DE was lower than that without DE. CONCLUSIONS The HCM patients had more DE than the DCM patients, and DE volume correlated to lower global and local LV function. DE-MRI may be useful to evaluate myocardial damage in HCM patients, and to differentiate the dilated phase of HCM from DCM.
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Affiliation(s)
- Fumitaka Matoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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36
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Dumont CA, Monserrat L, Peteiro J, Soler R, Rodriguez E, Bouzas A, Fernández X, Pérez R, Bouzas B, Castro-Beiras A. Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy. Am J Cardiol 2007; 99:1454-7. [PMID: 17493479 DOI: 10.1016/j.amjcard.2006.12.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/20/2022]
Abstract
The degree of exercise capacity is poorly predicted by conventional markers of disease severity in patients with hypertrophic cardiomyopathy (HC). The principal mechanism of exercise intolerance in patients with HC is the failure of stroke volume augmentation due to left ventricular (LV) diastolic dysfunction. The role of LV chamber stiffness, assessed noninvasively, as a determinant of exercise tolerance is unknown. Sixty-four patients with HC were studied with Doppler echocardiography, exercise testing, and gadolinium cardiac magnetic resonance. The LV chamber stiffness index was determined as the ratio of pulmonary capillary wedge pressure (derived from the E/Ea ratio) to LV end-diastolic volume (assessed by cardiac magnetic resonance). Maximal exercise tolerance was defined as achieved METs. There were inverse correlations between METs achieved and age (r = -0.38, p = 0.003), heart rate deficit (r = -0.39, p = 0.002), LV outflow tract gradient (r = -0.33, p = 0.009), the E/Ea ratio (r = -0.4, p = 0.001), mean LV wall thickness (r = -0.26, p = 0.04), and LV stiffness (r = -0.56, p <0.001) and a positive correlation between METs achieved and LV end-diastolic volume (r = 0.33, p = 0.01). On multivariate analysis, only LV chamber stiffness was associated with exercise capacity. A LV stiffness level of 0.18 mm Hg/ml had 100% sensitivity and 75% specificity (area under the curve 0.84) for predicting < or =7 METs achieved. In conclusion, LV diastolic dysfunction at rest, as manifested by increased LV chamber stiffness, is a major determinant of maximal exercise capacity in patients with HC.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Analysis of Variance
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/physiopathology
- Contrast Media
- Echocardiography, Doppler, Color
- Exercise Test
- Exercise Tolerance
- Female
- Gadolinium DTPA
- Heart Rate
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Pulmonary Wedge Pressure
- Regression Analysis
- Research Design
- Rest
- Sensitivity and Specificity
- Severity of Illness Index
- Stroke Volume
- Vascular Resistance
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
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Jackson E, Bellenger N, Seddon M, Harden S, Peebles C. Ischaemic and non-ischaemic cardiomyopathies—cardiac MRI appearances with delayed enhancement. Clin Radiol 2007; 62:395-403. [PMID: 17398263 DOI: 10.1016/j.crad.2006.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 11/09/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
Over the past few years, cardiovascular magnetic resonance (CMR) imaging has rapidly developed and is now a robust clinical tool capable of providing high-resolution images of the heart in any desired plane. Delayed contrast-enhanced CMR (DE-CMR) can be used for non-invasive tissue characterization, with differing patterns of hyperenhancement displayed by ischaemic and non-ischaemic cardiomyopathies. This review explains the theory behind delayed hyperenhancement, and demonstrates the potential of DE-CMR in the diagnosis of a wide range of different cardiac disease states.
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Affiliation(s)
- E Jackson
- Departments of Cardiothoracic Radiology, Southampton General Hospital, Tremona Road, Southampton, Hampshire, UK
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Tanaka YO, Ohtsuka S, Shindo M, Oyake Y, Minami M. Comparison of delayed myocardial enhancement in the early and late phase after contrast injection: is it possible to reduce the examination time for myocardial viability study? Magn Reson Imaging 2007; 25:232-7. [PMID: 17275619 DOI: 10.1016/j.mri.2006.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 09/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We studied whether we can obtain a myocardial viability study immediately after contrast injection to reduce the whole cardiac MR examination time. MATERIALS AND METHODS We examined 36 patients with cardiovascular abnormality on comprehensive cardiac MRI. T1-weighted images with inversion recovery (IR) were obtained 5 min after stress perfusion with 0.05 mmol/kg of gadodiamide and 15 min after the resting perfusion with the same dose. (The latter images were obtained 25 min after the initial administration.) We evaluated the existence, the number of sectors, and the degree of enhancement at each time. The contrast ratio was also calculated. The number of the enhanced sectors and the contrast ratio were statistically compared using Student's t test. RESULTS All 17 cases of delayed myocardial enhancement at 25 min after contrast injection showed some enhancement at 5 min after contrast injection. However, the number of enhanced sectors was larger at 25 min after the initial injection in 11 cases, and it was statistically significant (P=.017). The degree of enhancement was stronger at 25 min in 14 cases. However, the contrast ratio at 5 and 25 min after contrast injection was not significantly different (P=.245). CONCLUSION Myocardial viability study immediately after contrast injection is too early to evaluate the extent of myocardial injury.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernández X, Peteiro J, Bouzas B, Piñón P, Castro-Beiras A. Significado clínico del realce tardío de gadolinio con resonancia magnética en pacientes con miocardiopatía hipertrófica. Rev Esp Cardiol 2007. [DOI: 10.1157/13097921] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Vogel-Claussen J, Rochitte CE, Wu KC, Kamel IR, Foo TK, Lima JAC, Bluemke DA. Delayed enhancement MR imaging: utility in myocardial assessment. Radiographics 2006; 26:795-810. [PMID: 16702455 DOI: 10.1148/rg.263055047] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of magnetic resonance (MR) imaging for diagnosis of cardiac diseases and treatment monitoring is expanding. Delayed myocardial enhancement MR imaging is performed after administration of paramagnetic contrast agents and is used for a growing number of clinical applications. This technique was developed primarily for characterization of myocardial scarring after myocardial infarction. On delayed enhancement MR images, scarring or fibrosis appears as an area of high signal intensity that is typically subendocardial or transmural in a coronary artery distribution. However, delayed myocardial enhancement is not specific for myocardial infarction and can occur in a variety of other disorders, such as inflammatory or infectious diseases of the myocardium, cardiomyopathy, cardiac neoplasms, and congenital or genetic cardiac conditions, as well as after cardiac interventions. In nonischemic myocardial disease, the delayed enhancement usually does not occur in a coronary artery distribution and is often midwall rather than subendocardial or transmural. Therefore, the patient's clinical history is critical in the evaluation of delayed myocardial enhancement MR images.
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Affiliation(s)
- Jens Vogel-Claussen
- Department of Radiology, Johns Hopkins Hospital, MRI, Room 143, 600 N Wolfe St, Baltimore, MD 21287, USA
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Hartke LP, Gilkeson RC, O'Riordan MA, Siwik ES. Evaluation of Right Ventricular Fibrosis in Adult Congenital Heart Disease Using Gadolinium-enhanced Magnetic Resonance Imaging: Initial Experience in Patients with Right Ventricular Loading Conditions. CONGENIT HEART DIS 2006; 1:192-201. [DOI: 10.1111/j.1747-0803.2006.00035.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Soler R, Rodríguez E, Monserrat L, Méndez C, Martínez C. Magnetic resonance imaging of delayed enhancement in hypertrophic cardiomyopathy: relationship with left ventricular perfusion and contractile function. J Comput Assist Tomogr 2006; 30:412-20. [PMID: 16778615 DOI: 10.1097/00004728-200605000-00011] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to analyze the relationship between myocardial delayed enhancement, first-pass perfusion, and contractile function in hypertrophic cardiomyopathy (HCM) patients, using MR. METHODS Fifty-three patients diagnosed with HCM were prospectively examined using a 1.5-T MR unit. Multiphase gradient-echo sequences were performed to study global left ventricular function, wall thickness, and left ventricular mass. Myocardial tissue tagging was conducted to evaluate contractile function. T1-weighted inversion-recovery sequences were obtained at rest to study myocardial contrast enhancement at first pass and delayed enhancement 10 minutes later. RESULTS Delayed enhancement found in 30 patients (56.6%) was most commonly seen in hypertrophic segments. Nine patients exhibited delayed enhancement in segments with normal wall thickness (<15 mm). Sixteen patients (30.1%) showed first-pass perfusion defects at rest, which were associated with significantly lower stroke volume (P<0.05) and lower cardiac output (P<0.01). The hypokinetic segments found in 16 patients (30.1%) were significantly thicker at end diastole (P<0.01). Delayed enhancement correlated positively with perfusion defects (r=0.5, P<0.01) and hypokinetic segments (r=0.3, P<0.05). CONCLUSION Delayed myocardial enhancement is most commonly found in hypertrophic segments but also can be seen in segments with normal wall thickness. Perfusion defects at rest and impaired contractile function are related abnormalities with delayed myocardial enhancement. Further studies are necessary to assess the role of myocardial tagging, first-pass perfusion, and delayed enhancement in risk stratification for patients with HCM.
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Affiliation(s)
- Rafaela Soler
- Department of Radiology, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain.
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Beer M, Weidemann F, Breunig F, Knoll A, Koeppe S, Machann W, Hahn D, Wanner C, Strotmann J, Sandstede J. Impact of enzyme replacement therapy on cardiac morphology and function and late enhancement in Fabry's cardiomyopathy. Am J Cardiol 2006; 97:1515-8. [PMID: 16679096 DOI: 10.1016/j.amjcard.2005.11.087] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 11/16/2022]
Abstract
The present study evaluated the evolution of cardiac morphology, function, and late enhancement as a noninvasive marker of myocardial fibrosis, and their inter-relation during enzyme replacement therapy in patients with Fabry's disease using magnetic resonance imaging and color Doppler myocardial imaging. Late enhancement, which was present in up to 50% of patients, was associated with increased left ventricular mass, the failure of a significant regression of hypertrophy during enzyme replacement therapy, and worse segmental myocardial function. Late enhancement may predict the effect of enzyme replacement therapy on left ventricular mass and cardiac function.
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Affiliation(s)
- Meinrad Beer
- Institut für Röntgendiagnostik, Würzburg, Germany.
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Fowler SJ, Narula J, Gurudevan SV. Review of Noninvasive Imaging for Hypertrophic Cardiac Syndromes and Restrictive Physiology. Heart Fail Clin 2006; 2:215-30. [PMID: 17386891 DOI: 10.1016/j.hfc.2006.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Raney AR, Bello D. Cardiovascular Magnetic Resonance Assessment of Ischemic and Nonischemic Cardiomyopathies. Heart Fail Clin 2006; 2:145-61. [PMID: 17386886 DOI: 10.1016/j.hfc.2006.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim DH, Choi SI, Chang HJ, Choi DJ, Lim C, Park JH. Delayed Hyperenhancement by Contrast-Enhanced Magnetic Resonance Imaging. J Comput Assist Tomogr 2006; 30:226-32. [PMID: 16628037 DOI: 10.1097/00004728-200603000-00011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinical applications of contrast-enhanced magnetic resonance (MR) imaging for defining viability are evolving as a result of the advantage of the technique's excellent spatial resolution. The value of delayed hyperenhancement imaging is for the accurate identification of the infarcted myocardium with resolution that allows determination of the transmural extent of myocardial injury. In addition, nonischemic patterns of myocardial injury such as dilated or hypertrophic cardiomyopathy have been reported in other disease states. Delayed hyperenhancement may have an additional role in guiding the management of or determining the prognosis for diseases such as myocarditis. In this study, the clinical application of delayed hyperenhancement is demonstrated for various cardiac diseases such as myocardial infarction, including right ventricular infarction; microvascular obstruction; and nonischemic cardiomyopathy such as dilated cardiomyopathy and myocarditis.
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Affiliation(s)
- Dong Hun Kim
- Department of Radiology, Chosun University Hospital, Gwangju, Korea
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MacDonald KA, Wisner ER, Larson RF, Klose T, Kass PH, Kittleson MD. Comparison of myocardial contrast enhancement via cardiac magnetic resonance imaging in healthy cats and cats with hypertrophic cardiomyopathy. Am J Vet Res 2005; 66:1891-4. [PMID: 16334945 DOI: 10.2460/ajvr.2005.66.1891] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To quantify myocardial contrast enhancement (MCE) of the left ventricle (LV) by use of cardiac magnetic resonance imaging (CMRI) in healthy cats and cats with hypertrophic cardiomyopathy (HCM) and to compare MCE between the 2 groups. ANIMALS 10 healthy cats and 26 Maine Coon cats with moderate to severe HCM but without clinical evidence of congestive heart failure. PROCEDURE Anesthetized cats underwent gradient echo CMRI examination. Short-axis images of the LV were acquired before and 7 minutes after IV administration of gadolinium dimeglumine. Regions of interest were manually traced in the quadrants of 5 mid-LV slices acquired at end systole, and the MCE percentage was calculated from summed weight-averaged data from all slices. Doppler tissue imaging echocardiography was performed to measure the early diastolic myocardial velocity (Em) as an index of diastolic function. Three-way repeated-measures ANOVA was used to determine differences in MCE between cats with HCM and healthy cats. Simple linear regression was used to assess whether MCE was correlated with LV mass, LV mass index (LVMI), or Em. A Student t test was used to compare the SDs of the postcontrast myocardial signal intensity between the 2 groups. RESULTS There was no difference in MCE between cats with HCM and healthy cats. There was no correlation of MCE with LV mass, LVMI, or Em. There was no difference in heterogeneity of signal intensities of LV myocardium between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE Contrast-enhancement CMRI was not useful in detecting diffuse myocardial fibrosis in cats with HCM.
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MESH Headings
- Animals
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/veterinary
- Cat Diseases/diagnosis
- Cats
- Contrast Media/chemistry
- Echocardiography, Doppler/veterinary
- Heterocyclic Compounds/chemistry
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/veterinary
- Linear Models
- Magnetic Resonance Imaging/methods
- Magnetic Resonance Imaging/veterinary
- Meglumine/analogs & derivatives
- Meglumine/chemistry
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Affiliation(s)
- Kristin A MacDonald
- Department of Medicine and Epidemiology, University of California, Davis 95616, USA
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Taylor AM, Dymarkowski S, Verbeken EK, Bogaert J. Detection of pericardial inflammation with late-enhancement cardiac magnetic resonance imaging: initial results. Eur Radiol 2005; 16:569-74. [PMID: 16249864 DOI: 10.1007/s00330-005-0025-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 06/21/2005] [Accepted: 09/02/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the value of late-enhancement cardiac magnetic resonance imaging (MRI) for detection of pericardial inflammation. MATERIALS AND METHODS Late-enhancement cardiac MRI was performed in 16 patients with clinical suspicion of pericardial disease. Pericardial effusion, pericardial thickening and pericardial enhancement were assessed. MRI findings were compared with those of definitive pericardial histology (n=14) or microbiology (n=2). A control group of 12 patients with no clinical evidence of pericardial disease were also imaged with the same MRI protocol. RESULTS Sensitivity and specificity for late-enhancement MRI detection of pericardial inflammation was of 100%. There was MRI late enhancement of the pericardial layers in all five patients with histological/microbiological evidence of inflammatory pericarditis. MRI demonstrated no pericardial thickening and no MRI late enhancement with or without a pericardial effusion in any of the five patients with histological evidence of a normal pericardium. MRI detected pericardial thickening in the absence of both pericardial effusion and late enhancement in all six patients with histological evidence of chronic fibrosing pericarditis. The 12 control subjects showed no evidence of pericardial MRI late enhancement. CONCLUSIONS These findings demonstrate that MRI late enhancement can be used to visualize pericardial inflammation in patients with clinical suspicion of pericardial disease.
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Affiliation(s)
- Andrew M Taylor
- Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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Tanaka YO, Ohtsuka S, Shindo M, Katsumata Y, Oyake Y, Minami M. Efficacy of spectral presaturation of inversion recovery in evaluating delayed myocardial enhancement. Magn Reson Imaging 2005; 23:893-7. [PMID: 16275429 DOI: 10.1016/j.mri.2005.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 07/07/2005] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Delayed myocardial enhancement is caused by a variety of cardiovascular diseases. The extent of the enhanced area has been examined by the inversion recovery (IR) method, whereby at the inversion time (TI), normal myocardium shows a low signal intensity. In this sequence, as pericardial fat shows a very high intensity, a delayed enhancement just below the pericardium may be indistinct. To improve the accuracy of delayed myocardial enhancement, we employed the spectral presaturation of inversion recovery (SPIR) method. MATERIALS AND METHODS Thirty-five patients with symptoms of cardiovascular disease aged between 36 and 80 years old (mean age, 62 years old) were investigated. Thirty were men and five were women. Inversion recovery and SPIR images were obtained 25 min after initial administration of a gadolinium-based contrast material. Each TI, when the signal intensity of the normal myocardium was null, was determined by images obtained at serial different TIs. A radiologist and a cardiologist examined each image by a consensus reading. The extent of myocardial enhancement was described as none, subendocardial, transmural and a random pattern in each case. Images were ranked over three levels and were based on whether myocardial enhancement could be easily detected or whether the contour of the myocardium was visualized precisely. Student's t-test was conducted to compare the quality of two sequences in all patients and in 22 patients who showed delayed myocardial enhancement. RESULTS The imaging quality in evaluating delayed myocardial enhancement in all patients was superior with IR compared with SPIR, although it was not statistically significant. The imaging quality in the patients with delayed myocardial enhancement was similar between SPIR and IR. SPIR was superior to the IR sequence in two of the four patients who exhibited transmural enhancement. CONCLUSION SPIR exhibited equivalent image quality to IR in evaluating delayed myocardial enhancement. As it has the potential advantage in patients with rich adipose tissue surrounding the myocardium, it can be an alternative sequence to evaluate myocardial viability.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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MacDonald KA, Kittleson MD, Reed T, Larson R, Kass P, Wisner ER. Quantification of left ventricular mass using cardiac magnetic resonance imaging compared with echocardiography in domestic cats. Vet Radiol Ultrasound 2005; 46:192-9. [PMID: 16050275 DOI: 10.1111/j.1740-8261.2005.00038.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The hypotheses were that cardiac magnetic resonance imaging (cMRI) would accurately determine LV mass in domestic cats and would do so more accurately than echocardiography (ECHO). ECHO was performed on seven sedated cats. LV mass was calculated using the truncated ellipse formula from a right parasternal long-axis view. T1 weighted gradient echo cMRI was acquired from anesthetized cats during multiple phases of the cardiac cycle. Short-axis images were obtained by acquiring 3 mm thick contiguous slices perpendicular to the cardiac long axis. LV mass was determined using Simpson's rule. Endocardial and epicardial borders were traced on each slice at end-systole, end-diastole, and mid-cycle and the difference in areas was myocardial area. Myocardial area was multiplied by slice thickness to calculate myocardial volume. Total (summated) myocardial volume was multiplied by myocardial density (1.05) to obtain LV mass at three measured phases of the cardiac cycle. Cats were euthanized and the LV was dissected and weighed to determine true mass. CMRI at end-systole most accurately quantified LV mass and was more accurate than echocardiography (P = 0.0078). Actual LV mass ranged from 6.5 to 10.5 g (mean = 8.5 g, SD = 1.6 g) compared with MRI LV mass at end-systole, which ranged from 6.7 to 11.1 g (mean = 8.7 g, SD = 1.7 g) and echocardiographic LV mass at enddiastole, which ranged from 5.2 to 9.1 g (mean= 7.1 g, SD = 1.8 g). Inter- and intraobserver variability for cMRI was 2%. CMRI obtained at end-systole accurately and reliably quantifies LV mass in domestic cats. It is more accurate than the echocardiographic method used in this study.
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Affiliation(s)
- Kristin A MacDonald
- Department of Veterinary Medicine and Epidemiology, Veterinary Medical Teaching Hospital, University of California, Davis, CA 95616, USA.
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