1
|
Liu J, Zhao S, Yu S, Wu G, Wang D, Liu L, Song J, Zhu Y, Kang L, Wang J, Song L. Patterns of Replacement Fibrosis in Hypertrophic Cardiomyopathy. Radiology 2021; 302:298-306. [PMID: 34726536 DOI: 10.1148/radiol.2021210914] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Myocardial replacement fibrosis is one of the major histologic features of hypertrophic cardiomyopathy (HCM), but its characteristics have not been well delineated. Purpose To clarify the characteristics of replacement fibrosis in HCM and to evaluate the prognostic value of the regional extent of fibrosis. Materials and Methods This prospective study evaluated participants with HCM who underwent contrast-enhanced cardiac MRI from March 2011 to April 2019. For each participant, global and 16-segment extent of late gadolinium enhancement (LGE) in the left ventricle (LV) at cardiac MRI was analyzed. The primary end point was all-cause death. Results Among the 798 study participants enrolled (median age, 49 years [interquartile range {IQR}: 38-59 years]; 508 men), 588 (74%) underwent whole-exome sequencing. Thirty-five participants (4%) experienced death from any cause during a median follow-up of 2.9 years (IQR: 1.5-4.7 years). Spearman analysis showed weak correlations between the extent of LGE and wall thickness (LGE of global LV and maximal LV wall thickness, r = 0.35 [P < .001]; LGE and thickness of septum, r = 0.30 [P < .001]). In the 16-segment model, the distribution of LGE was visually inhomogeneous and higher in the basal anterior, basal septal, midanterior, and midseptal regions (P < .001). This similar distribution of LGE was observed in participants with asymmetric septal hypertrophy, those with apical HCM, participants positive for mutation and those negative for mutation, and participants with MYH7 and MYBPC3 mutations. Cox analysis indicated that both the global extent of LGE (adjusted hazard ratio = 1.68 per 10% increase in LGE; P < .001) and the regional extent of LGE (ie, basal, midventricular, and apical regions of LV when on the short-axis view; septum, anterior free wall, inferior free wall, and lateral free wall when on the long-axis view) were associated with adverse outcomes. Conclusion In hypertrophic cardiomyopathy, myocardial replacement fibrosis weakly correlated with hypertrophy, was inhomogeneous and asymmetric, and was predominantly distributed in the interventricular septal wall and anterior free wall at the basal and mid levels. Greater extent of fibrosis was associated with poor prognosis, regardless of its location in the left ventricle. © RSNA, 2021 See also the editorial by Hanneman in this issue.
Collapse
Affiliation(s)
- Jie Liu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Shihua Zhao
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Shiqin Yu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Guixin Wu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Dong Wang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lele Liu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Jialin Song
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Yuming Zhu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lianming Kang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Jizheng Wang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lei Song
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| |
Collapse
|
2
|
Stephenson E, Monney P, Pugliese F, Malcolmson J, Petersen SE, Knight C, Mills P, Wragg A, O'Mahony C, Sekhri N, Mohiddin SA. Ineffective and prolonged apical contraction is associated with chest pain and ischaemia in apical hypertrophic cardiomyopathy. Int J Cardiol 2018; 251:65-70. [PMID: 29197461 DOI: 10.1016/j.ijcard.2017.09.206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the hypothesis that persistence of apical contraction into diastole is linked to reduced myocardial perfusion and chest pain. BACKGROUND Apical hypertrophic cardiomyopathy (HCM) is defined by left ventricular (LV) hypertrophy predominantly of the apex. Hyperdynamic contractility resulting in obliteration of the apical cavity is often present. Apical HCM can lead to drug-refractory chest pain. METHODS We retrospectively studied 126 subjects; 76 with apical HCM and 50 controls (31 with asymmetrical septal hypertrophy (ASH) and 19 with non-cardiac chest pain and culprit free angiograms and structurally normal hearts). Perfusion cardiac magnetic resonance imaging (CMR) scans were assessed for myocardial perfusion reserve index (MPRi), late gadolinium enhancement (LGE), LV volumes (muscle and cavity) and regional contractile persistence (apex, mid and basal LV). RESULTS In apical HCM, apical MPRi was lower than in normal and ASH controls (p<0.05). In apical HCM, duration of contractile persistence was associated with lower MPRi (p<0.01) and chest pain (p<0.05). In multivariate regression, contractile persistence was independently associated with chest pain (p<0.01) and reduced MPRi (p<0.001). CONCLUSION In apical HCM, regional contractile persistence is associated with impaired myocardial perfusion and chest pain. As apical myocardium makes limited contributions to stroke volume, apical contractility is also largely ineffective. Interventions to reduce apical contraction and/or muscle mass are potential therapies for improving symptoms without reducing cardiac output.
Collapse
Affiliation(s)
- Edward Stephenson
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Pierre Monney
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Francesca Pugliese
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - James Malcolmson
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Charles Knight
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Peter Mills
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andrew Wragg
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | | | - Neha Sekhri
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Saidi A Mohiddin
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
| |
Collapse
|
3
|
Fujimoto A, Morimoto C, Hosokawa Y, Hasegawa A. Suturing method as a factor for uterine vascularity after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2017; 211:146-149. [PMID: 28260688 DOI: 10.1016/j.ejogrb.2017.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/25/2017] [Accepted: 02/26/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the vascularity of the myometrium after laparoscopic myomectomy sutured by two different methods using contrast-enhanced Magnetic Resonance Imaging. STUDY DESIGN Twenty-eight women who had symptomatic leiomyomas and underwent laparoscopic myomectomy between June 2013 and July 2014 were included in the present study. In the first half period, continuous sutures were used in 12 patients, and in the latter half period, single interrupted sutures were used in 16 patients. Contrast-enhanced Magnetic Resonance Imaging was used 3 or 6 months after surgery to evaluate vascularity after laparoscopic myomectomy. We defined avascularity index as the percentage of avascular area after surgery to cross sectional area of myoma before surgery. The Wilcoxon rank-sum test was applied to compare avascularity indeces in the two study groups. RESULTS At 3 months after surgery, avascularity index in continuous sutures group was significantly higher than that in single interrupted sutures group (median 5.0 vs.1.2, p<0.001), suggesting a poorer vascular recovery of the myometrium sutured continuously. CONCLUSION Simple interrupted suturing might be superior to continuous suturing in terms of vascularity evaluated using contrast enhanced Magnetic Resonance Imaging.
Collapse
Affiliation(s)
- Akihisa Fujimoto
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan.
| | - Chieko Morimoto
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan
| | - Yumi Hosokawa
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan
| | - Akiko Hasegawa
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan
| |
Collapse
|
4
|
Villa ADM, Sammut E, Zarinabad N, Carr-White G, Lee J, Bettencourt N, Razavi R, Nagel E, Chiribiri A. Microvascular ischemia in hypertrophic cardiomyopathy: new insights from high-resolution combined quantification of perfusion and late gadolinium enhancement. J Cardiovasc Magn Reson 2016; 18:4. [PMID: 26767610 PMCID: PMC4714488 DOI: 10.1186/s12968-016-0223-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/05/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Microvascular ischemia is one of the hallmarks of hypertrophic cardiomyopathy (HCM) and has been associated with poor outcome. However, myocardial fibrosis, seen on cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE), can be responsible for rest perfusion defects in up to 30% of patients with HCM, potentially leading to an overestimation of the ischemic burden. We investigated the effect of left ventricle (LV) scar on the total LV ischemic burden using novel high-resolution perfusion analysis techniques in conjunction with LGE quantification. METHODS 30 patients with HCM and unobstructed epicardial coronary arteries underwent CMR with Fermi constrained quantitative perfusion analysis on segmental and high-resolution data. The latter were corrected for the presence of fibrosis on a pixel-by-pixel basis. RESULTS High-resolution quantification proved more sensitive for the detection of microvascular ischemia in comparison to segmental analysis. Areas of LGE were associated with significant reduction of myocardial perfusion reserve (MPR) leading to an overestimation of the total ischemic burden on non-corrected perfusion maps. Using a threshold MPR of 1.5, the presence of LGE caused an overestimation of the ischemic burden of 28%. The ischemic burden was more severe in patients with fibrosis, also after correction of the perfusion maps, in keeping with more severe disease in this subgroup. CONCLUSIONS LGE is an important confounder in the assessment of the ischemic burden in patients with HCM. High-resolution quantitative analysis with LGE correction enables the independent evaluation of microvascular ischemia and fibrosis and should be used when evaluating patients with HCM.
Collapse
Affiliation(s)
- Adriana D M Villa
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Eva Sammut
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Niloufar Zarinabad
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | | | - Jack Lee
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | | | - Reza Razavi
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
| | - Eike Nagel
- DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt / Main, Frankfurt am Main, Germany.
| | - Amedeo Chiribiri
- Division of Imaging Sciences, King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, St Thomas' Hospital, London, UK.
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute - 4th Floor Lambeth Wing, St Thomas' Hospital, SE1 7EH, London, UK.
| |
Collapse
|
5
|
Chiribiri A, Leuzzi S, Conte MR, Bongioanni S, Bratis K, Olivotti L, De Rosa C, Lardone E, Di Donna P, Villa ADM, Cesarani F, Nagel E, Gaita F, Bonamini R. Rest perfusion abnormalities in hypertrophic cardiomyopathy: correlation with myocardial fibrosis and risk factors for sudden cardiac death. Clin Radiol 2015; 70:495-501. [PMID: 25659937 PMCID: PMC4398331 DOI: 10.1016/j.crad.2014.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/16/2014] [Accepted: 12/29/2014] [Indexed: 01/27/2023]
Abstract
Aim To measure the prevalence of abnormal rest perfusion in a population of consecutive patients with known hypertrophic cardiomyopathy (HCM) referred for cardiovascular MRI (CMR), and to assess any associations between abnormal rest perfusion and the presence, pattern, and severity of myocardial scar and the presence of risk factors for sudden death. Materials and methods Eighty consecutive patients with known HCM referred for CMR underwent functional imaging, rest first-pass perfusion, and late gadolinium enhancement (LGE). Results Thirty percent of the patients had abnormal rest perfusion, all of them corresponding to areas of mid-myocardial LGE and to a higher degree of segmental hypertrophy. Rest perfusion abnormalities correlated with more extensive and confluent LGE. The subgroup of patients with myocardial fibrosis and rest perfusion abnormalities (fibrosis+/perfusion+) had more than twice the incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring in comparison to patients with myocardial fibrosis and normal rest perfusion (fibrosis+/perfusion–) and patients with no fibrosis and normal rest perfusion (fibrosis–/perfusion–). Conclusions First-pass perfusion CMR identifies abnormal rest perfusion in a significant proportion of patients with HCM. These abnormalities are associated with the presence and distribution of myocardial scar and the degree of hypertrophy. Rest perfusion abnormalities identify patients with increased incidence of episodes of non-sustained ventricular tachycardia on Holter monitoring, independently from the presence of myocardial fibrosis. 30% of patients with HCM have perfusion abnormalities related to scar. No rest perfusion abnormalities were observed in areas of viable myocardium. Scar-related perfusion abnormalities were associated with the incidence of NSVT.
Collapse
Affiliation(s)
- A Chiribiri
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Internal Medicine, University of Torino, Italy.
| | - S Leuzzi
- Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - M R Conte
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - S Bongioanni
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - K Bratis
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - L Olivotti
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK; Department of Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - C De Rosa
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - E Lardone
- Division of Cardiology, A.O. Ordine Mauriziano di Torino Presidio Umberto I, Torino, Italy
| | - P Di Donna
- Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - A D M Villa
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - F Cesarani
- Department of Radiology, Cardinal Massaia Hospital, Asti, Italy
| | - E Nagel
- King's College London, Wellcome Trust/EPSRC Medical Engineering Centre, Division of Imaging Sciences, St Thomas' Hospital, UK
| | - F Gaita
- Department of Internal Medicine, University of Torino, Italy; Division of Cardiology, Cardinal Massaia Hospital, University of Torino, Asti, Italy
| | - R Bonamini
- Department of Internal Medicine, University of Torino, Italy
| |
Collapse
|
6
|
La risonanza magnetica cardiovascolare nella valutazione dello scompenso cardiaco: dalla morfologia alla caratterizzazione tissutale. J Cardiovasc Echogr 2012. [DOI: 10.1016/j.jcecho.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
7
|
Saito M, Okayama H, Yoshii T, Higashi H, Morioka H, Hiasa G, Sumimoto T, Inaba S, Nishimura K, Inoue K, Ogimoto A, Shigematsu Y, Hamada M, Higaki J. Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 13:617-23. [DOI: 10.1093/ejechocard/jer318] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
8
|
D'Andrea A, Fontana M, Cocchia R, Scarafile R, Calabrò R, Moon JC. Cardiovascular magnetic resonance in the evaluation of heart failure: a luxury or a need? J Cardiovasc Med (Hagerstown) 2011; 13:24-31. [PMID: 22130042 DOI: 10.2459/jcm.0b013e32834e4ad4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heart failure is a common syndrome with multiple causes. Cardiovascular magnetic resonance (CMR), using the available range of technique, is establishing itself as the gold standard noninvasive test for determining the underlying causes, and adding prognostic value, guiding therapy. Progress is continuing and rapid with promising new techniques such as diffuse fibrosis assessment. This article discusses the diverse roles of CMR in heart failure.
Collapse
Affiliation(s)
- Antonello D'Andrea
- Monaldi Hospital, Second University of Naples, AORN Ospedali dei Colli, Via Michelangelo Schipa 44, Naples, Italy.
| | | | | | | | | | | |
Collapse
|
9
|
Conte MR, Bongioanni S, Chiribiri A, Leuzzi S, Lardone E, Di Donna P, Pizzuti A, Luceri S, Cesarani F, Mabritto B, Zoccai GB, Bonamini R, Gaita F. Late gadolinium enhancement on cardiac magnetic resonance and phenotypic expression in hypertrophic cardiomyopathy. Am Heart J 2011; 161:1073-7. [PMID: 21641353 DOI: 10.1016/j.ahj.2011.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 03/15/2011] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) can identify areas of myocardial fibrosis in vivo in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to examine the association between clinical-morphological variables, risk factor for sudden death, and LGE findings in a consecutive, unselected population of HCM patients. METHODS From January 2005 to August 2009, 124 HCM patients (53 ± 17 years, 86 men) were prospectively evaluated with CMR examination, assessing left ventricular (LV) hypertrophy, function, and LGE. RESULTS In univariate analysis, patients were divided into tertiles according to the number of segments positive for LGE (first tertile, 0.3 ± 0.4; second tertile, 2.2 ± 0.4; third tertile, 5.2 ± 1.9 segments). Male gender (P = .05), maximum LV wall thickness (P = .002), nonsustained ventricular tachycardia (P = .001), ejection fraction <50% (P = .02), LV mass (P = .02), left atrium dilation (P = .04), perfusion defects (P ≤ .001), and telesystolic volume (P = .04) were all positively related with the number of segments of LGE. In multivariable analysis, male gender (P = .007), maximum LV wall thickness (P = .006), LV mass (P = .031), and perfusion alterations (P = .017) were independent predictors of LGE extent. CONCLUSIONS Our study shows an independent association, even at multivariate analysis, between the entity of LGE and maximum LV wall thickness, mass, and perfusion defects in patients with HCM. Whether the presence and the extent of LGE translates into clinical events later on awaits further long-term follow-up studies.
Collapse
|
10
|
Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 445] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
11
|
Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
12
|
O'Hanlon R, Pennell DJ. Cardiovascular Magnetic Resonance in the Evaluation of Hypertrophic and Infiltrative Cardiomyopathies. Heart Fail Clin 2009; 5:369-87, vi. [DOI: 10.1016/j.hfc.2009.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
13
|
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.
Collapse
Affiliation(s)
- Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Kjel Andersen
- Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
| | | | | | | | | | | |
Collapse
|
15
|
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.
Collapse
Affiliation(s)
- Fumitaka Matoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Petersen SE, Jerosch-Herold M, Hudsmith LE, Robson MD, Francis JM, Doll HA, Selvanayagam JB, Neubauer S, Watkins H. Evidence for microvascular dysfunction in hypertrophic cardiomyopathy: new insights from multiparametric magnetic resonance imaging. Circulation 2007; 115:2418-25. [PMID: 17452610 DOI: 10.1161/circulationaha.106.657023] [Citation(s) in RCA: 250] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Microvascular dysfunction in hypertrophic cardiomyopathy (HCM) may create an ischemic substrate conducive to sudden death, but it remains unknown whether the extent of hypertrophy is associated with proportionally poorer perfusion reserve. Comparisons between magnitude of hypertrophy, impairment of perfusion reserve, and extent of fibrosis may offer new insights for future clinical risk stratification in HCM but require multiparametric imaging with high spatial and temporal resolution. METHODS AND RESULTS Degree of hypertrophy, myocardial blood flow at rest and during hyperemia (hMBF), and myocardial fibrosis were assessed with magnetic resonance imaging in 35 HCM patients (9 [26%] male/26 female) and 14 healthy controls (4 [29%] male/10 female), aged 18 to 78 years (mean+/-SD, 42+/-14 years) with the use of the American Heart Association left ventricular 16-segment model. Resting MBF was similar in HCM patients and controls. hMBF was lower in HCM patients (1.84+/-0.89 mL/min per gram) than in healthy controls (3.42+/-1.76 mL/min per gram, with a difference of -0.95+/-0.30 [SE] mL/min per gram; P<0.001) after adjustment for multiple variables, including end-diastolic segmental wall thickness (P<0.001). In HCM patients, hMBF decreased with increasing end-diastolic wall thickness (P<0.005) and preferentially in the endocardial layer. The frequency of endocardial hMBF falling below epicardial hMBF rose with wall thickness (P=0.045), as did the incidence of fibrosis (P<0.001). CONCLUSIONS In HCM the vasodilator response is reduced, particularly in the endocardium, and in proportion to the magnitude of hypertrophy. Microvascular dysfunction and subsequent ischemia may be important components of the risk attributable to HCM.
Collapse
Affiliation(s)
- Steffen E Petersen
- University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Bernhardt P, Levenson B, Albrecht A, Engels T, Strohm O. Detection of cardiac small vessel disease by adenosine-stress magnetic resonance. Int J Cardiol 2006; 121:261-6. [PMID: 17196688 DOI: 10.1016/j.ijcard.2006.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 09/27/2006] [Accepted: 11/02/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients testing positive for myocardial ischemia but without significant coronary artery (CA) stenosis in coronary angiography (CXA) are characterized as having "small vessel disease" (SVD). The aim of our study was to identify these patients by stress perfusion cardiac magnetic resonance (CMR). METHODS 317 patients with suspected myocardial ischemia and clinical indication for CXA were scanned < 72 h before CXA in a whole-body 1.5T scanner. After 3 min of adenosine infusion (140 microg/kg/min), a myocardial first-pass perfusion sequence in 4-5 contiguous short-axis orientations using a Gadolinium-based contrast agent (0.1 mmol/kg) was performed. Images were analyzed qualitatively by two independent and blinded investigators. RESULTS Perfusion deficits were detected in 93% of our patients. In 78% of patients with relevant perfusion delay, perfusion deficits extended to > 1/3 of the wall thickness in > or = 2 myocardial segments, persisted for > 5 heartbeats and were regarded as relevant coronary macroangiopathy. All of these patients had significant CA stenosis (60% had luminal narrowing > 70% and 18% had 50-70%). 22% of the patients had perfusion deficits affecting < or = 1/3 of wall thickness with persistence for < or = 5 heartbeats and were regarded as having SVD. None of these patients had a CA stenosis of > 50% or received CA revascularization. These patients more frequently had hypertension (p<0.0001), diabetes (p<0.05) and circumferential perfusion deficits (p<0.0001) than other patients. CONCLUSION Stress perfusion CMR allows non-invasive differentiation between patients with significant CA stenosis and patients with SVD caused by hypertension and/or diabetes based on the temporal and spatial extent of perfusion deficits. Patients with SVD more often have diffuse perfusion deficits with shorter persistence than patients with significant CA disease.
Collapse
|
18
|
Koyama Y, Mochizuki T, Higaki J. Computed tomography assessment of myocardial perfusion, viability, and function. J Magn Reson Imaging 2004; 19:800-15. [PMID: 15170785 DOI: 10.1002/jmri.20067] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In addition to coronary artery assessment, contrast-enhanced multidetector spiral computed tomography (CE-MDCT) can provide valuable information about myocardial perfusion. Using CE-MDCT, myocardial perfusion defects are often observed in the early phase of the contrast bolus (early defect (ED)), with residual defects (RDs) and late enhancement (LE) observed in the late phase in myocardial infarction (MI). However, the clinical significance of EDs, RDs, and LE has not yet been fully described. This work reviews myocardial viability and function by CE-MDCT based on our prior data by including contrast-enhanced single-slice (detector) CT (CE-SSCT) and CE-MDCT. Recently, equivalent results were obtained, as seen in CE-SSCT with images by CE-MDCT. In this review, images that were acquired by MDCT will be presented. In this work, the following items will be the focus: myocardial enhancement patterns (EDs, LE, and RDs), early perfusion defects and their relationship to wall thickness (WT) and wall motion, early CT perfusion defects vs. Tl-201 single photon emission CT (SPECT), the protocol for performing dual-phase contrast CT, classification of enhancement patterns, enhancement patterns on dual-phase CE-MDCT vs. left ventricular functional recovery and WT, changes in enhancement patterns in conjunction with healing stage, enhancement patterns on dual-phase CE-MDCT vs. 201Tl/99mTc-pyrophosphate (dual-isotope SPECT), the clinical meaning of each enhancement pattern, pitfalls of enhancement patterns and other diseases, and study limitations and the future of MDCT.
Collapse
Affiliation(s)
- Yasushi Koyama
- Department of Cardiology, Ehime Prefectural Imabari Hospital, Ehime, Japan.
| | | | | |
Collapse
|