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Basile P, Soldato N, Pedio E, Siena P, Carella MC, Dentamaro I, Khan Y, Baggiano A, Mushtaq S, Forleo C, Ciccone MM, Pontone G, Guaricci AI. Cardiac magnetic resonance reveals concealed structural heart disease in patients with frequent premature ventricular contractions and normal echocardiography: A systematic review. Int J Cardiol 2024; 412:132306. [PMID: 38950789 DOI: 10.1016/j.ijcard.2024.132306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
Premature ventricular contractions (PVCs) are a common form of arrhythmic events, often representing an idiopathic and benign condition without further therapeutic interventions. However, in certain circumstances PVCs may represent the epiphenomenon of a concealed structural heart disease (SHD). Surface 12‑leads EKG and 24-h dynamic EKG are necessary to assess their main characteristics such as site of origin, frequency and complexity. Echocardiography represents the first-line imaging tool recommended to evaluate cardiac structures and function. Cardiac Magnetic Resonance (CMR) is recognized as a superior modality for detecting structural cardiac alterations, that might evade detection by conventional echocardiography. Moreover, in specific populations such as athletes, CMR may have a crucial role to exclude a concealed SHD and the risk of serious arrhythmic events during sport activity. Some clinical characteristics such as male sex, older age or family history of sudden cardiac death (SCD) or cardiomyopathy, and some electrocardiographic features of PVCs, in particular a right branch bundle block (RBBB) with superior/intermediate axis morphology, the reproducibility of VAs during exercise test (ET) or the evidence of complex ventricular arrhythmias, may warrant a CMR evaluation, due to the high probability of SHD. In this systematic review our objective was to provide an exhaustive overview on the role of CMR in detecting a concealed SHD in patients with high daily burden of PVCs and a normal echocardiographic evaluation, paving the way for a more extensive utilization of CMR in presence of certain high-risk clinical and/or EKG features identified during the diagnostic workup.
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Affiliation(s)
- Paolo Basile
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Nicolò Soldato
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Erika Pedio
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Paola Siena
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Maria Cristina Carella
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Ilaria Dentamaro
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Yamna Khan
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Cinzia Forleo
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Marco Matteo Ciccone
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Andrea Igoren Guaricci
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy.
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Papanastasiou CA, Bazmpani MA, Kampaktsis PN, Zegkos T, Gossios T, Parcharidou D, Kokkinidis DG, Tziatzios I, Economou FI, Nikolaidou C, Kamperidis V, Tsapas A, Ziakas A, Efthimiadis G, Karamitsos TD. Cardiac magnetic resonance for ventricular arrhythmias: a systematic review and meta-analysis. Heart 2024; 110:1113-1123. [PMID: 39084706 DOI: 10.1136/heartjnl-2024-324182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) allows comprehensive myocardial tissue characterisation, revealing areas of myocardial inflammation or fibrosis that may predispose to ventricular arrhythmias (VAs). With this study, we aimed to estimate the prevalence of structural heart disease (SHD) and decipher the prognostic implications of CMR in selected patients presenting with significant VAs. METHODS Electronic databases were searched for studies enrolling adult patients that underwent CMR for diagnostic or prognostic purposes in the setting of significant VAs. A random effects model meta-analysis of proportions was performed to estimate the prevalence of SHD. HRs were pooled together in order to evaluate the prognostic value of CMR. RESULTS The prevalence of SHD was reported in 18 studies. In all-comers with significant VAs, the pooled rate of SHD post-CMR evaluation was 39% (24% in the subgroup of premature ventricular contractions and/or non-sustained ventricular tachycardia vs 63% in the subgroup of more complex VAs). A change in diagnosis after use of CMR ranged from 21% to 66% with a pooled average of 35% (29%-41%). A non-ischaemic cardiomyopathy was the most frequently identified SHD (56%), followed by ischaemic heart disease (21%) and hypertrophic cardiomyopathy (5%). After pooling together data from six studies, we found that the presence of late gadolinium enhancement was associated with increased risk of major adverse outcomes in patients with significant VAs (pooled HR: 1.79; 95% CI 1.33 to 2.42). CONCLUSION CMR is a valuable tool in the diagnostic and prognostic evaluation of patients with VAs. CMR should be considered early after initial evaluation in the diagnostic algorithm for VAs of unclear aetiology as this strategy may also define prognosis and improve risk stratification.
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Affiliation(s)
- Christos A Papanastasiou
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
- Cardiology Department, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Maria-Anna Bazmpani
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Polydoros N Kampaktsis
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Thomas Zegkos
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Thomas Gossios
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Despoina Parcharidou
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Heart and Vascular Institute, L&M, Yale New Haven Health, New Haven, Connecticut, USA
| | - Ioannis Tziatzios
- Cardiology Department, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Fotios I Economou
- Cardiology Department, 424 General Military Training Hospital, Thessaloniki, Greece
| | | | - Vasileios Kamperidis
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Apostolos Tsapas
- Center for Clinical Research and Evidence-Based Medicine, Aristotle University Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
| | - Antonios Ziakas
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Georgios Efthimiadis
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Theodoros D Karamitsos
- 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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Nikolaidou C, Ormerod JO, Ziakas A, Neubauer S, Karamitsos TD. The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias. Rev Cardiovasc Med 2023; 24:252. [PMID: 39076394 PMCID: PMC11262447 DOI: 10.31083/j.rcm2409252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/31/2024] Open
Abstract
Cardiac arrhythmias are associated with significant morbidity, mortality and poor quality of life. Cardiovascular magnetic resonance (CMR) imaging, with its unsurpassed capability of non-invasive tissue characterisation, high accuracy, and reproducibility of measurements, plays an integral role in determining the underlying aetiology of cardiac arrhytmias. CMR can reliably diagnose previous myocardial infarction, non-ischemic cardiomyopathy, characterise congenital heart disease and valvular pathologies, and also detect the underlying substrate concealed on conventional investigations in a significant proportion of patients with arrhythmias. Determining the underlying substrate of arrhythmia is of paramount importance for treatment planning and prognosis. However, CMR imaging in patients with irregular heart rates can be problematic. Understanding the different ways to overcome the limitations of CMR in arrhythmia is essential for providing high-quality imaging, comprehensive information, and definitive answers in this diverse group of patients.
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Affiliation(s)
- Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research, University of
Oxford, John Radcliffe Hospital, Headington, OX3 9DU Oxford, UK
| | - Julian O.M. Ormerod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine,
University of Oxford, John Radcliffe Hospital, Headington, OX3 9DU
Oxford, UK
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, School of Medicine,
Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636
Thessaloniki, Greece
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, University of
Oxford, John Radcliffe Hospital, Headington, OX3 9DU Oxford, UK
| | - Theodoros D. Karamitsos
- Oxford Centre for Clinical Magnetic Resonance Research, University of
Oxford, John Radcliffe Hospital, Headington, OX3 9DU Oxford, UK
- First Department of Cardiology, AHEPA Hospital, School of Medicine,
Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636
Thessaloniki, Greece
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Bjerregaard CL, Skaarup KG, Lassen MCH, Biering-Sørensen T, Olsen FJ. Strain Imaging and Ventricular Arrhythmia. Diagnostics (Basel) 2023; 13:diagnostics13101778. [PMID: 37238262 DOI: 10.3390/diagnostics13101778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Ventricular arrhythmia is one of the main causes of sudden cardiac death. Hence, identifying patients at risk of ventricular arrhythmias and sudden cardiac death is important but can be challenging. The indication for an implantable cardioverter defibrillator as a primary preventive strategy relies on the left ventricular ejection fraction as a measure of systolic function. However, ejection fraction is flawed by technical constraints and is an indirect measure of systolic function. There has, therefore, been an incentive to identify other markers to optimize the risk prediction of malignant arrhythmias to select proper candidates who could benefit from an implantable cardioverter defibrillator. Speckle-tracking echocardiography allows for a detailed assessment of cardiac mechanics, and strain imaging has repeatedly been shown to be a sensitive technique to identify systolic dysfunction unrecognized by ejection fraction. Several strain measures, including global longitudinal strain, regional strain, and mechanical dispersion, have consequently been proposed as potential markers of ventricular arrhythmias. In this review, we will provide an overview of the potential use of different strain measures in the context of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Chang ZX, Li CH, Chang YC, Huang CYF, Chan MH, Hsiao M. Novel monodisperse FePt nanocomposites for T2-weighted magnetic resonance imaging: biomedical theranostics applications. NANOSCALE ADVANCES 2022; 4:377-386. [PMID: 36132698 PMCID: PMC9419603 DOI: 10.1039/d1na00613d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/19/2021] [Indexed: 06/07/2023]
Abstract
Given the high incidence and mortality of cancer, current research is focused on designing efficient diagnostic methods. At present, clinical diagnoses are made based on X-ray, computed tomography, magnetic resonance imaging (MRI), ultrasound, and fiber optic endoscopy. MRI is a powerful diagnostic tool because it is non-invasive, has a high spatial resolution, uses non-ionizing radiation, and has good soft-tissue contrast. However, the long relaxation time of water protons may result in the inability to distinguish different tissues. To overcome this drawback of MRI, magnetic resonance contrast agents can enhance the contrast, improve the sensitivity of MRI-based diagnoses, increase the success rate of surgery, and reduce tumor recurrence. This review focuses on using iron-platinum (FePt) nanoparticles (NPs) in T2-weighted MRI to detect tumor location based on dark-field changes. In addition, existing methods for optimizing and improving FePt NPs are reviewed, and the MRI applications of FePt NPs are discussed. FePT NPs are expected to strengthen MRI resolution, thereby helping to inhibit tumor development.
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Affiliation(s)
- Zhi-Xuan Chang
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University Taipei 112 Taiwan
| | - Chien-Hsiu Li
- Genomics Research Center, Academia Sinica Taipei 115 Taiwan
| | - Yu-Chan Chang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University Taipei 112 Taiwan
| | - Chi-Ying F Huang
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University Taipei 112 Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University Taipei 112 Taiwan
| | | | - Michael Hsiao
- Genomics Research Center, Academia Sinica Taipei 115 Taiwan
- Department of Biochemistry College of Medicine, Kaohsiung Medical University Kaohsiung 807 Taiwan
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Scorza R, Jansson A, Sörensson P, Rosenqvist M, Frykman V. Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings. Diagnostics (Basel) 2021; 11:1505. [PMID: 34441439 PMCID: PMC8392672 DOI: 10.3390/diagnostics11081505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023] Open
Abstract
The prognosis of patients with ventricular ectopy and a normal heart, as evaluated by echocardiography, is virtually unknown. Cardiac magnetic resonance (CMR) can detect focal ventricular anomalies that could act as a possible site of origin for premature ventricular contractions (PVCs). The aim of this study was to investigate the presence of cardiac anomalies in patients with normal findings at echocardiogram. METHODS Fifty-one consecutive patients (23 women, 28 men, mean age 59 years) with very high PVC burden (>10,000 PVC/day) and normal findings at standard echocardiography and exercise test were examined with CMR. The outcome was pathologic findings, defined as impaired ejection fraction, regional wall motion abnormalities, abnormal ventricular volume, myocardial edema and fibrosis. RESULTS Sixteen out of 51 patients (32%) had structural ventricular abnormalities at CMR. In five patients CMR showed impairment of the left ventricular and/or right ventricular systolic function, and six patients had a dilated left and/or right ventricle. Regional wall motion abnormalities were seen in six patients and fibrosis in four. No patient had CMR signs of edema or met CMR criteria for arrhythmogenic right ventricular cardiomyopathy. Five patients had extra-ventricular findings (enlarged atria in three cases, enlarged thoracic aorta in one case and pericardial effusion in one case). CONCLUSIONS In this study 16 out of 51 patients with a high PVC burden and normal findings at echocardiography showed signs of pathology in the ventricles with CMR. These findings indicate that CMR should be considered in evaluating patients with a high PVC burden and a normal standard investigation.
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Affiliation(s)
- Raffaele Scorza
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
| | - Anders Jansson
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
| | - Peder Sörensson
- Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Mårten Rosenqvist
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
| | - Viveka Frykman
- Cardiovascular Unit, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 18288 Stockholm, Sweden; (A.J.); (M.R.); (V.F.)
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