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Lo Monaco M, Stankowski K, Figliozzi S, Nicoli F, Scialò V, Gad A, Lisi C, Marchini F, Dellino CM, Mollace R, Catapano F, Stefanini GG, Monti L, Condorelli G, Bertella E, Francone M. Multiparametric Mapping via Cardiovascular Magnetic Resonance in the Risk Stratification of Ventricular Arrhythmias and Sudden Cardiac Death. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:691. [PMID: 38792874 PMCID: PMC11122968 DOI: 10.3390/medicina60050691] [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: 03/26/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Risk stratification for malignant ventricular arrhythmias and sudden cardiac death is a daunting task for physicians in daily practice. Multiparametric mapping sequences obtained via cardiovascular magnetic resonance imaging can improve the risk stratification for malignant ventricular arrhythmias by unveiling the presence of pathophysiological pro-arrhythmogenic processes. However, their employment in clinical practice is still restricted. The present review explores the current evidence supporting the association between mapping abnormalities and the risk of ventricular arrhythmias in several cardiovascular diseases. The key message is that further clinical studies are needed to test the additional value of mapping techniques beyond conventional cardiovascular magnetic resonance imaging for selecting patients eligible for an implantable cardioverter defibrillator.
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Affiliation(s)
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Vincenzo Scialò
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
| | - Federico Marchini
- Humanitas Gavazzeni, 24125 Bergamo, Italy
- Centro Cardiologico Universitario, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy
| | - Carlo Maria Dellino
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
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Bourke J, Tynan M, Stevenson H, Bremner L, Gonzalez-Fernandez O, McDiarmid AK. Arrhythmias and cardiac MRI associations in patients with established cardiac dystrophinopathy. Open Heart 2024; 11:e002590. [PMID: 38569668 PMCID: PMC10989184 DOI: 10.1136/openhrt-2023-002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/21/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS Some patients with cardiac dystrophinopathy die suddenly. Whether such deaths are preventable by specific antiarrhythmic management or simply indicate heart failure overwhelming medical therapies is uncertain. The aim of this prospective, cohort study was to describe the occurrence and nature of cardiac arrhythmias recorded during prolonged continuous ECG rhythm surveillance in patients with established cardiac dystrophinopathy and relate them to abnormalities on cardiac MRI. METHODS AND RESULTS A cohort of 10 patients (36.3 years; 3 female) with LVEF<40% due to Duchenne (3) or Becker muscular (4) dystrophy or Duchenne muscular dystrophy-gene carrying effects in females (3) were recruited, had cardiac MRI, ECG signal-averaging and ECG loop-recorder implants. All were on standard of care heart medications and none had prior history of arrhythmias.No deaths or brady arrhythmias occurred during median follow-up 30 months (range 13-35). Self-limiting episodes of asymptomatic tachyarrhythmia (range 1-29) were confirmed in 8 (80%) patients (ventricular only 2; ventricular and atrial 6). Higher ventricular arrhythmia burden correlated with extent of myocardial fibrosis (extracellular volume%, p=0.029; native T1, p=0.49; late gadolinium enhancement, p=0.49), but not with LVEF% (p=1.0) on MRI and atrial arrhythmias with left atrial dilatation. Features of VT episodes suggested various underlying arrhythmia mechanisms. CONCLUSIONS The overall prevalence of arrhythmias was low. Even in such a small sample size, higher arrhythmia counts occurred in those with larger scar burden and greater ventricular volume, suggesting key roles for myocardial stretch as well as disease progression in arrhythmogenesis. These features overlap with the stage of left ventricular dysfunction when heart failure also becomes overt. The findings of this pilot study should help inform the design of a definitive study of specific antiarrhythmic management in dystrophinopathy. TRIAL REGISTRATION NUMBER ISRCTN15622536.
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Affiliation(s)
- John Bourke
- Department of Cardiology, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Margaret Tynan
- Department of Cardiology, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Hannah Stevenson
- Cardiology Research, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Leslie Bremner
- Cardiology Research, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | | | - Adam K McDiarmid
- Department of Cardiology, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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3
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Feng X, Liu P, Liu X, Guo T, Li X, Yang H, Chen W, Wang Y, Zhang S. The Presence, Location, and Degree of Late Gadolinium Enhancement in Relation to Myocardial Dysfunction and Poor Prognosis in Patients with Systemic Lupus Erythematosus. J Cardiovasc Dev Dis 2023; 10:451. [PMID: 37998509 PMCID: PMC10672496 DOI: 10.3390/jcdd10110451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Patients with systemic lupus erythematosus (SLE) typically develop myocardial fibrosis. No studies have investigated the clinical significance of the presence, location, and degree of fibrosis in SLE patients. Seventy-four SLE patients were included. Thirty-seven non-autoimmune disease patients and thirty-seven healthy individuals were included as controls. Myocardial fibrosis was evaluated at cardiac magnetic resonance via a qualitative and quantitative assessment of late gadolinium enhancement (LGE). Myocardial function was measured via speckle-tracking echocardiography. All patients were followed up for the occurrence of major adverse cardiac events (MACE). The presence, locations, and degrees of LGE disturbed regional and global myocardial function. The presence of LGE, left ventricular free-wall LGE (LVFW LGE), and severe LGE were all independent predictors of MACE in SLE patients [LGE presence HR: 3.746 (1.434-9.79), p = 0.007; LVFW LGE HR: 2.395 (1.023-5.606), p = 0.044; severe LGE HR: 3.739 (1.241-11.266), p = 0.019]. LGE combined with SLE-related organ damage identified patients at high risk of MACE (p < 0.001). In conclusion, the presence, degree, and location of LGE were associated with myocardial dysfunction. The presence, location, and degree of LGE had the potential to independently predict poor prognosis and improve risk stratification in SLE patients.
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Affiliation(s)
- Xiaojin Feng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Peijun Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Xiaohang Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Tianchen Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Xinhao Li
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Huaxia Yang
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (X.F.); (X.L.); (T.G.); (X.L.); (W.C.)
- State Key Laboratory of Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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4
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Perone F, Bernardi M, Redheuil A, Mafrica D, Conte E, Spadafora L, Ecarnot F, Tokgozoglu L, Santos-Gallego CG, Kaiser SE, Fogacci F, Sabouret A, Bhatt DL, Paneni F, Banach M, Santos R, Biondi Zoccai G, Ray KK, Sabouret P. Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions. J Clin Med 2023; 12:5563. [PMID: 37685628 PMCID: PMC10487991 DOI: 10.3390/jcm12175563] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy;
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Alban Redheuil
- Laboratoire d’Imagerie Biomédicale, Sorbonne University, INSERM 1146, CNRS 7371, 75005 Paris, France;
| | - Dario Mafrica
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Edoardo Conte
- Cardiology Department, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20100 Milan, Italy;
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy; (M.B.); (D.M.); (L.S.)
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, 25000 Besancon, France;
| | - Lale Tokgozoglu
- Department of Cardiology, Medical Faculty, Hacettepe University, 06230 Ankara, Turkey;
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Sergio Emanuel Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro 23070-200, Brazil;
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | | | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY 10029, USA;
| | - Francesco Paneni
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland;
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland;
- Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Raul Santos
- Heart Institute, University of Sao Paulo Medical School, São Paulo 05403-903, Brazil;
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy;
- Mediterranea Cardiocentro, 80122 Napoli, Italy
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Department of Public Health and Primary Care, Imperial College London, London SW7 2BX, UK;
| | - Pierre Sabouret
- Heart Institute, Cardiology Department, Paris and National College of French Cardiologists, Pitié-Salpétrière Hospital, Sorbonne University, 75013 Paris, France
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5
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Javed S, Halliday BP. Implantable cardioverter-defibrillator implantation in non-ischaemic cardiomyopathy: towards individualized risk stratification. Eur J Heart Fail 2023; 25:751-753. [PMID: 36994653 DOI: 10.1002/ejhf.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Saad Javed
- Cardiovascular Research Centre, Cardiovascular Magnetic Resonance Unit & Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Brian P Halliday
- Cardiovascular Research Centre, Cardiovascular Magnetic Resonance Unit & Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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6
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Sherpa MD, Sonkawade SD, Jonnala V, Pokharel S, Khazaeli M, Yatsynovich Y, Kalot MA, Weil BR, Canty JM, Sharma UC. Galectin-3 Is Associated with Cardiac Fibrosis and an Increased Risk of Sudden Death. Cells 2023; 12:1218. [PMID: 37174619 PMCID: PMC10177039 DOI: 10.3390/cells12091218] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Myocardial fibrosis is a common postmortem finding among individuals with Sudden Cardiac Death (SCD). Numerous in vivo and in vitro studies have shown that increased galectin-3 (gal3) expression into the myocardium is associated with higher incidence of fibrosis. Although elevated gal3 expression is linked with myocardial fibrosis, its role in predicting the risk of SCD is unknown. METHODS We reviewed the clinical datasets and post-mortem examination of 221 subjects who had died suddenly. We examined myocardial pathology including the extent of cardiac hypertrophy, fibrosis, and the degree of coronary atherosclerosis in these subjects. In a select group of SCD subjects, we studied myocardial gal3 and periostin expression using immunohistochemistry. To further examine if a higher level of circulating gal3 can be detected preceding sudden death, we measured serum gal3 in a porcine model of subtotal coronary artery ligation which shows an increased tendency to develop lethal cardiac arrhythmias, including ventricular tachycardia or fibrillation. RESULTS Of the total 1314 human subjects screened, 12.7% had SCD. Comparison of age-matched SCD with non-SCD subjects showed that SCD groups had excessive myocardial fibrosis involving both the left ventricular free wall and interventricular septum. In pigs with subtotal coronary artery ligation and SCD, we detected significantly elevated circulating gal3 levels approximately 10 days preceding the SCD event. Immunohistochemistry showed increased myocardial gal3 and periostin expression in pigs that died suddenly, compared to the controls. CONCLUSION Our study shows that increased gal3 is associated with a higher risk of myocardial fibrosis and the risk of SCD. This supports the importance of larger translational studies to target gal3 to prevent cardiac fibrosis and attenuate the risk of SCD.
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Affiliation(s)
- Mingma D. Sherpa
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Swati D. Sonkawade
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Vinesh Jonnala
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Saraswati Pokharel
- Division of Thoracic Pathology and Oncology, Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Mahyar Khazaeli
- Department of Pathology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
| | - Yan Yatsynovich
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Mohamad A. Kalot
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Brian R. Weil
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - John M. Canty
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Umesh C. Sharma
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
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7
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Smith A, Kumar S, Moore HJ, Iskandrian AE, Nanda NC, Raman VK, Singh S, Fletcher RD, Deedwania P, Fonarow GC, Greenberg MD, Ahmed A, Lam PH. Imaging Modality for Left Ventricular Ejection Fraction Estimation and Effect of Implantable Cardioverter Defibrillator on Mortality in Patients with Heart Failure. Heart Rhythm 2023; 20:886-890. [PMID: 36907232 DOI: 10.1016/j.hrthm.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICD) improve outcomes in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤35%. Less is known whether outcomes varied between the two non-invasive imaging modalities used to estimate LVEF, the 2-dimensional echocardiography (2DE) and multi-gated acquisition radionuclide ventriculography (MUGA), which use different principles (geometric vs. count-based, respectively). OBJECTIVES To examine if the effect of ICD on mortality in patients with HF and LVEF ≤35% varied based on LVEF measured by 2DE or MUGA. METHODS Of the 2521 patients with HF with LVEF ≤35% in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 1676 were randomized to either placebo or ICD, of whom 1386 had LVEF measured by 2DE (n=971) or MUGA (n=415). Hazard ratios (HRs) and 97.5% CIs for mortality associated with ICD use were estimated overall, checking for interaction, and within the two imaging subgroups. RESULTS Among the 1386 patients in the current analysis, all-cause mortality occurred in 23.1% (160/692) and 29.7% (206/694) of patients randomized to ICD or placebo, respectively (HR, 0.77; 97.5% CI, 0.61-0.97), which is consistent with that in 1676 patients in the original report. HRs (97.5% CIs) for all-cause mortality in the 2DE and MUGA subgroups were 0.79 (0.60-1.04) and 0.72 (0.46-1.11), respectively (p for interaction, 0.693). Similar associations were observed for cardiac and arrhythmic mortalities. CONCLUSIONS We found no evidence that in patients with HF and LVEF ≤35%, the effect of ICD on mortality varied by the non-invasive imaging method used to measure LVEF.
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Affiliation(s)
- Alexander Smith
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sant Kumar
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia
| | - Hans J Moore
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; George Washington University, Washington, District of Columbia
| | | | - Navin C Nanda
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Venkatesh K Raman
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia
| | - Steven Singh
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia
| | - Ross D Fletcher
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia
| | | | | | - Michael D Greenberg
- Veterans Affairs Medical Center, Washington, District of Columbia; George Washington University, Washington, District of Columbia
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; George Washington University, Washington, District of Columbia
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia.
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DSP-Related Cardiomyopathy as a Distinct Clinical Entity? Emerging Evidence from an Italian Cohort. Int J Mol Sci 2023; 24:ijms24032490. [PMID: 36768812 PMCID: PMC9916412 DOI: 10.3390/ijms24032490] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Variants in desmoplakin gene (DSP MIM *125647) have been usually associated with Arrhythmogenic Cardiomyopathy (ACM), or Dilated Cardiomyopathy (DCM) inherited in an autosomal dominant manner. A cohort of 18 probands, characterized as heterozygotes for DSP variants by a target Next Generation Sequencing (NGS) cardiomyopathy panel, was analyzed. Cardiological, genetic data, and imaging features were retrospectively collected. A total of 16 DSP heterozygous pathogenic or likely pathogenic variants were identified, 75% (n = 12) truncating variants, n = 2 missense variants, n = 1 splicing variant, and n = 1 duplication variant. The mean age at diagnosis was 40.61 years (IQR 31-47.25), 61% of patients being asymptomatic (n = 11, New York Heart Association (NYHA) class I) and 39% mildly symptomatic (n = 7, NYHA class II). Notably, 39% of patients (n = 7) presented with a clinical history of presumed myocarditis episodes, characterized by chest pain, myocardial enzyme release, 12-lead electrocardiogram abnormalities with normal coronary arteries, which were recurrent in 57% of cases (n = 4). About half of the patients (55%, n = 10) presented with a varied degree of left ventricular enlargement (LVE), four showing biventricular involvement. Eleven patients (61%) underwent implantable cardioverter defibrillator (ICD) implantation, with a mean age of 46.81 years (IQR 36.00-64.00). Cardiac magnetic resonance imaging (CMRI) identified in all 18 patients a delayed enhancement (DE) area consistent with left ventricular (LV) myocardial fibrosis, with a larger localization and extent in patients presenting with recurrent episodes of myocardial injury. These clinical and genetic data confirm that DSP-related cardiomyopathy may represent a distinct clinical entity characterized by a high arrhythmic burden, variable degrees of LVE, Late Gadolinium Enhancement (LGE) with subepicardial distribution and episodes of myocarditis-like picture.
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9
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Cardiovascular magnetic resonance for the evaluation of patients with cardiovascular disease: An overview of current indications, limitations, and procedures. Hellenic J Cardiol 2023; 70:53-64. [PMID: 36706867 DOI: 10.1016/j.hjc.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular disease (CVD) is the most common cause of morbidity/mortality worldwide. Early diagnosis is the key to improve CVD prognosis, and cardiovascular imaging plays a crucial role in this direction. Echocardiography is the most commonly used imaging modality. However, the need for early diagnosis/treatment favors the development of modalities providing information about tissue characterization beyond echocardiography. In this context, the rapid evolution of cardiovascular magnetic resonance (CMR) led to the coexistence of cardiologists and radiologists in the CMR field. Our aim was to provide an overview of indications, sequences, and reporting of CMR findings in various CVDs. The indications/limitations of CMR as well as the pathophysiological significance of various sequences in adult/pediatric CVDs are presented and discussed in detail. The role of CMR indices in the evaluation of the most common clinical scenarios in cardiology and their impact on CVD diagnosis/prognosis were analyzed in detail. Additionally, the comparison of CMR versus other imaging modalities is also discussed. Finally, future research directions are presented. CMR can provide cardiac tissue characterization and biventricular/biatrial functional assessment in the same examination, allowing for early and accurate identification of important subclinical abnormalities, before clinically overt CVD takes place.
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Al-Sadawi M, Aslam F, Tao M, Fan R, Singh A, Rashba E. Association of Late-Gadolinium Enhancement in Cardiac Magnetic Resonance with Mortality, Ventricular Arrhythmias, and Heart Failure in Patients with Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis. Heart Rhythm O2 2023; 4:241-250. [PMID: 37124560 PMCID: PMC10134398 DOI: 10.1016/j.hroo.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) on cardiac magnetic resonance is a predictor of adverse events in patients with nonischemic cardiomyopathy (NICM). Objective This meta-analysis evaluated the correlation between LGE and mortality, ventricular arrhythmias (VAs) and sudden cardiac death (SCD), and heart failure (HF) outcomes. Methods A literature search was conducted for studies reporting the association between LGE in NICM and the study endpoints. The primary endpoint was mortality. Secondary endpoints included VA and SCD, HF hospitalization, improvement in left ventricular ejection fraction (LVEF) to >35%, and heart transplantation referral. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year. Results A total of 46 studies and 10,548 NICM patients (4610 with LGE, 5938 without LGE) were included; mean follow-up was 3 years (range 13-71 months). LGE was associated with increased mortality (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.3-3.8; P < .01) and VA and SCD (OR 4.6; 95% CI 3.5-6.0; P < .01). LGE was associated with an increased risk of HF hospitalization (OR 3.4; 95% CI 2.3-5.0; P < .01), referral for transplantation (OR 5.1; 95% CI 2.5-10.4; P < .01), and decreased incidence of LVEF improvement to >35% (OR 0.2; 95% CI 0.03-0.85; P = .03). Conclusion LGE in NICM patients is associated with increased mortality, VA and SCD, and HF hospitalization and heart transplantation referral during long-term follow up. Given these competing risks of mortality and HF progression, prospective randomized controlled trials are required to determine if LGE is useful for guiding prophylactic implantable cardioverter-defibrillator placement in NICM patients.
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Affiliation(s)
| | | | | | | | | | - Eric Rashba
- Address reprint requests and correspondence: Dr Eric Rashba, Stony Brook Heart Rhythm Center, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794.
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Engstrom N, Dobson GP, Ng K, Lander K, Win K, Gupta A, Letson HL. Validation of CalECG software for primary prevention heart failure patients: Reducing inter-observer measurement variability. J Electrocardiol 2022; 74:128-133. [PMID: 36191576 DOI: 10.1016/j.jelectrocard.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/09/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In primary prevention heart failure patients the 12‑lead electrocardiogram (ECG) may be useful for the prediction of ventricular arrhythmias. However, inter-observer measurement variability first needs to be identified and any software used, validated. OBJECTIVE To compare manual ECG measures with CalECG software and to assess the reliability of visual recognition of fragmented QRS (fQRS) by advanced cardiology trainees. METHODS 30 pre-implant ECGs were assessed on patients who met guidelines for primary prevention Implantable Cardiac Defibrillator. Parameters included RR, PR, QT, QRS duration, axis location, fQRS and T wave peak to T wave end (TpTe). ECGs were analyzed by members of the cardiology department with different levels of experience, and compared to CalECG software. Interobserver agreement was assessed using Fleiss' Kappa (κ) and intraclass correlation coefficients (ICC). Pearson correlation coefficient (r) was used to compare human and software measures. RESULTS Strong/very strong correlation was recorded across manual ECG measures (ICC = 0.749-0.979, p ≤ 0.0001) with moderate/strong correlation for TpTe (ICC = 0.547-0.765, p ≤ 0.001). Advanced cardiology trainees demonstrated substantial agreement on ECG interpretation (κ = 0.788, p ≤ 0.0001), however, reliability of fQRS assessment was only moderate for identification (κ = 0.5, p ≤ 0.0001) and fair for location (κ = 0.295, p = 0.001). CalECG software showed strong/very strong correlation with manual measurement for standard measures (r = 0.756-0.977, p ≤ 0.001). Concordance between human and software TpTe measurements varied between leads, with V5 showing a non-significant weak correlation (r = 0.197). CONCLUSION CalECG software showed strong/very strong correlation with standard manual measures which affirms its use in ECG analysis. Advanced cardiology trainees showed greater variability in the identification and location of fQRS.
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Affiliation(s)
- Nathan Engstrom
- College of Medicine & Dentistry, Heart and Trauma Research Laboratory, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia; Cardiac Investigations, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia.
| | - Geoffrey P Dobson
- College of Medicine & Dentistry, Heart and Trauma Research Laboratory, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
| | - Kevin Ng
- Cardiology Clinic, Cairns Hospital, 165 Esplanade, Cairns, QLD 4870, Australia.
| | - Krystle Lander
- Cardiology Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia.
| | - Kyi Win
- Cardiology Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia.
| | - Anudeep Gupta
- Cardiology Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD 4814, Australia.
| | - Hayley L Letson
- College of Medicine & Dentistry, Heart and Trauma Research Laboratory, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
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Elmadi J, Satish Kumar L, Pugalenthi LS, Ahmad M, Reddy S, Barkhane Z. Cardiovascular Magnetic Resonance Imaging: A Prospective Modality in the Diagnosis and Prognostication of Heart Failure. Cureus 2022; 14:e23840. [PMID: 35530891 PMCID: PMC9072284 DOI: 10.7759/cureus.23840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome resulting from structural cardiac remodeling and altered function that impairs tissue perfusion. This article aimed to highlight the current diagnostic and prognostic value of cardiac magnetic resonance (CMR) in the management of HF and prospective future applications. Reviewed are the physics associated with CMR, its use in ischemic and non-ischemic causes of HF, and its role in quantifying left ventricular ejection fraction. It also emphasized that CMR allows for noninvasive morphologic and functional assessment, tissue characterization, blood flow, and perfusion evaluation in patients with suspected or diagnosed HF. CMR has become a crucial instrument for the diagnosis, prognosis, and therapy planning in patients with HF and cardiomyopathy due to its accuracy in quantifying cardiac volumes and ejection fraction (considered the gold standard) as well as native and post-contrast myocardial tissue characterization.
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Corianò M, Tona F. Strategies for Sudden Cardiac Death Prevention. Biomedicines 2022; 10:biomedicines10030639. [PMID: 35327441 PMCID: PMC8944952 DOI: 10.3390/biomedicines10030639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 12/12/2022] Open
Abstract
Sudden cardiac death (SCD) represents a major challenge in modern medicine. The prevention of SCD orbits on two levels, the general population level and individual level. Much research has been done with the aim to improve risk stratification of SCD, although no radical changes in evidence and in therapeutic strategy have been achieved. Artificial intelligence (AI), and in particular machine learning (ML) models, represent novel technologic tools that promise to improve predictive ability of fatal arrhythmic events. In this review, firstly, we analyzed the electrophysiological basis and the major clues of SCD prevention at population and individual level; secondly, we reviewed the main research where ML models were used for risk stratification in other field of cardiology, suggesting its potentiality in the field of SCD prevention.
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