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Schweiger V, Hiller P, Utters R, Fenice A, Cammann VL, Di Vece D, Rajman K, Candreva A, Gotschy A, Gilhofer T, Würdinger M, Stähli BE, Seifert B, Müller SM, Templin C, Stehli J. A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiac arrest: the FACTOR study. Clin Res Cardiol 2024; 113:591-601. [PMID: 38329513 PMCID: PMC10954920 DOI: 10.1007/s00392-023-02367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Acute coronary syndromes (ACS) represent a substantial global healthcare challenge. In its most severe form, it can lead to out-of-hospital cardiac arrest (OHCA). Despite medical advancements, survival rates in OHCA patients remain low. Further, the prediction of outcomes in these patients poses a challenge to all health care providers involved. This study aims at developing a score with variables available on admission to assess in-hospital mortality of patients with OHCA undergoing coronary angiography. METHOD All patients with OHCA due to ACS admitted to a tertiary care center were included. A multivariate logistic regression analysis was conducted to explore the association between clinical variables and in-hospital all-cause mortality. A scoring system incorporating variables available upon admission to assess individual patients' risk of in-hospital mortality was developed (FACTOR score). The score was then validated. RESULTS A total of 291 patients were included in the study, with a median age of 65 [56-73] years, including 47 women (16.2%). The in-hospital mortality rate was 41.2%. A prognostic model was developed in the derivation cohort (n = 138) and included the following variables: age, downtime, first detected rhythm, and administration of epinephrine. The area under the curve for the FACTOR score was 0.823 (95% CI 0.737-0.894) in the derivation cohort and 0.828 (0.760-0.891) in the validation cohort (n = 153). CONCLUSION The FACTOR score demonstrated a reliable prognostic tool for health care providers in assessing in-hospital mortality of OHCA patients. Early acknowledgement of a poor prognosis may help in patient management and allocation of resources.
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Affiliation(s)
- Victor Schweiger
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Pauline Hiller
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Rahel Utters
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Angela Fenice
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Victoria Lucia Cammann
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Katja Rajman
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Stefan M Müller
- Schutz & Rettung Zürich, Neumühlequai 41, 8021, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Julia Stehli
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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2
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Würdinger M, Schweiger V, Gilhofer T, Cammann VL, Badorff A, Koleva I, Di Vece D, Niederseer D, Candreva A, Michel J, Gotschy A, Stehli J, Stähli BE, Ghadri JR, Templin C. Twenty-five-year trends in incidence, angiographic appearance, and management of spontaneous coronary artery dissection. Int J Cardiol 2024; 395:131429. [PMID: 37827283 DOI: 10.1016/j.ijcard.2023.131429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) has been described as an infrequent cause of acute coronary syndrome (ACS). Knowledge about the disease is still limited and SCAD might still be underdiagnosed. OBJECTIVES Trends in incidence, presentation, angiographic appearance, management, and outcomes of SCAD over 25 years were analyzed. METHODS Patients with SCAD between 1997 and 2021 at the University Hospital Zurich, Switzerland, were included. Incidences were assessed as total numbers and proportions of ACS cases. Clinical data were collected from medical records and angiographic findings were reviewed. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, cardiac arrest, SCAD recurrence or progression, other myocardial infarction, and stroke. RESULTS One hundred fifty-six SCAD cases were included in this study. The incidence increased significantly in total (p < 0.001) and relative to ACS cases (p < 0.001). This was based on an increase of shorter lesions (p = 0.004), SCAD type 2 (p < 0.001), and lesions in side branches (p = 0.014), whereas lesions in the left main coronary artery and proximal segments were decreasing (p-values 0.029 and < 0.001, respectively). There was an increase in conservative therapy (p < 0.001). The rate of MACE (24%) was stable, however, there was a reduced proportion of patients with a need for intensive care treatment (p = 0.017). CONCLUSIONS SCAD represents an important entity of ACS that still might be underappreciated. The increasing incidence of SCAD is likely based on better awareness and familiarity with the disease. A lower need for intensive care treatment suggests positive effects of the increasing implementation of conservative management.
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Affiliation(s)
- Michael Würdinger
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Victor Schweiger
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Thomas Gilhofer
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Annika Badorff
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Iva Koleva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - David Niederseer
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jonathan Michel
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Julia Stehli
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
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Moulin K, Stoeck CT, Axel L, Broncano J, Croisille P, Dall'Armellina E, Ennis DB, Ferreira PF, Gotschy A, Miro S, Schneider JE, Scott AD, Sosnovik DE, Teh I, Tous C, Tunnicliffe EM, Viallon M, Nguyen C. In Vivo Cardiac Diffusion Imaging Without Motion-Compensation Leads to Unreasonably High Diffusivity. J Magn Reson Imaging 2023; 58:1990-1991. [PMID: 37000010 DOI: 10.1002/jmri.28703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/01/2023] Open
Affiliation(s)
- Kevin Moulin
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH, Zurich, Switzerland
- Center for Preclinical Development, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Leon Axel
- Department of Radiology, New York University Grossman School of Medicine, New York City, New York, USA
| | - Jordi Broncano
- Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain
| | - Pierre Croisille
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
- CREATIS UMR CNRS5220 INSERM U1206, University of Lyon, Lyon, France
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH, Zurich, Switzerland
| | - Santiago Miro
- Department of Radiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - David E Sosnovik
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Cyril Tous
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Elizabeth M Tunnicliffe
- Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Magalie Viallon
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France
- CREATIS UMR CNRS5220 INSERM U1206, University of Lyon, Lyon, France
| | - Christopher Nguyen
- Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Schweiger V, Gilhofer T, Fang R, Candreva A, Seifert B, Di Vece D, Wuerdinger M, Koleva I, Rajman K, Cieslik M, Gotschy A, Michel J, Stehli J, Niederseer D, Ryberg L, Ghadri J, Ruschitzka F, Stähli B, Cammann VL, Templin C. Coronary microvascular dysfunction in Takotsubo syndrome: an analysis using angiography-derived index of microcirculatory resistance. Clin Res Cardiol 2023:10.1007/s00392-023-02329-7. [PMID: 37985475 DOI: 10.1007/s00392-023-02329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) has been proposed as a crucial factor in the pathophysiology of Takotsubo syndrome (TTS). The angiography-derived index of microcirculatory resistance (caIMR) offers an alternative to conventional hyperemic wire-based IMR to assess CMD. We aimed to evaluate CMD's prevalence, transience, and impact on in-hospital outcomes in TTS. METHODS All three coronary arteries of 96 patients with TTS were assessed for their coronary angiography derived Index of microcirculatory Resistance (caIMR) and compared to non-obstructed vessels of matched patients with ST-elevation myocardial infarction. Further, the association between caIMR and the TTS-specific combined in-hospital endpoint of death, cardiac arrest, ventricular arrhythmogenic events and cardiogenic shock was investigated. RESULTS Elevated IMR was present in all TTS patients, with significantly elevated caIMR values in all coronary arteries compared to controls. CaIMR did not differ between apical and midventricular TTS types. CaIMR normalized in TTS patients with follow-up angiographies performed at a median of 28 months (median caIMR at event vs follow-up: LAD 34.8 [29.9-41.1] vs 20.3 [16.0-25.3], p < 0.001; LCX: 38.7 [32.9-50.1] vs 23.7 [19.4-30.5], p < 0.001; RCA: 31.7 [25.0-39.1] vs 19.6 [17.1-24.0], p < 0.001). The extent of caIMR elevation significantly correlated with the combined in-hospital endpoint (p = 0.036). CONCLUSION TTS patients had evidence of elevated caIMR in at least one coronary artery with a trend towards higher LAD caIMR in apical type TTS and normalization after recovery. Furthermore, extent of caIMR elevation was associated with increased risk of in-hospital MACE of TTS patients.
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Affiliation(s)
- Victor Schweiger
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Rick Fang
- Suzhou Rainmed Medical Technology Co., Ltd, Building 31, Northeast District, Nano City, No. 99 Jinji Lake Avenue, Suzhou Industrial Park, Suzhou, China
| | - Alessandro Candreva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Wuerdinger
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Katja Rajman
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Maciej Cieslik
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jonathan Michel
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Julia Stehli
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Linn Ryberg
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jelena Ghadri
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Barbara Stähli
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Victoria Lucia Cammann
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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5
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Candreva A, Rizzini ML, Schweiger V, Gallo D, Montone RA, Würdinger M, Stehli J, Gilhofer T, Gotschy A, Frank R, Stähli BE, Chiastra C, Morbiducci U, Templin C. Is spontaneous coronary artery dissection (SCAD) related to local anatomy and hemodynamics? An exploratory study. Int J Cardiol 2023:S0167-5273(23)00657-5. [PMID: 37201616 DOI: 10.1016/j.ijcard.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/16/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is an increasingly diagnosed cause of myocardial infarction with unclear pathophysiology. The aim of the study was to test if vascular segments site of SCAD present distinctive local anatomy and hemodynamic profiles. METHODS Coronary arteries with spontaneously healed SCAD (confirmed by follow-up angiography) underwent three-dimensional reconstruction, morphometric analysis with definition of vessel local curvature and torsion, and computational fluid dynamics (CFD) simulations with derivation of time-averaged wall shear stress (TAWSS) and topological shear variation index (TSVI). The (reconstructed) healed proximal SCAD segment was visually inspected for co-localization with curvature, torsion, and CFD-derived quantities hot spots. RESULTS Thirteen vessels with healed SCAD underwent the morpho-functional analysis. Median time between baseline and follow-up coronary angiograms was 57 (interquartile range [IQR] 45-95) days. In seven cases (53.9%), SCAD was classified as type 2b and occurred in the left anterior descending artery or near a bifurcation. In all cases (100%), at least one hot spot co-localized within the healed proximal SCAD segment, in 9 cases (69.2%) ≥3 hot spots were identified. Healed SCAD in proximity of a coronary bifurcation presented lower TAWSS peak values (6.65 [IQR 6.20-13.2] vs. 3.81 [2.53-5.17] Pa, p = 0.008) and hosted less frequently TSVI hot spots (100% vs. 57.1%, p = 0.034). CONCLUSION Vascular segments of healed SCAD were characterized by high curvature/torsion and WSS profiles reflecting increased local flow disturbances. Hence, a pathophysiological role of the interaction between vessel anatomy and shear forces in SCAD is hypothesized.
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Affiliation(s)
- Alessandro Candreva
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland; PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio Lodi Rizzini
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Victor Schweiger
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Diego Gallo
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Julia Stehli
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Ruschitzka Frank
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Claudio Chiastra
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
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6
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Károlyi M, Kolossváry M, Weber L, Matziris I, Polacin M, Sokolska JM, Gotschy A, Alkadhi H, Manka R. Association between ECG parameters and late gadolinium enhancement along the course of myocarditis. Int J Cardiovasc Imaging 2023; 39:1169-1178. [PMID: 36826613 DOI: 10.1007/s10554-023-02811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Numerous electrocardiogram (ECG) abnormalities and late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging (CMR) have been related to poor prognosis in acute myocarditis. We evaluated whether ECG parameters are associated with the distribution and dynamic of LGE along the course of myocarditis. METHODS Fifty-one patients with CMR confirmed acute myocarditis were included who underwent CMR with LGE and 12-lead ECG at baseline and 3-month follow-up at our institution. The association between the presence, regional distribution and change of ECG parameters and LGE was investigated using linear regression analysis. LGE was quantified as visual presence score (VPS) and visual transmurality score (VTS). RESULTS Among many ECG parameters only > 1 mm ST-elevation (STE) was associated with VPS and VTS at baseline (β = 3.08 [95%CI: 1.75; 4.41], p = < 0.001 and β = 5.40 [95%CI: 1.92; 8.88], p = 0.004; respectively). STE was most frequent in lateral and inferior ECG-leads (48% and 31%) and it was associated with VPS and VTS in these localizations (p < 0.05 all), however no association between anterior-septal STE and LGE could be confirmed. At follow-up the regression of STE was associated with the regression of VPS and VTS in univariate analysis (β=-1.49 [95%CI: -2.41; -0.57], p = 0.003 and β=-4.87 [95%CI: -7.18; -2.56], p = 0.001, respectively), which remained significant for VTS using a multivariate model (β=-2.39 [95%CI: -3.32; -0.47], p = 0.019). CONCLUSION Although we demonstrated some promising associations between STE and LGE, the usability of ECG to estimate the territorial involvement and dynamical changes of LGE along the course of myocarditis is generally limited and cardiac magnetic resonance should be considered for this purpose.
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Affiliation(s)
- Mihály Károlyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Lucas Weber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Ioannis Matziris
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Justyna M Sokolska
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Alexander Gotschy
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland. .,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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7
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Gotschy A, Jordan S, Stoeck CT, von Deuster C, Peer T, Gastl M, Vishnevskiy V, Wissmann L, Dobrota R, Mihai C, Becker MO, Maurer B, Kozerke S, Ruschitzka F, Distler O, Manka R. Diffuse myocardial fibrosis precedes subclinical functional myocardial impairment and provides prognostic information in systemic sclerosis. Eur Heart J Cardiovasc Imaging 2023; 24:373-382. [PMID: 35639682 DOI: 10.1093/ehjci/jeac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 02/18/2023] Open
Abstract
AIMS Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease and its prognostic value are yet unknown. We used cardiovascular magnetic resonance (CMR) to investigate subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and established SSc and examined whether this was associated with mortality. METHODS AND RESULTS One hundred and ten SSc patients (86 established SSc, 24 VEDOSS) and 15 healthy controls were prospectively recruited. The patients were followed-up for a median duration of 7.0 years (interquartile range 6.0-7.3 years). Study subjects underwent CMR including assessment of myocardial fibrosis [native T1 and extracellular volume (ECV)] and measurement of global longitudinal (GLS) and circumferential (GCS) myocardial strain. Native T1 values and ECV were elevated in VEDOSS and SSc patients compared with controls (P < 0.001). GLS was similar in VEDOSS and controls but significantly impaired in patients with established SSc (P < 0.001). GCS was similar over all groups (P = 0.88). There were 12 deaths during follow-up. Elevated native T1 [hazard ratio (HR) 5.8, 95% confidence interval (CI): 1.7-20.4; P = 0.006] and reduced GLS (HR 6.1, 95% CI: 1.3-29.9; P = 0.038) identified subjects with increased risk of death. Only native T1 was predictive for cardiovascular mortality (P < 0.001). CONCLUSION Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by the expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment only occurs in established SSc. Native T1 and GLS have prognostic value for all-cause mortality in SSc patients.
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Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Tatiana Peer
- Cardiology Department, Stadtspital Waid and Triemli, Zurich, Switzerland
| | - Mareike Gastl
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Valery Vishnevskiy
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Radiation Oncology, Spital Thurgau AG, Münsterlingen, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mike O Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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8
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Cammann VL, Schweiger V, Cieslik M, Seifert B, Gilhofer T, Koleva I, Würdinger M, Candreva A, Gajic M, Michel J, Jakob P, Stehli J, Stähli B, Templin C, Gotschy A. Effectiveness of radiation protection systems in the cardiac catheterization laboratory: a comparative study. Clin Res Cardiol 2023; 112:605-613. [PMID: 36646858 PMCID: PMC10160176 DOI: 10.1007/s00392-022-02142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND As numbers and complexity of percutaneous coronary interventions are constantly increasing, optimal radiation protection is required to ensure operator safety. Suspended radiation protection systems (SRPS) and protective scatter-radiation absorbing drapes (PAD) are novel methods to mitigate fluoroscopic scattered radiation exposure. The aim of the study was to investigate the effectiveness regarding radiation protection of a SRPS and a PAD in comparison with conventional protection. METHODS A total of 229 cardiac catheterization procedures with SRPS (N = 73), PAD (N = 82) and standard radiation protection (N = 74) were prospectively included. Real-time dosimeter data were collected from the first operator and the assistant. Endpoints were the cumulative operator exposure relative to the dose area product [standardized operator exposure (SOE)] for the first operator and the assistant. RESULTS For the first operator, the SRPS and the PAD significantly decreased the overall SOE compared to conventional shielding by 93.9% and 66.4%, respectively (P < 0.001). The protective effect of the SRPS was significantly higher compared to the PAD (P < 0.001). For the assistant, the SRPS and the PAD provided a not statistically significant reduction compared to conventional shielding in the overall SOE by 38.0% and 30.6%, respectively. CONCLUSIONS The SRPS and the PAD enhance radiation protection significantly compared to conventional protection. In most clinical scenarios, the protective effect of SRPS is significantly higher than the additional protection provided by the PAD. Comparison of the additional radiation protection provided by protective scatter-radiation absorbing drapes (PAD) and the suspended radiation protection system (SRPS) system over standard protection with lead aprons.
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Affiliation(s)
- Victoria L Cammann
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Victor Schweiger
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Maciej Cieslik
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,PolitoBIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marko Gajic
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Jonathan Michel
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp Jakob
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Julia Stehli
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Barbara Stähli
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland.
| | - Alexander Gotschy
- Department of Cardiology, University Hospital Zurich, University Heart Center, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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9
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Polacin M, Károlyi M, Wilzeck V, Eberhard M, Gotschy A, Alkadhi H, Kozerke S, Manka R. Three-dimensional Whole-Heart Cardiac MRI Sequence for Measuring Trabeculation in Left Ventricular Noncompaction. Radiol Cardiothorac Imaging 2022; 4:e220109. [PMID: 36601458 PMCID: PMC9806726 DOI: 10.1148/ryct.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To compare three-dimensional (3D) whole-heart MRI with isotropic submillimeter resolution with standard two-dimensional (2D) cine MRI in measuring the bilayered myocardium in left ventricular noncompaction (LVNC). MATERIALS AND METHODS Twenty-four patients with LVNC (mean age, 42 years ± 16 [SD]) were retrospectively enrolled between October 2011 and July 2020. Compacted myocardium (CM) and noncompacted myocardium (NCM) were measured in long axis (Petersen approach) and short axis (Jacquier approach) at 3D whole-heart and 2D cine MRI by two independent readers. Image quality (1 = excellent, 2 = adequate, 3 = nondiagnostic), considering discrimination between NCM and CM and CM and adjacent tissue, was evaluated. Pearson, Spearman, and intraclass correlation tests were used as statistical tests. RESULTS In long-axis measurements, the correlation between both sequences was moderate to strong for CM (Pearson, 0.66-0.79; Spearman, 0.61-0.68) and strong to very strong for NCM (Pearson, 0.90-0.97; Spearman, 0.77-0.91). Intraclass correlation coefficient (ICC) in 3D whole-heart MRI was 0.90 (95% CI: 0.78, 0.95) for CM and 0.94 (95% CI: 0.84, 0.97) for NCM, while ICC in 2D cine MRI was 0.77 (95% CI: 0.55, 0.89) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. Short-axis CM and NCM measurements had a strong to very strong correlation between both sequences (Pearson, 0.86-0.98; Spearman, 0.82-0.98). ICC in 3D whole-heart MRI was 0.96 (95% CI: 0.94, 0.99) for CM and 0.98 (95% CI: 0.97, 0.99) for NCM, while ICC in 2D cine MRI was 0.82 (95% CI: 0.63, 0.92) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. 3D whole-heart MRI demonstrated higher image quality than did 2D cine MRI (P < .001). CONCLUSION 3D whole-heart MRI revealed higher image quality, with better structure discrimination and interobserver agreement in LVNC measurements, compared with standard 2D cine images.Keywords: MR Imaging, Cardiac, Cardiovascular Magnetic Resonance, Left Ventricular Noncompaction, Free-breathing Imaging Technique Supplemental material is available for this article. © RSNA, 2022See also the commentary by Jensen and Petersen in this issue.
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10
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Gülan U, Rossi VA, Gotschy A, Saguner AM, Manka R, Brunckhorst CB, Duru F, Schmied CM, Niederseer D. A comparative study on the analysis of hemodynamics in the athlete's heart. Sci Rep 2022; 12:16666. [PMID: 36198719 PMCID: PMC9534940 DOI: 10.1038/s41598-022-20839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
The pathophysiological mechanisms underlying the development of the athlete’s heart are still poorly understood. To characterize the intracavitary blood flows in the right ventricle (RV) and right-ventricular outflow tract (RVOT) in 2 healthy probands, patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and 2 endurance athletes, we performed 4D-MRI flow measurements to assess differences in kinetic energy and shear stresses. Time evolution of velocity magnitude, mean kinetic energy (MKE), turbulent kinetic energy (TKE) and viscous shear stress (VSS) were measured both along the whole RV and in the RVOT. RVOT regions had higher kinetic energy values and higher shear stresses levels compared to the global averaging over RV among all subjects. Endurance athletes had relatively lower kinetic energy and shear stresses in the RVOT regions compared to both healthy probands and ARVC patients. The athlete’s heart is characterized by lower kinetic energy and shear stresses in the RVOT, which might be explained by a higher diastolic compliance of the RV.
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Affiliation(s)
- Utku Gülan
- Hi-D Imaging, 8406, Winterthur, Switzerland
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Corinna B Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Christian M Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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11
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Hermes-Laufer J, Niederseer D, Karolyi M, Gotschy A, Templin C. Myocardial Infarction by a Myocardial Bridge in the LAD Combined With Atrioventricular Re-Entrant Supraventricular Tachycardia. JACC Case Rep 2022; 4:1115-1118. [PMID: 36124157 PMCID: PMC9481890 DOI: 10.1016/j.jaccas.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/06/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
We present the case of a patient who presented with palpitations and was found to have atrioventricular re-entrant tachycardia with unusually elevated cardiac biomarkers. A coronary computed tomographic angiography showed a myocardial left anterior descending artery bridge; an accessory pathway was ablated, and cardiac magnetic resonance revealed anteroseptal myocardial infarction resulting from hypoperfusion during tachycardia caused by the left anterior descending artery myocardial bridge. (Level of Difficulty: Intermediate.)
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12
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Károlyi M, Gotschy A, Polacin M, Plein S, Paetsch I, Jahnke C, Frick M, Gebker R, Alkadhi H, Kozerke S, Manka R. Diagnostic performance of 3D cardiac magnetic resonance perfusion in elderly patients for the detection of coronary artery disease as compared to fractional flow reserve. Eur Radiol 2022; 33:339-347. [PMID: 35984513 DOI: 10.1007/s00330-022-09040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/09/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In patients of advanced age, the feasibility of myocardial ischemia testing might be limited by age-related comorbidities and falling compliance abilities. Therefore, we aimed to test the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population as compared to reference standard fractional flow reserve (FFR). METHODS Fifty-six patients at age 75 years or older (mean age 79 ± 4 years, 35 male) underwent 3D CMR perfusion imaging and invasive coronary angiography with FFR in 5 centers using the same study protocol. The diagnostic accuracy of CMR was compared to a control group of 360 patients aged below 75 years (mean age 61 ± 9 years, 262 male). The percentage of myocardial ischemic burden (MIB) relative to myocardial scar burden was further analyzed using semi-automated software. RESULTS Sensitivity, specificity, and positive and negative predictive values of 3D perfusion CMR deemed similar for both age groups in the detection of hemodynamically relevant (FFR < 0.8) stenosis (≥ 75 years: 86%, 83%, 92%, and 75%; < 75 years: 87%, 80%, 82%, and 85%; p > 0.05 all). While MIB was larger in the elderly patients (15% ± 17% vs. 9% ± 13%), the diagnostic accuracy of 3D CMR perfusion was high in both elderly and non-elderly populations to predict pathological FFR (AUC: 0.906 and 0.866). CONCLUSIONS 3D CMR perfusion has excellent diagnostic accuracy for the detection of hemodynamically relevant coronary stenosis, independent of patient age. KEY POINTS • The increasing prevalence of coronary artery disease in elderly populations is accompanied with a larger ischemic burden of the myocardium as compared to younger individuals. • 3D cardiac magnetic resonance perfusion imaging predicts pathological fractional flow reserve in elderly patients aged ≥ 75 years with high diagnostic accuracy. • Ischemia testing with 3D CMR perfusion imaging has similarly high accuracy in the elderly as in younger patients and it might be particularly useful when other non-invasive techniques are limited by aging-related comorbidities and falling compliance abilities.
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Affiliation(s)
- Mihály Károlyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & the Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Frick
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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13
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Gastl M, Sokolska JM, Polacin M, Gotschy A, von Spiczak Brzezinski J, Alkadhi H, Kozerke S, Manka R. Parametric mapping CMR for the measurement of inflammatory reactions of the pericardium. Open Heart 2022; 9:openhrt-2021-001919. [PMID: 35618324 PMCID: PMC9137334 DOI: 10.1136/openhrt-2021-001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/04/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives Although cardiovascular magnetic resonance (CMR) is increasingly used to diagnose pericardial inflammation, imaging can still be challenging using conventional CMR techniques. Parametric mapping (T1/T2 mapping) techniques have emerged as novel methods to quantify focal and global changes of the myocardium without contrast agent. The aim of the present study was to implement parametric mapping to facilitate diagnostic decision-making in pericardial inflammation. Methods Twenty patients with pericardial inflammation underwent CMR (1.5T system) including T1-weighted/T2-weighted imaging, T1/T2 mapping and late gadolinium enhancement. T1/T2 mapping was performed in end-diastole covering three short-axis slices. Diagnosis of pericardial inflammation was made according to recent guidelines. T1/T2 measurements were pursued by manually drawing regions of interest (ROIs) in the thickened, diseased pericardium carefully avoiding contamination by other cardiac structures. Parametric values were correlated to further markers of pericardial inflammation, such as pericardial thickening and inflammatory parameters. Results On average, the pericardium displayed a thickness of 4.8±1.0 mm. Mean T1 value was 1363.0±227.1 ms and T2 value was 123.3±52.6 ms, which were above patient’s myocardial values (myocardial T1: 998.7±81.0 ms, p<0.001, median 1014.46 ms; T2: 68.0±28.9 m, p<0.001) and the values of a group of four patients with chronic pericarditis (T1: 953.0±16.7 ms; T2: 63.2±10.1 ms). T1 and T2 showed a correlation to the extent of the thickened pericardium (R=0.64, p=0.002 for T1, R=0.72, p=0.005 for T2). There was no correlation of pericardial T1/T2 to blood markers of inflammation, myocardial injury (C reactive protein, troponin, creatine kinase) or further CMR parameters. Conclusions In patients with pericardial inflammation, parametric mapping showed elevated T1 and T2 values. Parametric mapping may help to facilitate diagnosis of pericardial inflammation if conventional parameters such as pericardial hyperintensity in T1-weighted or T2-weighted imaging or contrast agent uptake are heterogeneous.
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Affiliation(s)
- Mareike Gastl
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Dusseldorf, Dusseldorf, Germany.,Institute for Biomedical Engineering, University and ETH Zurich, Zürich, Switzerland
| | - Justyna M Sokolska
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Polacin
- Institute for Biomedical Engineering, University and ETH Zurich, Zürich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zürich, Switzerland
| | | | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zürich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland .,Institute for Biomedical Engineering, University and ETH Zurich, Zürich, Switzerland
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14
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Gotschy A, Templin C. Individualised stent therapy 35 years after the first stent implantation. Swiss Med Wkly 2022; 152:w30130. [PMID: 35262487 DOI: 10.4414/smw.2022.w30130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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15
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Gotschy A, Jordan S, Stoeck CT, Von Deuster C, Gastl M, Vishnevskiy V, Wissmann L, Dobrota R, Mihai C, Becker MO, Maurer B, Kozerke S, Ruschitzka F, Distler O, Manka R. Diffuse myocardial fibrosis precedes impairment of myocardial strain in patients with systemic sclerosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background - Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease is yet unknown.
Purpose - To investigated the presence of subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and to compared the findings to patients with established SSc and healthy controls.
Methods - 110 SSc patients (86 with established SSc and 24 with VEDOSS) and 15 healthy controls were prospectively recruited. The study subjects underwent cardiovascular magnetic resonance on a clinical 1.5T system. Pre- and post-contrast T1 mapping was performed using a MOLLI (Modified Look-Locker Inversion Recovery) sequence. For extracellular volume (ECV) measurements, a single bolus protocol with image acquisition 15-20 min. post-contrast injection was used. For the assessment of subtle functional impairment, global longitudinal (GLS) and circumferential (GCS) myocardial strain were evaluated.
Results - Native T1 values and ECV were elevated in VEDOSS and in patients with established SSc compared to controls (p < 0.001; Figure 1 A & B). GLS was similar in VEDOSS and controls but significantly reduced in patients with established SSc (p < 0.001; Figure 1 C). GCS was similar over all groups (p = 0.88). Patients with clinical evidence of pulmonary or gastrointestinal involvement had higher ECV or T1 values, respectively. Patients with clinical signs of cardiac involvement had lower absolute GLS. SSc subtype, classification or disease duration were not associated with the extent of myocardial fibrosis or impaired strain.
Conclusion - Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment as measured by GLS only occurs in established SSc. No single clinical feature of SSc shows a strong association with subtle myocardial involvement.
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Affiliation(s)
- A Gotschy
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - S Jordan
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - CT Stoeck
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - C Von Deuster
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - M Gastl
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - V Vishnevskiy
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - L Wissmann
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - R Dobrota
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - C Mihai
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - MO Becker
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - B Maurer
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - S Kozerke
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - F Ruschitzka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - O Distler
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - R Manka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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16
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Karolyi M, Gotschy A, Plein S, Paetsch I, Jahnke C, Frick M, Gebker R, Alkadhi H, Manka R. 3D cardiac magnetic resonance stress-perfusion in elderly patients. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation
Introduction
Age related comorbidities and reduced compliance often limit ischaemia testing in elderly patients.
Purpose
To assessed the accuracy of 3D cardiac magnetic resonance (CMR) stress perfusion in the elderly population.
Methods
56 patients aged ≥75 years underwent 3D CMR stress-perfusion and invasive coronary angiography with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as part of a multicenter study. The accuracy of 3D CMR stress-perfusion was compared to patients aged <75 years old (n = 360) using qualitative and quantitative imaging parameters.
Results
Sensitivity, specificity, positive and negative predictive values of qualitative 3D perfusion CMR were similar for both age groups in the detection of high-grade (≥50%) coronary stenosis on QCA and hemodynamically relevant (<0.8) stenosis on FFR, p > 0.05 all. Quantitative myocardial ischemia burden was larger in elderly patients (15% ± 17% vs. 9% ± 13%) with similarly high diagnostic accuracy of quantitative 3D CMR perfusion in both age groups to predict pathological FFR (AUC ≥75: 0.906; AUC <75: 0.866).
Conclusions
3D CMR perfusion is well suited for myocardial ischaemia testing in the elderly patients with similarly high diagnostic accuracy as in younger individuals.
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Affiliation(s)
- M Karolyi
- University of Zurich, Zurich, Switzerland
| | - A Gotschy
- University of Zurich, Zurich, Switzerland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - I Paetsch
- University of Leipzig, Leipzig, Germany
| | - C Jahnke
- University of Leipzig, Leipzig, Germany
| | - M Frick
- RWTH University Hospital Aachen, Aachen, Germany
| | - R Gebker
- German Heart Institute Berlin, Berlin, Germany
| | - H Alkadhi
- University of Zurich, Zurich, Switzerland
| | - R Manka
- University of Zurich, Zurich, Switzerland
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17
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Oebel S, Gotschy A, Paetsch I, Jahnke C, Plein S, Gebker R, Hamada S, Frick M, von Spiczak J, Polacin M, Enseleit F, Marx N, Lüscher TF, Ruschitzka F, Kozerke S, Alkadhi H, Manka R. Accuracy of dynamic three-dimensional magnetic resonance perfusion imaging for the detection of coronary artery disease in patients with reduced ejection fraction. Imaging 2021. [DOI: 10.1556/1647.2020.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractBackgroundTo assess the accuracy of 3D cardiovascular magnetic resonance (CMR) perfusion imaging for the detection of coronary artery disease (CAD) against fractional flow reserve (FFR) and quantitative coronary angiography (QCA) in patients with reduced ejection fraction (EF).MethodsOut of 447 patients who underwent 3D CMR perfusion imaging (at 1.5 and 3.0 T under adenosine stress and at rest) at 5 European centers, 86 cases with an EF ≤50% were identified (mean age 64 ± 11 yrs, 80% male). Significant CAD was defined as a FFR value <0.8 and a QCA >50%. 86 individuals matched for age, gender and major cardiovascular risk factors, were chosen as the control group.ResultsThe prevalence of CAD defined by FFR (<0.8) was 59% (EF≤50%) vs. 54% (EF>50%), P = 0.4). In relation to FFR, 3D perfusion imaging yielded a sensitivity of 84.5% (95% CI 76.0–90.4) and specificity of 77.3% (95% CI 66.7–85.3). The sensitivity of perfusion imaging was higher in patients with an EF≤50% (90.2 vs. 78.3%, P = 0.1) whereas specificity showed the reverse (62.9 vs. 90.0%, P = 0.005) The diagnostic accuracy was comparable in both subgroups (AUC 79.1 vs. 83.7%, P = 0.25). According to QCA, the prevalence of CAD was 78 vs. 72% (P = 0.4). Perfusion imaging yielded a sensitivity and specificity of 82.1 vs. 62.9%, P = 0.01 and 79.0 vs. 95.8%, P = 0.09 respectively with a high diagnostic accuracy in both subgroups (AUC 82.0 vs. 80.5%).Conclusion3D-CMR perfusion imaging yields a high sensitivity and diagnostic accuracy with regards to the detection of significant CAD irrespective of left ventricular (LV) systolic function.
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Affiliation(s)
- Sabrina Oebel
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Alexander Gotschy
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & the Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sandra Hamada
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Frick
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Enseleit
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas F. Lüscher
- Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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18
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Polacin M, Karolyi M, Eberhard M, Gotschy A, Baessler B, Alkadhi H, Kozerke S, Manka R. Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images. Sci Rep 2021; 11:12376. [PMID: 34117271 PMCID: PMC8195981 DOI: 10.1038/s41598-021-90283-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/26/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate whether segmental strain is noticeably affected in chronic infarcts and thus can be potentially used for infarct detection based on routinely acquired non-contrast cine images in patients with known coronary artery disease (CAD). Forty-six patients with known CAD and chronic scars in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age-matched controls with normal cardiac MRI (2 female, mean age 47 ± 13 years) were retrospectively enrolled. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual wall motion assessment of short axis cine images as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient and control were presented in random order to two independent blinded readers, which should localize potentially infarcted segments in those datasets blinded to LGE images and patient information. Global strain values were impaired in patients compared to controls (GPCS p = 0.02; GPLS p = 0.04; GPRS p = 0.01). Patients with preserved ejection fraction showed also impeded GPCS compared to healthy individuals (p = 0.04). In patients, mean SPCS was significantly impaired in subendocardially (- 5.4% ± 2) and in transmurally infarcted segments (- 1.2% ± 3) compared to remote myocardium (- 12.9% ± 3, p = 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut-off value for SPCS for discriminating infarcted from remote myocardium of - 7.2% with a sensitivity of 89.4% and specificity of 85.7%. Mean SPRS was impeded in transmurally infarcted segments (15.9% ± 6) compared to SPRS of remote myocardium (31.4% ± 5; p = 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16.6% with a sensitivity of 83.3% and specificity of 76.5%. 80.3% of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Global strain parameters are impaired in patients with chronic infarcts compared to controls. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected due to wall motion abnormalities in visual wall motion assessment. Analysis of segmental circumferential strain shows a promising method for detection of chronic scars in routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.
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Affiliation(s)
- M Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - M Karolyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - A Gotschy
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - B Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
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19
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Anwer S, Heiniger PS, Rogler S, Erhart L, Cassani D, Kuzo N, Rebellius L, Schoenenberger-Berzins R, Schmid D, Nussbaum S, Schindler M, Kebernik J, Pazhenkottil AP, Gotschy A, Manka R, Meyer M, Gruner C, Tanner FC. Left ventricular mechanics and cardiovascular outcomes in non-compaction phenotype. Int J Cardiol 2021; 336:73-80. [PMID: 33964317 DOI: 10.1016/j.ijcard.2021.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 12/24/2022]
Abstract
AIMS This study aims at understanding left ventricular (LV) mechanics of non-compaction (LVNC) phenotype using echocardiographic strain analysis and at assessing the association of functional parameters with cardiovascular (CV) outcomes. METHODS AND RESULTS Longitudinal (GLS) and circumferential strain (GCS) as well as rotation of the LV were analyzed in 55 LVNC patients and 55 matched controls. Cardiovascular outcomes were documented for a median follow-up duration of 6 years. GLS and GCS were impaired in LVNC. Similary, regional longitudinal and circumferential strain as well as twist were reduced. CV events occurred in 28 LVNC patients. Apical peak circumferential strain (APCS), peak systolic rotation of apical segments (APSR), and twist were strongly associated with events. This was independent of and incremental to LVEF and non-compacted to compacted myocardial thickness ratio (NC:C ratio). The association of twist with events was also independent of and slightly superior to GLS. CONCLUSIONS GLS, GCS, regional strain, and twist were impaired in LVNC. APCS, APSR, and twist exhibited strong association with CV events independent of and incremental to LVEF and NC:C ratio, and in case of twist even GLS. Thus, STE-derived parameters may complement the echocardiographic assessment of LVNC patients in clinical routine.
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Affiliation(s)
- Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Pascal S Heiniger
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Sebastian Rogler
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Ladina Erhart
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Daniela Cassani
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Nazar Kuzo
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Lina Rebellius
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | | | - Dominik Schmid
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Sinuhe Nussbaum
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Matthias Schindler
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Julia Kebernik
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Aju Paul Pazhenkottil
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Martin Meyer
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Christiane Gruner
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zürich, Zurich, Switzerland.
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20
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Candreva A, Gotschy A, Templin C. [MINOCA and the invasive assessment of the coronary microvascular function]. Ther Umsch 2021; 78:36-40. [PMID: 33538628 DOI: 10.1024/0040-5930/a001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
MINOCA and the invasive assessment of the coronary microvascular function Abstract. Around 10 % of patients undergoing coronary catheterization for acute myocardial infarction show no obstructive lesion of the epicardial vessels. In these cases, for a proper clinical management further anatomical and functional assessments are recommended, so that Myocardial infarctions with non-obstructive coronary arteries (MINOCAs) could be detected according to the current guidelines. On the other hand, investigations could lead to the diagnosis of Takotsubo Syndrome, the pathophysiologic understanding of which remains largely unclear. Since microvascular dysfunction was shown to play a major role in the origin of the disease, intracoronary flow measurements promise to deliver new meaningful pathophysiologic insights in the matter.
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Affiliation(s)
- Alessandro Candreva
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Alexander Gotschy
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Christian Templin
- Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
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21
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Anwer S, Heiniger P, Rogler S, Cassani D, Rebellius L, Kuzo N, Gotschy A, Erhart L, Kebernik J, Schmid D, Pazhenkottil A, Meyer M, Schoenenberger-Berzins R, Gruner C, Tanner F. Circumferential deformation in diagnosis and risk assessment of patients with left ventricular non-compaction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Echocardiography-based deformation analysis is used for studying left ventricular (LV) mechanics and have an emerging role in the diagnosis of cardiomyopathies. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterised by a two-layered LV myocardium with prominent trabeculae separated by deep recesses perfused from the LV cavity. Left ventricular hypertrabeculation (LVHT) may be difficult to differentiate from LVNC. In this study, we aim to develop a diagnostic algorithm based on the circumferential deformation (CD) of LVNC, LVHT and controls; and find their associations with LVNC outcomes.
Methods
We compared 45 LVNC patients, 45 LVHT individuals, and 45 matched healthy controls. LVNC was diagnosed according to current echocardiographic criteria. LVHT was defined as presence of three or more trabeculae in the LV apex visualised in both parasternal short axis and apical views. Controls had a normal echocardiographic examination and no evidence of cardiovascular disease. Strain analysis was performed using TomTec Image-Arena (version 4.6).
Results
Receiver observer characteristics curve (ROC) analyses revealed that GCS <22.3% differentiated LVNC from control or LVHT. In individuals with global circumferential strain (GCS) below 22.3%, an apical peak circumferential strain (PCS) cut-off value of 18.4% differentiated LVNC [<18.4%] and LVHT [≥18.4%] (fig. 1). An independent echocardiographer (Table 1) performed blind validation of diagnosis on 32 subjects from each group.
Combined endpoint of cardiovascular events in LVNC (CVE) is described in figure 2. Multi-variate regression analyses have shown that GCS was associated with 11-fold increased risk of CVE independent of LVEF and NC:C ratio, while global longitudinal strain (GLS) displayed only 2-fold increased risk. Regional basal and apical peak circumferential or longitudinal strain, left ventricular twist, basal-apical rotation ratio have shown significant associations (Fig. 3).
Conclusions
A diagnostic algorithm with GCS and aPCS (threshold value 18.4%) differentiates LVNC from LVHT and control with very high sensitivity and specificity independent of additional echocardiographic or clinical information. Circumferential strain derived parameters exhibit a very strong association with outcomes independent of LVEF and NC:C ratio. Absence of CVE in LVHT provides further evidence on the distinct nature of LVNC and LVHT.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): 2018 research grant from the Swiss Heart Foundation
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Affiliation(s)
- S Anwer
- University Heart Center, Zurich, Switzerland
| | | | - S Rogler
- University Heart Center, Zurich, Switzerland
| | - D Cassani
- University Heart Center, Zurich, Switzerland
| | - L Rebellius
- University Heart Center, Zurich, Switzerland
| | - N Kuzo
- University Heart Center, Zurich, Switzerland
| | - A Gotschy
- University Heart Center, Zurich, Switzerland
| | - L Erhart
- University Heart Center, Zurich, Switzerland
| | - J Kebernik
- University Heart Center, Zurich, Switzerland
| | - D Schmid
- University of Zurich, Zurich, Switzerland
| | | | - M Meyer
- University Heart Center, Zurich, Switzerland
| | | | - C Gruner
- University Heart Center, Zurich, Switzerland
| | - F.C Tanner
- University Heart Center, Zurich, Switzerland
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Steeden JA, Quail M, Gotschy A, Mortensen KH, Hauptmann A, Arridge S, Jones R, Muthurangu V. Rapid whole-heart CMR with single volume super-resolution. J Cardiovasc Magn Reson 2020; 22:56. [PMID: 32753047 PMCID: PMC7405461 DOI: 10.1186/s12968-020-00651-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Three-dimensional, whole heart, balanced steady state free precession (WH-bSSFP) sequences provide delineation of intra-cardiac and vascular anatomy. However, they have long acquisition times. Here, we propose significant speed-ups using a deep-learning single volume super-resolution reconstruction, to recover high-resolution features from rapidly acquired low-resolution WH-bSSFP images. METHODS A 3D residual U-Net was trained using synthetic data, created from a library of 500 high-resolution WH-bSSFP images by simulating 50% slice resolution and 50% phase resolution. The trained network was validated with 25 synthetic test data sets. Additionally, prospective low-resolution data and high-resolution data were acquired in 40 patients. In the prospective data, vessel diameters, quantitative and qualitative image quality, and diagnostic scoring was compared between the low-resolution, super-resolution and reference high-resolution WH-bSSFP data. RESULTS The synthetic test data showed a significant increase in image quality of the low-resolution images after super-resolution reconstruction. Prospectively acquired low-resolution data was acquired ~× 3 faster than the prospective high-resolution data (173 s vs 488 s). Super-resolution reconstruction of the low-resolution data took < 1 s per volume. Qualitative image scores showed super-resolved images had better edge sharpness, fewer residual artefacts and less image distortion than low-resolution images, with similar scores to high-resolution data. Quantitative image scores showed super-resolved images had significantly better edge sharpness than low-resolution or high-resolution images, with significantly better signal-to-noise ratio than high-resolution data. Vessel diameters measurements showed over-estimation in the low-resolution measurements, compared to the high-resolution data. No significant differences and no bias was found in the super-resolution measurements in any of the great vessels. However, a small but significant for the underestimation was found in the proximal left coronary artery diameter measurement from super-resolution data. Diagnostic scoring showed that although super-resolution did not improve accuracy of diagnosis, it did improve diagnostic confidence compared to low-resolution imaging. CONCLUSION This paper demonstrates the potential of using a residual U-Net for super-resolution reconstruction of rapidly acquired low-resolution whole heart bSSFP data within a clinical setting. We were able to train the network using synthetic training data from retrospective high-resolution whole heart data. The resulting network can be applied very quickly, making these techniques particularly appealing within busy clinical workflow. Thus, we believe that this technique may help speed up whole heart CMR in clinical practice.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK.
| | - Michael Quail
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
- Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Alexander Gotschy
- Great Ormond Street Hospital, London, WC1N 3JH, UK
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Andreas Hauptmann
- Department of Computer Science, University College London, London, WC1E 6BT, UK
- Research Unit of Mathematical Sciences, University of Oulu, Oulu, Finland
| | - Simon Arridge
- Department of Computer Science, University College London, London, WC1E 6BT, UK
| | - Rodney Jones
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, 30 Guildford Street, London, WC1N 1EH, UK
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Gotschy A, Manka R, Templin C. Hosepipe-kinking of a dissected coronary artery: an unusual kind of pseudo lesion. Eur Heart J Case Rep 2020; 4:1-2. [PMID: 32974446 PMCID: PMC7501902 DOI: 10.1093/ehjcr/ytaa112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/18/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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24
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Stämpfli SF, Gotschy A, Kiarostami P, Özkartal T, Gruner C, Niemann M, Manka R, Tanner FC. Right ventricular involvement in left ventricular non-compaction cardiomyopathy. Cardiol J 2020; 29:454-462. [PMID: 32648250 PMCID: PMC9170309 DOI: 10.5603/cj.a2020.0095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Left ventricular non-compaction cardiomyopathy (LVNC) features extensive trabeculations. Involvement of the right ventricle (RV) has been reported; however, distinction from normal RV trabeculation is difficult. This study aimed at assessing RV morphology and function in LVNC by cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE). METHODS Dimensional and functional parameters were assessed according to guidelines. Novel CMR parameters were RV end-diastolic (ED) trabeculated area, RV ED trabeculated volume, and RV ED non-compacted to compacted (NC/N) ratio in short axis (SAX) as well as in 4-chamber view (4CH). RESULTS Twenty patients with LVNC and twenty controls were included. RV size and function were comparable in LVNC and controls and exhibited a good correlation between TTE and CMR. Although RV trabeculated area, RV trabeculated volume, and RV ED NC/C ratio in SAX as well as in 4CH were larger in LVNC, there was a major overlap with values in controls. RV ED NC/C ratio in SAX correlated with LV ED NC/C ratio (not in 4CH). Quantitative assessment of RV non-compaction was not feasible in TTE. CONCLUSIONS Right ventricle size and function in LVNC can be measured by CMR and TTE, while RV trabeculation can only be quantified by CMR. RV myocardium displays more trabeculations in LVNC; however, overlap with normal individuals is extensive, not allowing separation of patients with LVNC from controls.
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Affiliation(s)
- Simon F Stämpfli
- Department of Cardiology, Luzerner Kantonsspital,, Luzern, Switzerland. .,Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
| | - Alexander Gotschy
- Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Pascal Kiarostami
- Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Tardu Özkartal
- Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christiane Gruner
- Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Markus Niemann
- Faculty Mechanical and Medical Engineering, Furtwangen University, Germany
| | - Robert Manka
- Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Felix C Tanner
- Departement of Cardiology University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Gastl M, Sürder D, Corti R, Faruque Osmany D, Gotschy A, von Spizcak J, Sokolska J, Metzen D, Alkadhi H, Ruschitzka F, Kozerke S, Manka R. Effect of intracoronary bone marrow-derived mononuclear cell injection early and late after myocardial infarction on CMR-derived myocardial strain. Int J Cardiol 2020; 310:108-115. [DOI: 10.1016/j.ijcard.2020.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
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Montalt-Tordera J, Kowalik G, Gotschy A, Steeden J, Muthurangu V. Rapid 3D whole-heart cine imaging using golden ratio stack of spirals. Magn Reson Imaging 2020; 72:1-7. [PMID: 32562742 DOI: 10.1016/j.mri.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Three-dimensional cine imaging provides a wealth of information about cardiac anatomy and function, but its use in the clinical environment is limited because data acquisition is very time consuming. In this work, a free-breathing 3D whole-heart cine imaging framework was developed using a time-efficient stack of spirals trajectory and accelerated reconstruction. Two suitable view ordering methods are considered with different spacing between k-space readouts in the partition dimension: uniform and tiny golden ratio based. A simulation study suggested the latter did not present any benefits in terms of similarity to the true image. The proposed method was subsequently tested on 10 prospective subjects and compared with conventional multi-slice breath-hold imaging. Image quality was evaluated using objective and subjective scores and ventricular measurements were compared to assess clinical accuracy. Image quality was lower in the proposed technique than in breath-hold images but good agreement was found in clinically relevant ventricular measurements. In addition, the proposed method was fast to acquire, required minimal planning and provided full anatomical coverage with isotropic resolution.
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Affiliation(s)
| | | | - Alexander Gotschy
- Great Ormond Street Hospital, London, UK; Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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Gastl M, Gruner C, Labucay K, Gotschy A, Von Spiczak J, Polacin M, Boenner F, Kelm M, Ruschitzka F, Alkadhi H, Kozerke S, Manka R. Cardiovascular magnetic resonance T2* mapping for the assessment of cardiovascular events in hypertrophic cardiomyopathy. Open Heart 2020; 7:e001152. [PMID: 32201584 PMCID: PMC7076262 DOI: 10.1136/openhrt-2019-001152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/12/2019] [Accepted: 02/10/2020] [Indexed: 11/03/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of adverse cardiac events. Beyond classic risk factors, relative myocardial ischaemia and succeeding myocardial alterations, which can be detected using either contrast agents or parametric mapping in cardiovascular magnetic resonance (CMR) imaging, have shown an impact on outcome in HCM. CMR may help to risk stratify using parametric T2* mapping. Therefore, the aim of the present study was to evaluate the association of T2* values or fibrosis with cardiovascular events in HCM. Methods The relationship between T2* with supraventricular, ventricular arrhythmia or heart failure was retrospectively assessed in 91 patients with HCM referred for CMR on a 1.5T MR imaging system. Fibrosis as a reference was added to the model. Patients were subdivided into groups according to T2* value quartiles. Results 47 patients experienced an event of ventricular arrhythmia, 25 of atrial fibrillation/flutter and 17 of heart failure. T2*≤28.7 ms yielded no association with ventricular events in the whole HCM cohort. T2* of non-obstructive HCM showed a significant association with ventricular events in univariate analysis, but not in multivariate analysis. For the combined endpoint of arrhythmic events, there was already an association for the whole HCM cohort, but again only in univariate analyses. Fibrosis stayed the strongest predictor in all analyses. There was no association for T2* and fibrosis with heart failure. Conclusions Decreased T2* values by CMR only provide a small association with arrhythmic events in HCM, especially in non-obstructive HCM. No information is added for heart failure.
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Affiliation(s)
- Mareike Gastl
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Dusseldorf, Germany
| | - Christiane Gruner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Karin Labucay
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Jochen Von Spiczak
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Florian Boenner
- Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Dusseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, Heinrich Heine University, Dusseldorf, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Sokolska JM, von Spiczak J, Gotschy A, Kozerke S, Manka R. Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art. Kardiol Pol 2019; 77:1123-1133. [PMID: 31719511 DOI: 10.33963/kp.15057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The new 2019 European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes emphasize the role of noninvasive functional imaging of myocardial ischemia in diagnosing coronary artery disease to guide decision making regarding revascularization. Cardiac magnetic resonance imaging (CMR) stands out relative to other imaging modalities given its high safety profile, absence of ionizing radiation, and its versatility in encoding various image contrasts. It also allows an assessment of myocardial function, ischemia, and viability as well as permits tissue characterization including detection of edema in a single examination. In recent years, a number of meta‑analyses and studies considering the role of CMR for detecting ischemia have been published. The recent multicenter randomized MR‑INFORM trial has demonstrated the clinical utility of CMR in patients with stable angina and cardiovascular risk factors. This landmark study has proved that a perfusion CMR‑based strategy leads to a lower number of revascularizations while being noninferior to an invasive coronary angiography with fractional flow reserve-guided therapy in terms of major adverse cardiac events at 1 year. In light of recent and future technical improvements, CMR will become increasingly important in the assessment of myocardial ischemia in patients with chronic coronary syndromes.
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Affiliation(s)
- Justyna M Sokolska
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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29
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Gotschy A, von Deuster C, van Gorkum RJH, Gastl M, Vintschger E, Schwotzer R, Flammer AJ, Manka R, Stoeck CT, Kozerke S. Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging. J Cardiovasc Magn Reson 2019; 21:56. [PMID: 31484544 PMCID: PMC6727537 DOI: 10.1186/s12968-019-0563-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial microstructure. This study applied CMR DTI in CA to assess microstructural alterations and their consequences for myocardial function compared to healthy controls. METHODS Ten patients with CA (8 AL, 2 ATTR) and ten healthy controls were studied using a diffusion-weighed second-order motion-compensated spin-echo sequence at 1.5 T. Additionally, left ventricular morphology, ejection fraction, strain and native T1 values were obtained in all subjects. In CA patients, T1 mapping was repeated after the administration of gadolinium for extracellular volume fraction (ECV) calculation. CMR DTI analysis was performed to yield the scalar diffusion metrics mean diffusivity (MD) and fractional anisotropy (FA) as well as the characteristics of myofiber orientation including helix, transverse and E2A sheet angle (HA, TA, E2A). RESULTS MD and FA were found to be significantly different between CA patients and healthy controls (MD 1.77 ± 0.17 10- 3 vs 1.41 ± 0.07 10- 3 mm2/s, p < 0.001; FA 0.25 ± 0.04 vs 0.35 ± 0.03, p < 0.001). MD demonstrated an excellent correlation with native T1 (r = 0.908, p < 0.001) while FA showed a significant correlation with ECV in the CA population (r = - 0.851, p < 0.002). HA exhibited a more circumferential orientation of myofibers in CA patients, in conjunction with a higher TA standard deviation and a higher absolute E2A sheet angle. The transmural HA slope was found to be strongly correlated with the global longitudinal strain (r = 0.921, p < 0.001). CONCLUSION CMR DTI reveals significant alterations of scalar diffusion metrics in CA patients versus healthy controls. Elevated MD and lower FA values indicate myocardial disarray with higher diffusion in CA that correlates well with native T1 and ECV measures. In CA patients, CMR DTI showed pronounced circumferential orientation of the myofibers, which may provide the rationale for the reduction of global longitudinal strain that occurs in amyloidosis patients. Accordingly, CMR DTI captures specific features of amyloid infiltration, which provides a deeper understanding of the microstructural consequences of CA.
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Affiliation(s)
- Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Constantin von Deuster
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Robbert J. H. van Gorkum
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Mareike Gastl
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Ella Vintschger
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Rahel Schwotzer
- Division of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas J. Flammer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian T. Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich, 8092 Switzerland
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30
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Gastl M, Gotschy A, von Spiczak J, Polacin M, Bönner F, Gruner C, Kelm M, Ruschitzka F, Alkadhi H, Kozerke S, Manka R. Cardiovascular magnetic resonance T2* mapping for structural alterations in hypertrophic cardiomyopathy. Eur J Radiol Open 2019; 6:78-84. [PMID: 30775414 PMCID: PMC6365365 DOI: 10.1016/j.ejro.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 12/28/2022] Open
Abstract
HCM patients exhibited significantly decreased T2* values compared to controls. Within HCM patients, those with myocardial fibrosis presented with decreased T2* values. T2* provided good diagnostic accuracy to diagnose HCM with fibrosis. T2* may add information for identifying a higher risk sub-group of HCM patients.
Purpose Hypertrophic cardiomyopathy (HCM) is characterized by a heterogeneous morphology and variable prognosis. A mismatch between left ventricular mass (LVM) and microvascular circulation with corresponding relative ischemia has been implicated to cause myocardial replacement fibrosis that deteriorates prognosis. Besides parametric T1 mapping, Cardiovascular Magnetic Resonance (CMR) T2* mapping is able to identify ischemia as well as fibrosis in cardiac and extracardiac diseases. Therefore, we aimed to investigate the value of T2* mapping to characterize structural alterations in patients with HCM. Methods CMR was performed on a 1.5 T MR imaging system (Achieva, Philips, Best, Netherlands) using a 5-channel coil in patients with HCM (n = 103, 50.6 ± 16.4 years) and in age- and gender-matched controls (n = 20, 44.8 ± 16.9 years). T2* mapping (1 midventricular short axis slice) was acquired in addition to late gadolinium enhancement (LGE). T2* values were compared between patients with HCM and controls as well as between HCM patients with- and without fibrosis. Results HCM patients showed significantly decreased T2* values compared to controls (26.2 ± 4.6 vs. 31.3 ± 4.3 ms, p < 0.001). Especially patients with myocardial fibrosis presented with decreased T2* values in comparison to those without fibrosis (25.2 ± 4.0 vs. 28.7 ± 5.3 ms, p = 0.003). A regression model including maximum wall thickness, LVM and T2* values provided good overall diagnostic accuracy of 80% to diagnose HCM with and without fibrosis. Conclusion In this study, parametric mapping identified lower T2* values in HCM patients compared to controls, especially in a sub-group of patients with myocardial fibrosis. As myocardial fibrosis has been suggested to influence prognosis of patients with HCM, T2* mapping may add information for identifying a higher risk sub-group of HCM patients.
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Affiliation(s)
- Mareike Gastl
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
- Dept. Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
- Corresponding author.
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Florian Bönner
- Dept. Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Christiane Gruner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Malte Kelm
- Dept. Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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31
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Gastl M, Peereboom SM, Gotschy A, Fuetterer M, von Deuster C, Boenner F, Kelm M, Schwotzer R, Flammer AJ, Manka R, Kozerke S. Myocardial triglycerides in cardiac amyloidosis assessed by proton cardiovascular magnetic resonance spectroscopy. J Cardiovasc Magn Reson 2019; 21:10. [PMID: 30700314 PMCID: PMC6354424 DOI: 10.1186/s12968-019-0519-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiac involvement of amyloidosis leads to left-ventricular (LV) wall thickening with progressive heart failure requiring rehospitalization. Cardiovascular magnetic resonance (CMR) is a valuable tool to non-invasively assess myocardial thickening as well as structural changes. Proton CMR spectroscopy (1H-CMRS) additionally allows assessing metabolites including triglycerides (TG) and total creatine (CR). However, opposing results exist regarding utilization of these metabolites in LV hypertrophy or thickening. Therefore, the aim of this study was to measure metabolic alterations using 1H-CMRS in a group of patients with thickened myocardium caused by cardiac amyloidosis. METHODS 1H-CMRS was performed on a 1.5 T system (Achieva, Philips Healthcare, Best, The Netherlands) using a 5-channel receive coil in 11 patients with cardiac amyloidosis (60.5 ± 11.4 years, 8 males) and 11 age- and gender-matched controls (63.2 ± 8.9 years, 8 males). After cardiac morphology and function assessment, proton spectra from the interventricular septum (IVS) were acquired using a double-triggered PRESS sequence. Post-processing was performed using a customized reconstruction pipeline based on ReconFrame (GyroTools LLC, Zurich, Switzerland). Spectra were fitted in jMRUI/AMARES and the ratios of triglyceride-to-water (TG/W) and total creatine-to-water (CR/W) were calculated. RESULTS Besides an increased LV mass and a thickened IVS concomitant to the disease characteristics, patients with cardiac amyloidosis presented with decreased global longitudinal (GLS) and circumferential (GCS) strain. LV ejection fraction was preserved relative to controls (60.0 ± 13.2 vs. 66.1 ± 4.3%, p = 0.17). Myocardial TG/W ratios were significantly decreased compared to controls (0.53 ± 0.23 vs. 0.80 ± 0.26%, p = 0.015). CR/W ratios did not show a difference between both groups, but a higher standard deviation in patients with cardiac amyloidosis was observed. Pearson correlation revealed a negative association between elevated LV mass and TG/W (R = - 0.59, p = 0.004) as well as GCS (R = - 0.48, p = 0.025). CONCLUSIONS A decrease in myocardial TG/W can be detected in patients with cardiac amyloidosis alongside impaired cardiac function with an association to the degree of myocardial thickening. Accordingly, 1H-CMRS may provide an additional diagnostic tool to gauge progression of cardiac amyloidosis along with standard imaging sequences. TRIAL REGISTRATION EK 2013-0132.
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Affiliation(s)
- Mareike Gastl
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Department Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Sophie M. Peereboom
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Maximilian Fuetterer
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Constantin von Deuster
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Florian Boenner
- Department Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Malte Kelm
- Department Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Rahel Schwotzer
- Comprehensive Cancer Center Zürich, University Hospital Zurich, Zurich, Switzerland
| | - Andreas J. Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
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Gülan U, Saguner AM, Akdis D, Gotschy A, Tanner FC, Kozerke S, Manka R, Brunckhorst C, Holzner M, Duru F. Hemodynamic Changes in the Right Ventricle Induced by Variations of Cardiac Output: A Possible Mechanism for Arrhythmia Occurrence in the Outflow Tract. Sci Rep 2019; 9:100. [PMID: 30643204 PMCID: PMC6331649 DOI: 10.1038/s41598-018-36614-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/23/2018] [Indexed: 01/07/2023] Open
Abstract
The rationale of this paper is to investigate right ventricular (RV) hemodynamics in relation to changes in cardiac output, and in particular to study exercise-induced stresses at the RV outflow tract (RVOT), which is a common site of ventricular arrhythmias in the athlete’s heart. We hypothesize that the thin-walled RVOT is exposed to high wall shear stresses (WSS) during physiological states associated with high cardiac output such as exercise, and therefore, may be particularly prone to substrate formation leading to ventricular tachyarrhythmias. 3D Particle Tracking Velocimetry (3D-PTV), an optical imaging method, has been performed in a novel anatomically accurate compliant silicone right heart model derived from a high resolution MRI heart scan of a healthy male proband. RV and RVOT flow patterns at resting conditions were obtained from two healthy athletic male proband’s hearts and two patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) via phase contrast magnetic resonance imaging (PC-MRI). The healthy case was used as a reference for validating the in vitro flow patterns of the silicone model, while the diseased cases were used to generalize our findings and investigate possible changes in hemodynamic stresses with RV morphological remodelling. Our results showed that both healthy and diseased geometries consistently displayed an increased WSS in the RVOT relative to the rest of the RV. We found that increases in cardiac output may lead to increases of mean kinetic energy (MKE), laminar viscous dissipation and WSS at the RVOT. Furthermore, higher peak WSS magnitudes were found for the diseased cases. The identified high WSS regions may correlate with the common site of RVOT ventricular tachycardia in athletes and patients with ARVC/D. Our results imply that exercise, as well as anatomical and functional remodeling might alter RV wall shear stress both in magnitude and spatial distribution, leading to increased hemodynamic stresses in the RVOT.
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Affiliation(s)
- Utku Gülan
- ETH Zurich, Institute of Environmental Engineering, Zurich, 8093, Switzerland.
| | | | - Deniz Akdis
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Alexander Gotschy
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, 8092, Switzerland
| | - Felix C Tanner
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, 8092, Switzerland
| | - Robert Manka
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland.,Institute of Diagnostic and Interventional Radiology, University and ETH Zurich, Zurich, 8092, Switzerland
| | - Corinna Brunckhorst
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Markus Holzner
- ETH Zurich, Institute of Environmental Engineering, Zurich, 8093, Switzerland
| | - Firat Duru
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, 8091, Switzerland
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Walheim J, Gotschy A, Kozerke S. On the limitations of partial Fourier acquisition in phase-contrast MRI of turbulent kinetic energy. Magn Reson Med 2018; 81:514-523. [PMID: 30265753 DOI: 10.1002/mrm.27397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/04/2018] [Accepted: 05/20/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate limitations of partial Fourier acquisition in phase-contrast MRI of turbulent kinetic energy (TKE). METHODS To assess the validity of partial Fourier reconstruction of TKE and phase images, computational fluid dynamics data of mean and turbulent velocities in a stenotic U-bend phantom was used. Partial Fourier acquisition with 75% k-space coverage was simulated and TKE data were reconstructed using zero-filling, homodyne reconstruction, and the method of projections onto convex sets (POCS). Results were compared to data from fully sampled k-space and 75% symmetric sampling. In addition, compressed sensing (CS) reconstruction was compared for a standard variable density sampling pattern and a variable density sampling pattern combined with 75% partial Fourier. For illustration purposes, in vivo examples of velocity magnitude and TKE maps of aortic flow reconstructed with the different methods are provided. RESULTS In accordance with theory, partial Fourier reconstruction of TKE maps from phase-contrast data results in artifacts relative to fully sampled data. It is demonstrated that neither homodyne reconstruction nor POCS can improve reconstruction of TKE data with respect to zero-filling reconstruction when compared to ground-truth (RMS error: 4.70%, 4.34%, and 2.45% for homodyne, POCS, and zero-filling reconstruction of in vivo data, respectively). CS reconstruction from data acquired with partial Fourier did not recover the resolution loss incurred by partial Fourier sampling. CONCLUSION Partial Fourier reconstruction of TKE maps from phase-contrast data does not yield a benefit over zero-filling reconstruction. In consequence, symmetric sampling is preferred over partial Fourier acquisition for a given number of phase-encodes in phase-contrast MRI.
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Affiliation(s)
- Jonas Walheim
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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Gotschy A, Von Deuster C, Van Gorkum RJH, Gastl M, Vintschger E, Flammer AJ, Manka R, Stoeck CT, Kozerke S. 4383Characterizing cardiac involvement in amyloidosis using in-vivo cardiac diffusion tensor imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Gotschy
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - C Von Deuster
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - R J H Van Gorkum
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - M Gastl
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - E Vintschger
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - A J Flammer
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - R Manka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - C T Stoeck
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
| | - S Kozerke
- University and ETH Zurich, Institute for Biomedical Engineering, Zurich, Switzerland
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Gastl M, Peereboom S, Gotschy A, Fuetterer M, Von Deuster C, Boenner F, Kelm M, Flammer A, Manka R, Kozerke S. 1162Quantification of cardiac creatine and triglycerides in amyloidosis using proton MR spectroscopy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Gastl
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - S Peereboom
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - A Gotschy
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - M Fuetterer
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - C Von Deuster
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - F Boenner
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology, Düsseldorf, Germany
| | - M Kelm
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology, Düsseldorf, Germany
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - R Manka
- University Heart Center, Zurich, Switzerland
| | - S Kozerke
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
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Hamada S, Gotschy A, Wissmann L, Paetsch I, Jahnke C, Plein S, Gebker R, Oebel S, Alkadhi H, Marx N, Lüscher TF, Kozerke S, Manka R. Multi-centre study of whole-heart dynamic 3D cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: gender based analysis of diagnostic performance. Eur Heart J Cardiovasc Imaging 2018; 18:1099-1106. [PMID: 28984890 DOI: 10.1093/ehjci/jex160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/19/2017] [Indexed: 11/15/2022] Open
Abstract
Aims Coronary artery disease (CAD) is a leading cause of morbidity and mortality in women and non-invasive testing for CAD in women can be more challenging than in men. This study compared the diagnostic performance of whole-heart dynamic 3D cardiovascular magnetic resonance (CMR) stress perfusion imaging in female and male patients with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as reference tests. Methods and results Four hundred sixteen patients with suspected or known CAD were enrolled in five European centres. CMR imaging was performed prior to clinically indicated coronary angiography. QCA was performed in all patients and FFR in 357 of 416 patients. Whole-heart dynamic 3D CMR first-pass perfusion imaging was conducted at rest and during adenosine stress. All CMR analyses were operated by experienced investigators blinded to all clinical data. One hundred nineteen female and 297 male patients were included and successfully examined (mean age 65 ± 11 and 63 ± 11 years, respectively). FFR was performed in 106 female and 251 male patients. Sensitivity and specificity of whole-heart dynamic 3D CMR stress perfusion imaging were 89% (95% CI: 77-96) and 82% (95% CI: 70-90) in the female population and 83% (95% CI: 77-86) and 79% (95% CI: 71-86) in the male population relative to QCA (P = 0.474 and P = 0.83, P-values for comparison between genders). Sensitivity and specificity were 95% (95% CI: 82-99) and 84% (95% CI: 73-92) in the female population and 83% (95% CI: 76-89) and 82% (95% CI: 74-88) in the male population when using FFR as the reference (P = 0.134 and P = 0.936, P-values for comparison between genders). Diagnostic accuracy in females was 92% (95% CI: 85-96) and 86% (95% CI: 81-90) in males when using FFR as the reference. The prevalence of CAD as defined by FFR (<0.8) was 36% in females and 53% in males. Conclusion Whole-heart dynamic 3D CMR stress perfusion imaging has a high diagnostic accuracy for the detection of significant CAD irrespective of gender and is therefore a suitable non-invasive testing tool to detect myocardial ischaemia in both genders.
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Affiliation(s)
- Sandra Hamada
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.,Department of Cardiology, Pneumology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland.,Division of Internal Medicine, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland
| | - Ingo Paetsch
- HELIOS Heart Center Leipzig - University Hospital of Leipzig, Department of Rhythmology, Struempellstrasse 39, Leipzig 04289, Germany
| | - Cosima Jahnke
- HELIOS Heart Center Leipzig - University Hospital of Leipzig, Department of Rhythmology, Struempellstrasse 39, Leipzig 04289, Germany
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Center & the Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS29JT, UK
| | - Rolf Gebker
- German Heart Institute Berlin, Department of Internal Medicine - Cardiology, Augustenburger Platz 1, Berlin 13353, Germany
| | - Sabrina Oebel
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Critical Care (Medical Clinic 1), University Hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, Zurich 8092, Switzerland
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Gülan U, Saguner A, Akdis D, Gotschy A, Manka R, Brunckhorst C, Holzner M, Duru F. Investigation of Atrial Vortices Using a Novel Right Heart Model and Possible Implications for Atrial Thrombus Formation. Sci Rep 2017; 7:16772. [PMID: 29196688 PMCID: PMC5711865 DOI: 10.1038/s41598-017-17117-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/22/2017] [Indexed: 11/15/2022] Open
Abstract
The main aim of this paper is to characterize vortical flow structures in the healthy human right atrium, their impact on wall shear stresses and possible implications for atrial thrombus formation. 3D Particle Tracking Velocimetry is applied to a novel anatomically accurate compliant silicone right heart model to study the phase averaged and fluctuating flow velocity within the right atrium, inferior vena cava and superior vena cava under physiological conditions. We identify the development of two vortex rings in the bulk of the right atrium during the atrial filling phase leading to a rinsing effect at the atrial wall which break down during ventricular filling. We show that the vortex ring formation affects the hemodynamics of the atrial flow by a strong correlation (ρ = 0.7) between the vortical structures and local wall shear stresses. Low wall shear stress regions are associated with absence of the coherent vortical structures which might be potential risk regions for atrial thrombus formation. We discuss possible implications for atrial thrombus formation in different regions of the right atrium.
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Affiliation(s)
- Utku Gülan
- ETH Zurich, Institute of Environmental Engineering, Zurich, 8093, Switzerland.
| | - Ardan Saguner
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Deniz Akdis
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Alexander Gotschy
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, 8092, Switzerland
| | - Robert Manka
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Corinna Brunckhorst
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland
| | - Markus Holzner
- ETH Zurich, Institute of Environmental Engineering, Zurich, 8093, Switzerland
| | - Firat Duru
- University Heart Center, Department of Cardiology, Zurich, 8091, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, 8091, Switzerland
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Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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39
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Saguner A, Gotschy A, Akdis D, Niemann M, Hamada S, Parmon E, Brunckhorst C, Delgado V, Bax J, Kozerke S, Duru F, Tanner F, Manka R. P1598A novel right ventricular outflow tract measure in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Binter C, Gotschy A, Sündermann SH, Frank M, Tanner FC, Lüscher TF, Manka R, Kozerke S. Turbulent Kinetic Energy Assessed by Multipoint 4-Dimensional Flow Magnetic Resonance Imaging Provides Additional Information Relative to Echocardiography for the Determination of Aortic Stenosis Severity. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005486. [PMID: 28611119 DOI: 10.1161/circimaging.116.005486] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/21/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Christian Binter
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Alexander Gotschy
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Simon H. Sündermann
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Michelle Frank
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Felix C. Tanner
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Thomas F. Lüscher
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Robert Manka
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Sebastian Kozerke
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
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Gotschy A, Saguner AM, Niemann M, Hamada S, Akdis D, Yoon JN, Parmon EV, Delgado V, Bax JJ, Kozerke S, Brunckhorst C, Duru F, Tanner FC, Manka R. Right ventricular outflow tract dimensions in arrhythmogenic right ventricular cardiomyopathy/dysplasia—a multicentre study comparing echocardiography and cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2017; 19:516-523. [DOI: 10.1093/ehjci/jex092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
- Division of Internal Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Markus Niemann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Faculty of Mechanical and Medical Engineering, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany
| | - Sandra Hamada
- Department of Cardiology, Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ji-Na Yoon
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Elena V Parmon
- Institute of Heart and Vessels, Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Gotschy A, Bauer WR, Winter P, Nordbeck P, Rommel E, Jakob PM, Herold V. Local versus global aortic pulse wave velocity in early atherosclerosis: An animal study in ApoE-/--mice using ultrahigh field MRI. PLoS One 2017; 12:e0171603. [PMID: 28207773 PMCID: PMC5313136 DOI: 10.1371/journal.pone.0171603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/23/2017] [Indexed: 11/25/2022] Open
Abstract
Increased aortic stiffness is known to be associated with atherosclerosis and has a predictive value for cardiovascular events. This study aims to investigate the local distribution of early arterial stiffening due to initial atherosclerotic lesions. Therefore, global and local pulse wave velocity (PWV) were measured in ApoE-/- and wild type (WT) mice using ultrahigh field MRI. For quantification of global aortic stiffness, a new multi-point transit-time (TT) method was implemented and validated to determine the global PWV in the murine aorta. Local aortic stiffness was measured by assessing the local PWV in the upper abdominal aorta, using the flow/area (QA) method. Significant differences between age matched ApoE-/- and WT mice were determined for global and local PWV measurements (global PWV: ApoE-/-: 2.7±0.2m/s vs WT: 2.1±0.2m/s, P<0.03; local PWV: ApoE-/-: 2.9±0.2m/s vs WT: 2.2±0.2m/s, P<0.03). Within the WT mouse group, the global PWV correlated well with the local PWV in the upper abdominal aorta (R2 = 0.75, P<0.01), implying a widely uniform arterial elasticity. In ApoE-/- animals, however, no significant correlation between individual local and global PWV was present (R2 = 0.07, P = 0.53), implying a heterogeneous distribution of vascular stiffening in early atherosclerosis. The assessment of global PWV using the new multi-point TT measurement technique was validated against a pressure wire measurement in a vessel phantom and showed excellent agreement. The experimental results demonstrate that vascular stiffening caused by early atherosclerosis is unequally distributed over the length of large vessels. This finding implies that assessing heterogeneity of arterial stiffness by multiple local measurements of PWV might be more sensitive than global PWV to identify early atherosclerotic lesions.
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Affiliation(s)
- Alexander Gotschy
- Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- * E-mail:
| | - Wolfgang R. Bauer
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center / Deutsches Zentrum für Herzinsuffizienz, University of Würzburg, Würzburg, Germany
| | - Patrick Winter
- Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center / Deutsches Zentrum für Herzinsuffizienz, University of Würzburg, Würzburg, Germany
| | - Eberhard Rommel
- Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
| | - Peter M. Jakob
- Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center / Deutsches Zentrum für Herzinsuffizienz, University of Würzburg, Würzburg, Germany
| | - Volker Herold
- Department of Experimental Physics V, University of Würzburg, Würzburg, Germany
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Wissmann L, Gotschy A, Santelli C, Tezcan KC, Hamada S, Manka R, Kozerke S. Analysis of spatiotemporal fidelity in quantitative 3D first-pass perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:11. [PMID: 28125995 PMCID: PMC5270366 DOI: 10.1186/s12968-017-0324-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-heart first-pass perfusion cardiovascular magnetic resonance (CMR) relies on highly accelerated image acquisition. The influence of undersampling on myocardial blood flow (MBF) quantification has not been systematically investigated yet. In the present work, the effect of spatiotemporal scan acceleration on image reconstruction accuracy and MBF error was studied using a numerical phantom and validated in-vivo. METHODS Up to 10-fold scan acceleration using k-t PCA and k-t SPARSE-SENSE was simulated using the MRXCAT CMR numerical phantom framework. Image reconstruction results were compared to ground truth data in the k-f domain by means of modulation transfer function (MTF) analysis. In the x-t domain, errors pertaining to specific features of signal intensity-time curves and MBF values derived using Fermi model deconvolution were analysed. In-vivo first-pass CMR data were acquired in ten healthy volunteers using a dual-sequence approach assessing the arterial input function (AIF) and myocardial enhancement. 10x accelerated 3D k-t PCA and k-t SPARSE-SENSE were compared and related to non-accelerated 2D reference images. RESULTS MTF analysis revealed good recovery of data upon k-t PCA reconstruction at 10x undersampling with some attenuation of higher temporal frequencies. For 10x k-t SPARSE-SENSE the MTF was found to decrease to zero at high spatial frequencies for all temporal frequencies indicating a loss in spatial resolution. Signal intensity-time curve errors were most prominent in AIFs from 10x k-t PCA, thereby emphasizing the need for separate AIF acquisition using a dual-sequence approach. These findings were confirmed by MBF estimation based on AIFs from fully sampled and undersampled simulations. Average in-vivo MBF estimates were in good agreement between both accelerated and the fully sampled methods. Intra-volunteer MBF variation for fully sampled 2D scans was lower compared to 10x k-t PCA and k-t SPARSE-SENSE data. CONCLUSION Quantification of highly undersampled 3D first-pass perfusion CMR yields accurate MBF estimates provided the AIF is obtained using fully sampled or moderately undersampled scans as part of a dual-sequence approach. However, relative to fully sampled 2D perfusion imaging, intra-volunteer variation is increased using 3D approaches prompting for further developments.
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Affiliation(s)
- Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Santelli
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Kerem Can Tezcan
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Sandra Hamada
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, RWTH Aachen University, Aachen, Germany
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Division of Imaging Sciences, King’s College London, London, UK
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Manka R, Oebel S, Gotschy A, Kozerke S. 3-D-Perfusion – höhere Auflösung, bessere Aussagekraft? Aktuel Kardiol 2016. [DOI: 10.1055/s-0042-118225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. Manka
- Klinik für Kardiologie, Universitäres Herzzentrum, UniversitätsSpital Zürich, Schweiz
| | - S. Oebel
- Institut für Diagnostische und Interventionelle Radiologie, UniversitätsSpital Zürich, Schweiz
| | - A. Gotschy
- Klinik für Kardiologie, Universitäres Herzzentrum, UniversitätsSpital Zürich, Schweiz
| | - S. Kozerke
- Institut für Biomedizinische Technik, Eidgenössische Technische Hochschule Zürich, Schweiz
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Gulan U, Saguner A, Akdis D, Brunckhorst C, Gotschy A, Binter C, Holzner M, Duru F. 176-02: A Novel In-Vitro Model to Study Flow Dynamics in the Human Right Heart. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i117a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gotschy A, Wissmann L, Goolaub DS, Niemann M, Hamada S, Kozerke S, Manka R. First fusion and combined evaluation of 3D-CMR perfusion with 3D-MR coronary angiography. Int J Cardiol 2016; 202:62-3. [DOI: 10.1016/j.ijcard.2015.08.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
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Wissmann L, Niemann M, Gotschy A, Manka R, Kozerke S. Quantitative three-dimensional myocardial perfusion cardiovascular magnetic resonance with accurate two-dimensional arterial input function assessment. J Cardiovasc Magn Reson 2015; 17:108. [PMID: 26637221 PMCID: PMC4669617 DOI: 10.1186/s12968-015-0212-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/24/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Quantification of myocardial perfusion from first-pass cardiovascular magnetic resonance (CMR) images at high contrast agent (CA) dose requires separate acquisition of blood pool and myocardial tissue enhancement. In this study, a dual-sequence approach interleaving 2D imaging of the arterial input function with high-resolution 3D imaging for myocardial perfusion assessment is presented and validated for low and high CA dose. METHODS A dual-sequence approach interleaving 2D imaging of the aortic root and 3D imaging of the whole left ventricle using highly accelerated k-t PCA was implemented. Rest perfusion imaging was performed in ten healthy volunteers after administration of a Gadolinium-based CA at low (0.025 mmol/kg b.w.) and high dose (0.1 mmol/kg b.w.). Arterial input functions extracted from the 2D and 3D images were analysed for both doses. Myocardial contrast-to-noise ratios (CNR) were compared across volunteers and doses. Variations of myocardial perfusion estimates between volunteers and across myocardial territories were studied. RESULTS High CA dose imaging resulted in strong non-linearity of the arterial input function in the 3D images at peak CA concentration, which was avoided when the input function was derived from the 2D images. Myocardial CNR was significantly increased at high dose compared to low dose, with a 2.6-fold mean CNR gain. Most robust myocardial blood flow estimation was achieved using the arterial input function extracted from the 2D image at high CA dose. In this case, myocardial blood flow estimates varied by 24% between volunteers and by 20% between myocardial territories when analysed on a per-volunteer basis. CONCLUSION Interleaving 2D imaging for arterial input function assessment enables robust quantitative 3D myocardial perfusion imaging at high CA dose.
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Affiliation(s)
- Lukas Wissmann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
| | - Markus Niemann
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Furtwangen University, Faculty Mechanical and Medical Engineering, Villingen-Schwenningen, Germany.
| | - Alexander Gotschy
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Robert Manka
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
- Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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Manka R, Wissmann L, Gebker R, Jogiya R, Motwani M, Frick M, Reinartz S, Schnackenburg B, Niemann M, Gotschy A, Kuhl C, Nagel E, Fleck E, Marx N, Luescher TF, Plein S, Kozerke S. Multicenter evaluation of dynamic three-dimensional magnetic resonance myocardial perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003061. [PMID: 25901043 DOI: 10.1161/circimaging.114.003061] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND First-pass myocardial perfusion cardiovascular magnetic resonance (CMR) imaging yields high diagnostic accuracy for the detection of coronary artery disease (CAD). However, standard 2D multislice CMR perfusion techniques provide only limited cardiac coverage, and hence considerable assumptions are required to assess myocardial ischemic burden. The aim of this prospective study was to assess the diagnostic performance of 3D myocardial perfusion CMR to detect functionally relevant CAD with fractional flow reserve (FFR) as a reference standard in a multicenter setting. METHODS AND RESULTS A total of 155 patients with suspected CAD listed for coronary angiography with FFR were prospectively enrolled from 5 European centers. 3D perfusion CMR was acquired on 3T MR systems from a single vendor under adenosine stress and at rest. All CMR perfusion analyses were performed in a central laboratory and blinded to all clinical data. One hundred fifty patients were successfully examined (mean age 62.9±10 years, 45 female). The prevalence of CAD defined by FFR (<0.8) was 56.7% (85 of 150 patients). The sensitivity and specificity of 3D perfusion CMR were 84.7% and 90.8% relative to the FFR reference. Comparison to quantitative coronary angiography (≥50%) yielded a prevalence of 65.3%, sensitivity and specificity of 76.5% and 94.2%, respectively. CONCLUSIONS In this multicenter study, 3D myocardial perfusion CMR proved highly diagnostic for the detection of significant CAD as defined by FFR.
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Affiliation(s)
- Robert Manka
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Lukas Wissmann
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Rolf Gebker
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Roy Jogiya
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Manish Motwani
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Michael Frick
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Sebastian Reinartz
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Bernhard Schnackenburg
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Markus Niemann
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Alexander Gotschy
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Christiane Kuhl
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Eike Nagel
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Eckart Fleck
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Nikolaus Marx
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Thomas F Luescher
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Sven Plein
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.)
| | - Sebastian Kozerke
- From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.).
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Niemann M, Alkadhi H, Gotschy A, Kozerke S, Manka R. [Epicardial fat: Imaging and implications for diseases of the cardiovascular system]. Herz 2014; 40 Suppl 3:282-90. [PMID: 25178875 DOI: 10.1007/s00059-014-4146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
Since the discovery of the obese (ob) gene product leptin, fat has been considered an endocrine organ. Especially epicardial fat has gained increasing attention in recent years. The epicardial fat plays a major role in fat metabolism; however, harmful properties have also been reported. Echocardiography, computed tomography and cardiac magnetic resonance imaging are the non-invasive tools used to measure epicardial fat volume. This review briefly introduces the basic physiological and pathophysiological considerations concerning epicardial fat. The main issue of this review is the presentation of non-invasive measurement techniques of epicardial fat using various imaging modalities and a literature overview of associations between epicardial fat and common cardiovascular diseases.
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Affiliation(s)
- M Niemann
- Institut für Biomedizinische Technik, Universität und ETH Zürich, Gloriastr. 35, CH-8092, Zürich, Schweiz,
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