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Vanmali A, Alhumaid W, White JA. Cardiovascular Magnetic Resonance-Based Tissue Characterization in Patients With Hypertrophic Cardiomyopathy. Can J Cardiol 2024:S0828-282X(24)00202-2. [PMID: 38490449 DOI: 10.1016/j.cjca.2024.02.029] [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: 12/04/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common hereditable cardiomyopathy that affects between 1:200 to 1:500 of the general population. The role of cardiovascular magnetic resonance (CMR) imaging in the management of HCM has expanded over the past 2 decades to become a key informant of risk in this patient population, delivering unique insights into tissue health and its influence on future outcomes. Numerous mature CMR-based techniques are clinically available for the interrogation of tissue health in patients with HCM, inclusive of contrast and noncontrast methods. Late gadolinium enhancement imaging remains a cornerstone technique for the identification and quantification of myocardial fibrosis with large cumulative evidence supporting value for the prediction of arrhythmic outcomes. T1 mapping delivers improved fidelity for fibrosis quantification through direct estimations of extracellular volume fraction but also offers potential for noncontrast surrogate assessments of tissue health. Water-sensitive imaging, inclusive of T2-weighted dark blood imaging and T2 mapping, have also shown preliminary potential for assisting in risk discrimination. Finally, emerging techniques, inclusive of innovative multiparametric methods, are expanding the utility of CMR to assist in the delivery of comprehensive tissue characterization toward the delivery of personalized HCM care. In this narrative review we summarize the contemporary landscape of CMR techniques aimed at characterizing tissue health in patients with HCM. The value of these respective techniques to identify patients at elevated risk of future cardiovascular outcomes are highlighted.
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Affiliation(s)
- Atish Vanmali
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Waleed Alhumaid
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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Trenti C, Fedak PWM, White JA, Garcia J, Dyverfeldt P. Oscillatory shear stress is elevated in patients with bicuspid aortic valve and aortic regurgitation: a 4D flow cardiovascular magnetic resonance cross-sectional study. Eur Heart J Cardiovasc Imaging 2024; 25:404-412. [PMID: 37878753 PMCID: PMC10883729 DOI: 10.1093/ehjci/jead283] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Patients with bicuspid aortic valve (BAV) and aortic regurgitation have higher rate of aortic complications compared with patients with BAV and stenosis, as well as BAV without valvular disease. Aortic regurgitation alters blood haemodynamics not only in systole but also during diastole. We therefore sought to investigate wall shear stress (WSS) during the whole cardiac cycle in BAV with aortic regurgitation. METHODS AND RESULTS Fifty-seven subjects that underwent 4D flow cardiovascular magnetic resonance imaging were included: 13 patients with BAVs without valve disease, 14 BAVs with aortic regurgitation, 15 BAVs with aortic stenosis, and 22 normal controls with tricuspid aortic valve. Peak and time averaged WSS in systole and diastole and the oscillatory shear index (OSI) in the ascending aorta were computed. Student's t-tests were used to compare values between the four groups where the data were normally distributed, and the non-parametric Wilcoxon rank sum tests were used otherwise. BAVs with regurgitation had similar peak and time averaged WSS compared with the patients with BAV without valve disease and with stenosis, and no regions of elevated WSS were found. BAV with aortic regurgitation had twice as high OSI as the other groups (P ≤ 0.001), and mainly in the outer mid-to-distal ascending aorta. CONCLUSION OSI uniquely characterizes altered WSS patterns in BAVs with aortic regurgitation, and thus could be a haemodynamic marker specific for this specific group that is at higher risk of aortic complications. Future longitudinal studies are needed to verify this hypothesis.
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Affiliation(s)
- Chiara Trenti
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
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Mallabone M, Labib D, Abdelhaleem A, Dykstra S, Thompson RB, Paterson DI, Thompson SK, Hasanzadeh F, Mikami Y, Rivest S, Flewitt J, Feng Y, Macdonald M, King M, Bristow M, Kolman L, Howarth AG, Lydell CP, Miller RJ, Fine NM, White JA. Sex-based Differences in the Phenotypic Expression and Prognosis of Idiopathic Non-ischemic Cardiomyopathy: A Cardiovascular Magnetic Resonance Study. Eur Heart J Cardiovasc Imaging 2024:jeae014. [PMID: 38236156 DOI: 10.1093/ehjci/jeae014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
AIMS We sought to characterize sex-related differences in CMR-based cardiovascular phenotypes and prognosis in patients with idiopathic non-ischemic cardiomyopathy (NICM). METHODS AND RESULTS Patients with NICM enrolled in the Cardiovascular Imaging Registry of Calgary (CIROC) between 2015 and 2021 were identified. Z-score values for chamber volumes and function were calculated as standard deviation from mean values of 157 sex-matched healthy volunteers, ensuring reported differences were independent of known sex-dependencies. Patients were followed for the composite outcome of all-cause mortality, heart failure admission, or ventricular arrhythmia.A total of 747 patients were studied, 531 (71%) males. By Z-score values, females showed significantly higher left ventricular (LV) ejection fraction (EF; median difference 1 SD) and right ventricular (RV) EF (difference 0.6 SD) with greater LV mass (difference 2.1 SD; p-value<0.01 for all) versus males despite similar chamber volumes. Females had a significantly lower prevalence of mid-wall striae (MWS) fibrosis (23% versus 36%; p-value<0.001). Over a median follow-up of 4.7 years, 173 patients (23%) developed the composite outcome, with equal distribution in males and females. LV EF and MWS were significant independent predictors of the outcome (respective HR [95% CI] 0.97 [0.95-0.99] and 1.6 [1.2-2.3]; p-value=0.003 and 0.005). There was no association of sex with the outcome. CONCLUSIONS In a large contemporary cohort, NICM was uniquely expressed in females versus males. Despite similar chamber dilation, females demonstrated greater concentric remodelling, lower reductions in bi-ventricular function, and a lower burden of replacement fibrosis. Overall, their prognosis remained similar to male patients with NICM.
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Affiliation(s)
- Maggie Mallabone
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | | | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Richard B Thompson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - D Ian Paterson
- Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sam K Thompson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Fereshteh Hasanzadeh
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yuanchao Feng
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Melanie King
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Michael Bristow
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert Jh Miller
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M Fine
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Kim D, Collins JD, White JA, Hanneman K, Lee DC, Patel AR, Hu P, Litt H, Weinsaft JW, Davids R, Mukai K, Ng MY, Luetkens JA, Roguin A, Rochitte CE, Woodard PK, Manisty C, Zareba KM, Mont L, Bogun F, Ennis DB, Nazarian S, Webster G, Stojanovska J. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device. J Cardiovasc Magn Reson 2024; 26:100995. [PMID: 38219955 DOI: 10.1016/j.jocmr.2024.100995] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
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Affiliation(s)
- Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital and Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - Daniel C Lee
- Department of Medicine (Division of Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amit R Patel
- Cardiovascular Division, University of Virginia, Charlottesville, VA, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Division of Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Rachel Davids
- SHS AM NAM USA DI MR COLLAB ADV-APPS, Siemens Medical Solutions USA, Inc., Chicago, Il, USA
| | - Kanae Mukai
- Salinas Valley Memorial Healthcare System, Ryan Ranch Center for Advanced Diagnostic Imaging, Monterey, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and Faculty of Medicine. Technion - Israel Institute of Technology, Israel
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Webster
- Department of Pediatrics (Cardiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jadranka Stojanovska
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY, USA
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Kashyap N, Nikhanj A, Labib D, Prosia E, Rivest S, Flewitt J, Pfeffer G, Bakal JA, Siddiqi ZA, Coulden RA, Thompson R, White JA, Oudit GY. Prognostic Utility of Cardiovascular Magnetic Resonance-Based Phenotyping in Patients With Muscular Dystrophy. J Am Heart Assoc 2023; 12:e030229. [PMID: 37929714 PMCID: PMC10727409 DOI: 10.1161/jaha.123.030229] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Background The prognostic utility of cardiovascular magnetic resonance imaging, including strain analysis and tissue characterization, has not been comprehensively investigated in adult patients with muscular dystrophy. Methods and Results We prospectively enrolled 148 patients with dystrophinopathies (including heterozygotes), limb-girdle muscular dystrophy, and type 1 myotonic dystrophy (median age, 36.0 [interquartile range, 23.0-50.0] years; 51 [34.5%] women) over 7.7 years in addition to an age- and sex-matched healthy control cohort (n=50). Cardiovascular magnetic resonance markers, including 3-dimensional strain and fibrosis, were assessed for their respective association with major adverse cardiac events. Our results showed that markers of contractile performance were reduced across all muscular dystrophy groups. In particular, the dystrophinopathies cohort experienced reduced left ventricular (LV) ejection fraction and high burden of replacement fibrosis. Patients with type 1 myotonic dystrophy showed a 26.8% relative reduction in LV mass with corresponding reduction in chamber volumes. Eighty-two major adverse cardiac events occurred over a median follow-up of 5.2 years. Although LV ejection fraction was significantly associated with major adverse cardiac events (adjusted hazard ratio [aHR], 3.0 [95% CI, 1.4-6.4]) after adjusting for covariates, peak 3-dimensional strain amplitude demonstrated greater predictive value (minimum principal amplitude: aHR, 5.5 [95% CI, 2.5-11.9]; maximum principal amplitude: aHR, 3.3 [95% CI, 1.6-6.8]; circumferential amplitude: aHR, 3.4 [95% CI, 1.6-7.2]; longitudinal amplitude: aHR, 3.4 [95% CI, 1.7-6.9]; and radial strain amplitude: aHR, 3.0 [95% CI, 1.4-6.1]). Minimum principal strain yielded incremental prognostic value beyond LV ejection fraction for association with major adverse cardiac events (change in χ2=13.8; P<0.001). Conclusions Cardiac dysfunction is observed across all muscular dystrophy subtypes; however, the subtypes demonstrate distinct phenotypic profiles. Myocardial deformation analysis highlights unique markers of principal strain that improve risk assessment over other strain markers, LV ejection fraction, and late gadolinium enhancement in this vulnerable patient population.
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Affiliation(s)
- Niharika Kashyap
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
| | - Anish Nikhanj
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
| | - Dina Labib
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Easter Prosia
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Sandra Rivest
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Jacqueline Flewitt
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Gerald Pfeffer
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain Institute, University of CalgaryCalgaryAlbertaCanada
| | - Jeffrey A. Bakal
- Alberta Strategy for Patient Oriented Research UnitUniversity of CalgaryCalgaryAlbertaCanada
- Provincial Research Data ServicesUniversity of AlbertaEdmontonAlbertaCanada
| | - Zaeem A. Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Richard A. Coulden
- Department of Radiology and Diagnostic ImagingUniversity of Alberta HospitalEdmontonAlbertaCanada
| | - Richard Thompson
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
| | - James A. White
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Gavin Y. Oudit
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
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Ballantyne BA, Vandenberk B, Dykstra S, Labib D, Chew DS, Lydell C, Howarth A, Heydari B, Fine N, Howlett J, White JA, Miller R. Patients with non-ischemic cardiomyopathy and mid-wall striae have similar arrhythmic outcomes as ischemic cardiomyopathy. Int J Cardiovasc Imaging 2023; 39:2005-2014. [PMID: 37421578 DOI: 10.1007/s10554-023-02904-z] [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: 03/02/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE While implantable cardioverter-defibrillator (ICD) therapy provides clear benefit in patients with ischemic cardiomyopathy (ICM), this is less clear in patients with non-ischemic cardiomyopathy (NICM). Mid-wall striae (MWS) fibrosis is an established cardiovascular magnetic resonance (CMR) risk marker observed in patients with NICM. We evaluated whether patients with NICM and MWS have similar risk of arrhythmia-related cardiovascular events as patients with ICM. METHODS We studied a cohort of patients undergoing CMR. The presence of MWS was adjudicated by experienced physicians. The primary outcome was a composite of implantable cardioverter-defibrillator (ICD) implant, hospitalization for ventricular tachycardia, resuscitated cardiac arrest, or sudden cardiac death. Propensity-matched analysis was performed to compare outcomes for patients NICM with MWS and ICM. RESULTS A total of 1,732 patients were studied, 972 NICM (706 without MWS, 266 with MWS) and 760 ICM. NICM patients with MWS were more likely to experience the primary outcome versus those without MWS (unadjusted subdistribution hazard ratio (subHR) 2.26, 95% confidence interval [CI] 1.51-3.41) with no difference versus ICM patients (unadjusted subHR 1.32, 95% CI 0.93-1.86). Similar results were seen in a propensity-matched population (adjusted subHR 1.11, 95% CI 0.63-1.98, p = 0.711). CONCLUSION Patients with NICM and MWS demonstrate significantly higher arrhythmic risk compared to NICM without MWS. After adjustment, the arrhythmia risk of patients with NICM and MWS was similar to patients with ICM. Accordingly, physicians could consider the presence of MWS when making clinical decisions regarding arrhythmia risk management in patients with NICM.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bert Vandenberk
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen Lydell
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Andrew Howarth
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Bobak Heydari
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Nowell Fine
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Jonathan Howlett
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Robert Miller
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Averbuch T, White JA, Fine NM. Anderson-Fabry disease cardiomyopathy: an update on epidemiology, diagnostic approach, management and monitoring strategies. Front Cardiovasc Med 2023; 10:1152568. [PMID: 37332587 PMCID: PMC10272370 DOI: 10.3389/fcvm.2023.1152568] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by deficient activity of the enzyme alpha-galactosidase. While AFD is recognized as a progressive multi-system disorder, infiltrative cardiomyopathy causing a number of cardiovascular manifestations is recognized as an important complication of this disease. AFD affects both men and women, although the clinical presentation typically varies by sex, with men presenting at a younger age with more neurologic and renal phenotype and women developing a later onset variant with more cardiovascular manifestations. AFD is an important cause of increased myocardial wall thickness, and advances in imaging, in particular cardiac magnetic resonance imaging and T1 mapping techniques, have improved the ability to identify this disease non-invasively. Diagnosis is confirmed by the presence of low alpha-galactosidase activity and identification of a mutation in the GLA gene. Enzyme replacement therapy remains the mainstay of disease modifying therapy, with two formulations currently approved. In addition, newer treatments such as oral chaperone therapy are now available for select patients, with a number of other investigational therapies in development. The availability of these therapies has significantly improved outcomes for AFD patients. Improved survival and the availability of multiple agents has presented new clinical dilemmas regarding disease monitoring and surveillance using clinical, imaging and laboratory biomarkers, in addition to improved approaches to managing cardiovascular risk factors and AFD complications. This review will provide an update on clinical recognition and diagnostic approaches including differentiation from other causes of increased ventricular wall thickness, in addition to modern strategies for management and follow-up.
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Affiliation(s)
- Tauben Averbuch
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Center, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M. Fine
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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Heydari B, Satriano A, Jerosch-Herold M, Kolm P, Kim DY, Cheng K, Choi YL, Antiochos P, White JA, Mahmod M, Chan K, Raman B, Desai MY, Ho CY, Dolman SF, Desvigne-Nickens P, Maron MS, Friedrich MG, Schulz-Menger J, Piechnik SK, Appelbaum E, Weintraub WS, Neubauer S, Kramer CM, Kwong RY. 3-Dimensional Strain Analysis of Hypertrophic Cardiomyopathy: Insights From the NHLBI International HCM Registry. JACC Cardiovasc Imaging 2023; 16:478-491. [PMID: 36648040 PMCID: PMC10802851 DOI: 10.1016/j.jcmg.2022.10.005] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abnormal global longitudinal strain (GLS) has been independently associated with adverse cardiac outcomes in both obstructive and nonobstructive hypertrophic cardiomyopathy. OBJECTIVES The goal of this study was to understand predictors of abnormal GLS from baseline data from the National Heart, Lung, and Blood Institute (NHLBI) Hypertrophic Cardiomyopathy Registry (HCMR). METHODS The study evaluated comprehensive 3-dimensional left ventricular myocardial strain from cine cardiac magnetic resonance in 2,311 patients from HCMR using in-house validated feature-tracking software. These data were correlated with other imaging markers, serum biomarkers, and demographic variables. RESULTS Abnormal median GLS (> -11.0%) was associated with higher left ventricular (LV) mass index (93.8 ± 29.2 g/m2 vs 75.1 ± 19.7 g/m2; P < 0.0001) and maximal wall thickness (21.7 ± 5.2 mm vs 19.3 ± 4.1 mm; P < 0.0001), lower left (62% ± 9% vs 66% ± 7%; P < 0.0001) and right (68% ± 11% vs 69% ± 10%; P < 0.01) ventricular ejection fractions, lower left atrial emptying functions (P < 0.0001 for all), and higher presence and myocardial extent of late gadolinium enhancement (6 SD and visual quantification; P < 0.0001 for both). Elastic net regression showed that adjusted predictors of GLS included female sex, Black race, history of syncope, presence of systolic anterior motion of the mitral valve, reverse curvature and apical morphologies, LV ejection fraction, LV mass index, and both presence/extent of late gadolinium enhancement and baseline N-terminal pro-B-type natriuretic peptide and troponin levels. CONCLUSIONS Abnormal strain in hypertrophic cardiomyopathy is associated with other imaging and serum biomarkers of increased risk. Further follow-up of the HCMR cohort is needed to understand the independent relationship between LV strain and adverse cardiac outcomes in hypertrophic cardiomyopathy.
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | | | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James A White
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Chan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Martin S Maron
- Lahey Hospital & Medical Center, Boston, Massachusetts, USA
| | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Stefan Neubauer
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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9
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Hassan R, Miller RJH, Howlett JG, White JA, Fine NM. Prevalence, incidence and clinical outcomes of epicardial coronary artery disease among transthyretin amyloidosis cardiomyopathy patients. BMC Cardiovasc Disord 2023; 23:124. [PMID: 36890444 PMCID: PMC9996970 DOI: 10.1186/s12872-023-03140-y] [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: 07/07/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Transthyretin amyloidosis cardiomyopathy (ATTR-CM) patients are often older and may be at risk for obstructive epicardial coronary artery disease (oeCAD). While ATTR-CM may cause small vessel coronary disease, the prevalence and clinical significance of oeCAD is not well described. METHODS AND RESULTS The prevalence and incidence of oeCAD and its association with all-cause mortality and hospitalization among 133 ATTR-CM patients with ≥ 1-year follow-up was evaluated. The mean age was 78 ± 9 years, 119 (89%) were male, 116 (87%) had wild-type and 17 (13%) had hereditary subtypes. Seventy-two (54%) patients underwent oeCAD investigations, with 30 (42%) receiving a positive diagnosis. Among patients with a positive oeCAD diagnosis, 23 (77%) were diagnosed prior to ATTR-CM diagnosis, 6 (20%) at the time of ATTR-CM diagnosis, and 1 (3%) after ATTR-CM diagnosis. Baseline characteristics between patients with and without oeCAD were similar. Among patients with oeCAD, only 2 (7%) required additional investigations, intervention or hospitalization after ATTR-CM diagnosis. After a median follow-up of 27 months there were 37 (28%) deaths in the study population, including 5 patients with oeCAD (17%). Fifty-six (42%) patients in the study population required hospitalization, including 10 patients with oeCAD (33%). There was no significant difference in the rates of death or hospitalization among ATTR-CM patients with and without oeCAD, and oeCAD was not significantly associated with either outcome by univariable regression analysis. CONCLUSIONS While oeCAD is prevalent in ATTR-CM patients, this diagnosis is frequently known at time of ATTR-CM diagnosis and characteristics are similar to patients without oeCAD.
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Affiliation(s)
- Rana Hassan
- Division of Cardiology, Department of Cardiac Sciences, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary Alberta, T3M 1M4, Canada
| | - Robert J H Miller
- Division of Cardiology, Department of Cardiac Sciences, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary Alberta, T3M 1M4, Canada
| | - Jonathan G Howlett
- Division of Cardiology, Department of Cardiac Sciences, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary Alberta, T3M 1M4, Canada
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary Alberta, T3M 1M4, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary Alberta, T3M 1M4, Canada.
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10
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Schroth D, Garg R, Bocova X, Hansmann J, Haass M, Yan AT, Fernando C, Chacko BR, Oikonomou A, White JA, Alhussein MM, Giusca S, Ochs A, Korosoglou G, Friedrich MG, Ochs MM. PREDICTORS OF PERSISTENT SYMPTOMS AFTER MRNA SARS-COV-2 VACCINE-RELATED MYOCARDITIS (MYOVACC REGISTRY). J Am Coll Cardiol 2023. [PMCID: PMC9982916 DOI: 10.1016/s0735-1097(23)01823-5] [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: 03/06/2023]
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11
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Nabet E, Dykstra S, Islam S, Flewitt JA, Rivera S, Manoushagian S, Lydell C, Howarth AG, Marzo KP, Fine NM, White JA, Gaztanaga J. RESPECTIVE AND COMBINED CONTRIBUTIONS OF LEFT AND RIGHT VENTRICULAR FUNCTION FOR THE DEVELOPMENT OF HEART FAILURE SYMPTOMS AND RELEVANT CLINICAL OUTCOMES: A STUDY OF 10,082 PATIENTS FROM THE CIROC REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01824-7] [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: 03/06/2023]
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12
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Perera K, Kashyap N, Wang K, Omar F, Prosia E, Thompson RB, Paterson DI, Fine NM, White JA, Khan A, Oudit GY. Integrating Cardiac MRI Imaging and Multidisciplinary Clinical Care is Associated With Improved Outcomes in Patients With Fabry Disease. Curr Probl Cardiol 2023; 48:101476. [PMID: 36328338 DOI: 10.1016/j.cpcardiol.2022.101476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 01/04/2023]
Abstract
Given the inherent complexities of Fabry disease (FD) and evolving landscape of cardiovascular clinical management, there is no established ideal clinical care model for these patients. We identified clinical factors predictive of increased risk of major adverse cardiac events (MACE) in patients with FD targeted to improve clinical outcomes. Ninety-five patients studied over a median follow-up time of 6.3 years, and 26 patients reached the composite endpoint with a high prevalence of heart failure and cerebrovascular events and no cardiac-related mortality. Patients with MACE had worse health-related quality of life scores. Hypertrophy and presence of myocardial fibrosis increase risk of MACE by 4-5 times, and dyslipidemia increases risk of MACE by 3 times. Early Fabry-specific treatment and close monitoring of comorbidities reduce cardiac complications and mortality. These findings highlight the importance of comprehensive multidisciplinary management to help improve outcomes in FD patients.
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Affiliation(s)
- Kevin Perera
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Niharika Kashyap
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kaiming Wang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Fadya Omar
- School of Health and Public Safety, Southern Alberta Institute of Technology, Calgary, Alberta, Canada; Metabolics and Genetics in Canada (M.A.G.I.C.) Clinic Ltd., Calgary, Alberta, Canada
| | - Easter Prosia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - D Ian Paterson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nowell M Fine
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary Alberta, Canada
| | - Aneal Khan
- Metabolics and Genetics in Canada (M.A.G.I.C.) Clinic Ltd., Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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13
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Mustafa Alhussein M, Rabbani M, Sarak B, Dykstra S, Labib D, Flewitt J, Lydell CP, Howarth AG, Filipchuck N, Kealey A, Colbert J, Guron N, Kolman L, Merchant N, Bandali M, Bristow M, White JA. Natural History of Myocardial Injury After COVID-19 Vaccine-Associated Myocarditis. Can J Cardiol 2022; 38:1676-1683. [PMID: 35944800 PMCID: PMC9356639 DOI: 10.1016/j.cjca.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/11/2022] [Revised: 06/26/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication. METHODS Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured. RESULTS Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P < 0.015). Global LGE burden was reduced by 66% (P < 0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was < 5% of LV mass in 85% of cases. No patient experienced major clinical outcomes. CONCLUSIONS COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.
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Affiliation(s)
- Muhammad Mustafa Alhussein
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mohamad Rabbani
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bradley Sarak
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carmen P. Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil Filipchuck
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela Kealey
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jillian Colbert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nita Guron
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Murad Bandali
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Corresponding author: Dr James A. White, Stephenson Cardiac Imaging Centre, #0700, SSB, Foothills Medical Centre, 1403-29th St NW, Calgary, Alberta T2N 2T9, Canada. Tel.: +1-403-944-8806; fax: +1-403-944-8510
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14
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Roshankar G, White GC, Cadet S, Fine NM, Chan D, White JA, Jimenez-Zepeda V, Slomka PJ, Miller RJH. Quantitative technetium pyrophosphate and cardiovascular magnetic resonance in patients with suspected cardiac amyloidosis. J Nucl Cardiol 2022; 29:2679-2690. [PMID: 34604925 DOI: 10.1007/s12350-021-02806-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quantitation of myocardial 99m Tc-pyrophosphate activity may have high diagnostic accuracy, but its correlation with disease burden is unknown. We examined the relationship between 99m Tc-pyrophosphate quantitation and cardiac magnetic resonance (CMR) measures in patients with suspected transthyretin cardiac amyloidosis (ATTR-CM) or light chain cardiac amyloidosis (AL-CM). METHODS Consecutive patients who underwent 99mTc-pyrophosphate imaging and CMR were included. ATTR-CM and AL-CM were diagnosed using standard criteria. 99mTc-pyrophosphate images were assessed with standard parameters and quantified with cardiac pyrophosphate activity (CPA) and volume of involvement (VOI). We assessed the association between 99mTc-pyrophosphate image interpretation and CMR tissue characteristics. RESULTS Seventy patients were identified, mean age 70.4 ± 11.4 years, with ATTR-CM and AL-CM diagnosed in 22 (31%) and 11 (16%) patients, respectively. In patients with ATTR-CM, there were significant correlations between CPA (r2 = 0.509, P < 0.001) and VOI (r2 = 0.586, P < 0.001) with native myocardial T1 mapping values. Additionally, CPA (adjusted hazard ratio (aHR) 1.04, P = 0.016), VOI (aHR 1.12, P = 0.034), and average myocardial T1 (aHR 1.12, P = 0.025) were associated with incidence of heart failure hospitalization or death. CONCLUSION CPA and VOI were correlated with CMR measures of myocardial fibrosis in patients with ATTR-CM. 99mTc-pyrophosphate quantitation may have a role in ATTR-CM disease staging, guiding treatment, or following response to therapy.
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Affiliation(s)
- Golnaz Roshankar
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Geneva C White
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Sebastien Cadet
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nowell M Fine
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Denise Chan
- Department of Nuclear Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | | | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.
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15
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Dykstra S, Satriano A, Cornhill AK, Lei LY, Labib D, Mikami Y, Flewitt J, Rivest S, Sandonato R, Feuchter P, Howarth AG, Lydell CP, Fine NM, Exner DV, Morillo CA, Wilton SB, Gavrilova ML, White JA. Machine learning prediction of atrial fibrillation in cardiovascular patients using cardiac magnetic resonance and electronic health information. Front Cardiovasc Med 2022; 9:998558. [PMID: 36247426 PMCID: PMC9554748 DOI: 10.3389/fcvm.2022.998558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is a commonly encountered cardiac arrhythmia associated with morbidity and substantial healthcare costs. While patients with cardiovascular disease experience the greatest risk of new-onset AF, no risk model has been developed to predict AF occurrence in this population. We hypothesized that a patient-specific model could be delivered using cardiovascular magnetic resonance (CMR) disease phenotyping, contextual patient health information, and machine learning.MethodsNine thousand four hundred forty-eight patients referred for CMR imaging were enrolled and followed over a 5-year period. Seven thousand, six hundred thirty-nine had no prior history of AF and were eligible to train and validate machine learning algorithms. Random survival forests (RSFs) were used to predict new-onset AF and compared to Cox proportional-hazard (CPH) models. The best performing features were identified from 115 variables sourced from three data domains: (i) CMR-based disease phenotype, (ii) patient health questionnaire, and (iii) electronic health records. We evaluated discriminative performance of optimized models using C-index and time-dependent AUC (tAUC).ResultsA RSF-based model of 20 variables (CIROC-AF-20) delivered an overall C-index of 0.78 for the prediction of new-onset AF with respective tAUCs of 0.80, 0.79, and 0.78 at 1-, 2- and 3-years. This outperformed a novel CPH-based model and historic AF risk scores. At 1-year of follow-up, validation cohort patients classified as high-risk of future AF by CIROC-AF-20 went on to experience a 17.3% incidence of new-onset AF, being 24.7-fold higher risk than low risk patients.ConclusionsUsing phenotypic data available at time of CMR imaging we developed and validated the first described risk model for the prediction of new-onset AF in patients with cardiovascular disease. Complementary value was provided by variables from patient-reported measures of health and the electronic health record, illustrating the value of multi-domain phenotypic data for the prediction of AF.
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Affiliation(s)
- Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aidan K. Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lucy Y. Lei
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen P. Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M. Fine
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Derek V. Exner
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carlos A. Morillo
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B. Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - James A. White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- *Correspondence: James A. White
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16
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Rabbani M, Satriano A, Garcia J, Thompson S, Wu JN, Pejevic M, Anderson T, Dufour A, Phillips A, White JA. Limits of Cardiovascular Adaptation During an Extreme Ultramarathon: Insights From Serial Multidimensional, Multiparametric CMR. JACC Case Rep 2022; 4:1104-1109. [PMID: 36124158 PMCID: PMC9481903 DOI: 10.1016/j.jaccas.2022.05.028] [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] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Extreme endurance athletic challenges provide unique opportunities to study the cardiovascular system's capacity for structural, functional, and hemodynamic adaptation. The authors present a case of a male subject who ran 2,469 km, with serial multiparametric cardiac magnetic resonance imaging used to demonstrate adaptive and maladaptive alterations in cardiac remodeling and myocardial tissue health. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Mohamad Rabbani
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Alessandro Satriano
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Julio Garcia
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Skye Thompson
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Jian-Nong Wu
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Milada Pejevic
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Todd Anderson
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Antoine Dufour
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Aaron Phillips
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - James A. White
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
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Aliabadi S, Sojoudi A, Bandali MF, Bristow MS, Lydell C, Fedak PWM, White JA, Garcia J. Intra-cardiac pressure drop and flow distribution of bicuspid aortic valve disease in preserved ejection fraction. Front Cardiovasc Med 2022; 9:903277. [PMID: 36093173 PMCID: PMC9448951 DOI: 10.3389/fcvm.2022.903277] [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: 03/24/2022] [Accepted: 08/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Bicuspid aortic valve (BAV) is more than a congenital defect since it is accompanied by several secondary complications that intensify induced impairments. Hence, BAV patients need lifelong evaluations to prevent severe clinical sequelae. We applied 4D-flow magnetic resonance imaging (MRI) for in detail visualization and quantification of in vivo blood flow to verify the reliability of the left ventricular (LV) flow components and pressure drops in the silent BAV subjects with mild regurgitation and preserved ejection fraction (pEF). Materials and methods A total of 51 BAV patients with mild regurgitation and 24 healthy controls were recruited to undergo routine cardiac MRI followed by 4D-flow MRI using 3T MRI scanners. A dedicated 4D-flow module was utilized to pre-process and then analyze the LV flow components (direct flow, retained inflow, delayed ejection, and residual volume) and left-sided [left atrium (LA) and LV] local pressure drop. To elucidate significant diastolic dysfunction in our population, transmitral early and late diastolic 4D flow peak velocity (E-wave and A-wave, respectively), as well as E/A ratio variable, were acquired. Results The significant means differences of each LV flow component (global measurement) were not observed between the two groups (p > 0.05). In terms of pressure analysis (local measurement), maximum and mean as well as pressure at E-wave and A-wave timepoints at the mitral valve (MV) plane were significantly different between BAV and control groups (p: 0.005, p: 0.02, and p: 0.04 and p: <0.001; respectively). Furthermore, maximum pressure and pressure difference at the A-wave timepoint at left ventricle mid and left ventricle apex planes were significant. Although we could not find any correlation between LV diastolic function and flow components, Low but statistically significant correlations were observed with local pressure at LA mid, MV and LV apex planes at E-wave timepoint (R: −0.324, p: 0.005, R: −0.327, p: 0.004, and R: −0.306, p: 0.008, respectively). Conclusion In BAV patients with pEF, flow components analysis is not sensitive to differentiate BAV patients with mild regurgitation and healthy control because flow components and EF are global parameters. Inversely, pressure (local measurement) can be a more reliable biomarker to reveal the early stage of diastolic dysfunction.
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Yakimenka A, Labib D, Dykstra S, Mikami Y, Satriano A, Flewitt J, Feuchter P, Rivest S, Howarth AG, Lydell CP, Quinn FR, Wilton SB, White JA. Influence of Sex-Based Differences in Cardiac Phenotype on Atrial Fibrillation Recurrence in Patients Undergoing Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:894592. [PMID: 35966521 PMCID: PMC9366168 DOI: 10.3389/fcvm.2022.894592] [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: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPulmonary vein isolation (PVI) is a commonly engaged therapy for symptomatic atrial fibrillation (AF). Prior studies have documented elevated AF recurrence rates among females vs. males. Sex-specific mechanisms underlying this phenomenon are poorly understood. This prospective cohort study aimed to evaluate the sex-based differences in cardiac phenotype and their influence on (AF) recurrence following first-time PVI.MethodsA total of 204 consecutive patients referred for first-time PVI and 101 healthy subjects were prospectively studied by cardiovascular magnetic resonance (CMR) imaging. Multi-chamber volumetric and functional measures were assessed by sex-corrected Z-score analyses vs. healthy subjects. Patients were followed for a median of 2.6 years for the primary outcome of clinical AF recurrence. Multivariable analyses adjusting for age and comorbidities were performed to identify independent predictors of AF recurrence.ResultsAF recurrence following first PVI occurred in 41% of males and 59% of females (p = 0.03). Females were older with higher prevalence of hypertension and thyroid disorders. Z-score-based analyses revealed significantly reduced ventricular volumes, greater left atrial (LA) volumes, and reduced LA contractility in females vs. males. Multivariable analysis revealed each of LA minimum and pre-systolic volumes and booster EF Z-scores to be independently associated with AF recurrence, providing respective hazard ratios of 1.10, 1.19, and 0.89 (p = 0.001, 0.03, and 0.01).ConclusionAmong patients referred for first time PVI, females were older and demonstrated significantly poorer LA contractile health vs. males, the latter independently associated with AF recurrence. Assessment of LA contractile health may therefore be of value to identify female patients at elevated risk of AF recurrence. Factors influencing female patient referral for PVI at more advanced stages of atrial disease warrant focused investigation.
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Affiliation(s)
- Alena Yakimenka
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen P. Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - F. Russell Quinn
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B. Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- *Correspondence: James A. White,
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Khayambashi S, Elzinga K, Hahn C, Chhibber S, Mahe E, Miller RJH, White JA, Howlett JG, Jimenez-Zepeda V, Fine NM. Amyloidosis Tissue Confirmation for Tafamidis Eligibility Using Transverse Carpal Ligament and Tenosynovium Biopsy. Can J Cardiol 2022; 38:1643-1646. [PMID: 35752424 DOI: 10.1016/j.cjca.2022.06.012] [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: 02/11/2022] [Revised: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022] Open
Abstract
In most Canadian provinces, eligibility criteria for public reimbursement coverage for tafamidis for treatment of transthyretin amyloidosis cardiomyopathy (ATTR-CM) include tissue biopsy confirmation of amyloidosis. Carpal tunnel syndrome requiring surgical release is common in ATTR-CM. We report our experience performing simultaneous transverse carpal ligament and tenosynovium biopsy during CTR, with all patients positive for amyloidosis, facilitating initiation of tafamidis.
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Affiliation(s)
- Shahin Khayambashi
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kate Elzinga
- Division of Plastic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Hahn
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sameer Chhibber
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Etienne Mahe
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert J H Miller
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan G Howlett
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Victor Jimenez-Zepeda
- Division of Hematology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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20
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Cornhill AK, Dykstra S, Satriano A, Labib D, Mikami Y, Flewitt J, Prosio E, Rivest S, Sandonato R, Howarth AG, Lydell C, Eastwood CA, Quan H, Fine N, Lee J, White JA. Machine Learning Patient-Specific Prediction of Heart Failure Hospitalization Using Cardiac MRI-Based Phenotype and Electronic Health Information. Front Cardiovasc Med 2022; 9:890904. [PMID: 35783851 PMCID: PMC9245012 DOI: 10.3389/fcvm.2022.890904] [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: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart failure (HF) hospitalization is a dominant contributor of morbidity and healthcare expenditures in patients with systolic HF. Cardiovascular magnetic resonance (CMR) imaging is increasingly employed for the evaluation of HF given capacity to provide highly reproducible phenotypic markers of disease. The combined value of CMR phenotypic markers and patient health information to deliver predictions of future HF events has not been explored. We sought to develop and validate a novel risk model for the patient-specific prediction of time to HF hospitalization using routinely reported CMR variables, patient-reported health status, and electronic health information.MethodsStandardized data capture was performed for 1,775 consecutive patients with chronic systolic HF referred for CMR imaging. Patient demographics, symptoms, Health-related Quality of Life, pharmacy, and routinely reported CMR features were provided to both machine learning (ML) and competing risk Fine-Gray-based models (FGM) for the prediction of time to HF hospitalization.ResultsThe mean age was 59 years with a mean LVEF of 36 ± 11%. The population was evenly distributed between ischemic (52%) and idiopathic non-ischemic cardiomyopathy (48%). Over a median follow-up of 2.79 years (IQR: 1.59–4.04) 333 patients (19%) experienced HF related hospitalization. Both ML and competing risk FGM based models achieved robust performance for the prediction of time to HF hospitalization. Respective 90-day, 1 and 2-year AUC values were 0.87, 0.83, and 0.80 for the ML model, and 0.89, 0.84, and 0.80 for the competing risk FGM-based model in a holdout validation cohort. Patients classified as high-risk by the ML model experienced a 34-fold higher occurrence of HF hospitalization at 90 days vs. the low-risk group.ConclusionIn this study we demonstrated capacity for routinely reported CMR phenotypic markers and patient health information to be combined for the delivery of patient-specific predictions of time to HF hospitalization. This work supports an evolving migration toward multi-domain data collection for the delivery of personalized risk prediction at time of diagnostic imaging.
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Affiliation(s)
- Aidan K. Cornhill
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Easter Prosio
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Carmen Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Cathy A. Eastwood
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- *Correspondence: James A. White,
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Chow K, Hayes G, Flewitt JA, Feuchter P, Lydell C, Howarth A, Pagano JJ, Thompson RB, Kellman P, White JA. Improved accuracy and precision with three-parameter simultaneous myocardial T 1 and T 2 mapping using multiparametric SASHA. Magn Reson Med 2022; 87:2775-2791. [PMID: 35133018 DOI: 10.1002/mrm.29170] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/03/2021] [Revised: 11/21/2021] [Accepted: 01/05/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE To develop and validate a three-parameter model for improved precision multiparametric SAturation-recovery single-SHot Acquisition (mSASHA) cardiac T1 and T2 mapping with high accuracy in a single breath-hold. METHODS The mSASHA acquisition consists of nine images of variable saturation recovery and T2 preparation in 11 heartbeats with T1 and T2 values calculated using a three-parameter model. It was validated in simulations and phantoms at 3 T with comparison to a four-parameter joint T1 -T2 technique. The mSASHA acquisition was compared with MOLLI, SASHA, and T2 -prepared balanced SSFP in 10 volunteers. RESULTS The mSASHA technique had high accuracy in phantoms compared to spin echo, with -0.2 ± 0.3% T1 error and -2.4 ± 1.3% T2 error. The mSASHA coefficient of variation in phantoms for T1 was similar to MOLLI (0.7 ± 0.2% for both) and T2 -prepared balanced SSFP for T2 (1.3 ± 0.7% vs 1.4 ± 0.3%, adjusted p > .05 for both). In simulations, three-parameter mSASHA had higher precision than four-parameter joint T1 -T2 for both T1 and T2 (46% and 11% reductions in T1 and T2 interquartile range for native myocardium). In vivo myocardial mSASHA T1 was similar to SASHA (1523 ± 18 ms vs 1520 ± 18 ms) with similar coefficient of variation to both MOLLI and SASHA (3.3 ± 0.6% vs 3.1 ± 0.6% and 3.3 ± 0.5% respectively, adjusted p > .05 for all). Myocardial mSASHA T2 was 37.1 ± 1.1 ms with similar precision to T2 -prepared balanced SSFP (6.7 ± 1.7% vs 6.0 ± 1.6%, adjusted p > .05). CONCLUSION Three-parameter mSASHA provides high-accuracy cardiac T1 and T2 quantification in a single breath-hold with similar precision to MOLLI and T2 -prepared balanced SSFP. Further study is required to both establish normative values and demonstrate clinical utility in patient populations.
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Affiliation(s)
- Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Genevieve Hayes
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline A Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Carmen Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Joseph J Pagano
- Division of Pediatric Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James A White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
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Geeraert P, Jamalidinan F, Burns F, Jarvis K, Bristow MS, Lydell C, Hidalgo Tobon SS, de Celis Alonso B, Fedak PWM, White JA, Garcia J. Hemodynamic Assessment in Bicuspid Aortic Valve Disease and Aortic Dilation: New Insights From Voxel-By-Voxel Analysis of Reverse Flow, Stasis, and Energetics. Front Bioeng Biotechnol 2022; 9:725113. [PMID: 35096784 PMCID: PMC8793887 DOI: 10.3389/fbioe.2021.725113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/27/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives: Clinical management decisions surrounding ascending aorta (AAo) dilation in bicuspid aortic valve (BAV) disease benefit from personalized predictive tools. 4D-flow MRI may provide patient-specific markers reflective of BAV-associated aortopathy. This study aims to explore novel 4D-flow MRI parametric voxel-by-voxel forward flow, reverse flow, kinetic energy and stasis in BAV disease. We hypothesize that novel parametric voxel-by-voxel markers will be associated with aortic dilation and referral for surgery and can enhance our understanding of BAV hemodynamics beyond standard metrics. Methods: A total of 96 subjects (73 BAV patients, 23 healthy controls) underwent MRI scan. Healthy controls had no known cardiovascular disease. Patients were clinically referred for AAo dilation assessment. Indexed diameters were obtained by dividing the aortic diameter by the patient’s body surface area. Patients were followed for the occurrence of aortic surgery. 4D-flow analysis was performed by a single observer in five regions: left ventricular outflow tract (LVOT), AAo, arch, proximal descending aorta (PDAo), and distal descending aorta (DDAo). In each region peak velocity, kinetic energy (KE), forward flow (FF), reverse flow (RF), and stasis were measured on a voxel-by-voxel basis. T-tests (or non-parametric equivalent) compared flow parameters between cohorts. Univariate and multivariate analyses explored associations between diameter and parametric voxel-by-voxel parameters. Results: Compared to controls, BAV patients showed reduced stasis (p < 0.01) and increased RF and FF (p < 0.01) throughout the aorta, and KE remained similar. In the AAo, indexed diameter correlated with age (R = 0.326, p = 0.01), FF (R = −0.648, p < 0.001), RF (R = −0.441, p < 0.001), and stasis (R = −0.288, p < 0.05). In multivariate analysis, FF showed a significant inverse association with AAo indexed diameter, independent of age. During a median 179 ± 180 days of follow-up, 23 patients (32%) required aortic surgery. Compared to patients not requiring surgery, they showed increased KE and peak velocity in the proximal aorta (p < 0.01), accompanied by increased RF and reduced stasis throughout the entire aorta (p < 0.01). Conclusion: Novel voxel-by-voxel reverse flow and stasis were altered in BAV patients and are associated with aortic dilation and surgical treatment.
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Affiliation(s)
- Patrick Geeraert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Fatemehsadat Jamalidinan
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Fiona Burns
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Michael S. Bristow
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Carmen Lydell
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | | | - Benito de Celis Alonso
- Faculty of Mathematical and Physical Sciences, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico
| | - Paul W. M. Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - James A. White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- *Correspondence: Julio Garcia,
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Pandya A, Yu YJ, Ge Y, Nagel E, Kwong RY, Bakar RA, Grizzard JD, Merkler AE, Ntusi N, Petersen SE, Rashedi N, Schwitter J, Selvanayagam JB, White JA, Carr J, Raman SV, Simonetti OP, Bucciarelli-Ducci C, Sierra-Galan LM, Ferrari VA, Bhatia M, Kelle S. Evidence-based cardiovascular magnetic resonance cost-effectiveness calculator for the detection of significant coronary artery disease. J Cardiovasc Magn Reson 2022; 24:1. [PMID: 34986851 PMCID: PMC8734365 DOI: 10.1186/s12968-021-00833-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs. METHODS We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR Cost-Effectiveness Calculator) based on a larger CMR cost-effectiveness simulation model that can approximate CMR lifetime discount cost, QALY, and cost effectiveness compared to relevant comparators [such as single-photon emission computed tomography (SPECT), coronary computed tomography angiography (CCTA)] or invasive coronary angiography. RESULTS CMR was cost-effective for evaluation of significant CAD (either health-improving and cost saving or having a cost-per-QALY or cost-per-life-year result lower than the cost-effectiveness threshold) versus its relevant comparator in 10 out of 15 studies, with 3 studies reporting uncertain cost effectiveness, and 2 studies showing CCTA was optimal. Our cost-effectiveness calculator showed that CCTA was not cost-effective in the US compared to CMR when the most recent publications on imaging performance were included in the model. CONCLUSIONS Based on current world-wide evidence in the literature, CMR usually represents a cost-effective option compared to relevant comparators to assess for significant CAD.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA.
| | - Yuan-Jui Yu
- National Taiwan University Hospital, Taipei, Taiwan
| | - Yin Ge
- Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, Partner Site RheinMain, University Hospital Frankfurt/Main, Frankfurt am Main, Germany
| | - Raymond Y Kwong
- Cardiovascular Division of the Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rafidah Abu Bakar
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University Medical Center, Main Hospital, Richmond, VA, USA
| | - Alexander E Merkler
- Department of Neurology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Nina Rashedi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juerg Schwitter
- Division of Cardiology, Cardiovascular Department, CMR Center University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, UniL, Lausanne, Switzerland
| | - Joseph B Selvanayagam
- Department of Medicine, School of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Orlando P Simonetti
- Departments of Internal Medicine and Radiology, The Ohio State University, Columbus, OH, USA
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals and School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Lilia M Sierra-Galan
- Cardiovascular Division, Department of Cardiology, American British Cowdray Medical Center, Mexico City, Mexico
| | - Victor A Ferrari
- Cardiovascular Division and Penn Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
- Department of Internal Medicine and Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, German Heart Institute Berlin (DHZB), Berlin, Germany
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González-Ayala J, Calvo Hernández A, White JA, Medina A, Roco JMM, Velasco S. Success versus failure: Efficient heat devices in thermodynamics. Phys Rev E 2022; 105:014115. [PMID: 35193266 DOI: 10.1103/physreve.105.014115] [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: 09/28/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Classical equilibrium thermodynamics provides, in a general way, upper Carnot bounds for the performance of energy converters. Nevertheless, to suggest lower bounds is a much more subtle issue, especially when they are related to a definition of convenience. Here, this issue is investigated in a unified way for heat engines, refrigerators, and heat pumps. First, irreversibilities are weighted in the context of heat reservoir stability for irreversible engines by using the thermodynamic distance between minimum energy and maximum entropy steady states. Some stability coefficients can be related to a majorization process and the obtention of Pareto fronts, linking stability and optimization by means of efficiency and entropy due to correlations between system and reservoirs. Second, these findings are interpreted in a very simple context. A region where the heat device is efficient is defined in a general scheme and, below this zone, the heat device is inefficient in the sense that irreversibilities somehow dominate its behavior. These findings allow for a clearer understanding of the role played by some well-known figures of merit in the scope of finite-time and -size optimization. Comparison with experimental results is provided.
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Affiliation(s)
- J González-Ayala
- Departamento de Física Aplicada and Instituto Universitario de Física y Matemáticas (IUFFYM), Universidad de Salamanca, 37008 Salamanca, Spain
| | - A Calvo Hernández
- Departamento de Física Aplicada and Instituto Universitario de Física y Matemáticas (IUFFYM), Universidad de Salamanca, 37008 Salamanca, Spain
| | - J A White
- Departamento de Física Aplicada and Instituto Universitario de Física y Matemáticas (IUFFYM), Universidad de Salamanca, 37008 Salamanca, Spain
| | - A Medina
- Departamento de Física Aplicada and Instituto Universitario de Física y Matemáticas (IUFFYM), Universidad de Salamanca, 37008 Salamanca, Spain
| | - J M M Roco
- Departamento de Física Aplicada and Instituto Universitario de Física y Matemáticas (IUFFYM), Universidad de Salamanca, 37008 Salamanca, Spain
| | - S Velasco
- Departamento de Física Aplicada and Instituto Universitario de Física y Matemáticas (IUFFYM), Universidad de Salamanca, 37008 Salamanca, Spain
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Kim H, Sheitt H, Wilton SB, White JA, Garcia J. Left Ventricular Flow Distribution as a Novel Flow Biomarker in Atrial Fibrillation. Front Bioeng Biotechnol 2021; 9:725121. [PMID: 34900953 PMCID: PMC8657405 DOI: 10.3389/fbioe.2021.725121] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Four-dimensional (4-D) flow cardiac magnetic resonance imaging can be used to elegantly describe the hemodynamic efficiency of left ventricular (LV) flow throughout the cardiac cycle. Patients with nonvalvular paroxysmal atrial fibrillation (PAF) may have occult LV disease. Flow distribution analysis, based on 4-D flow, may unmask the presence of LV disease by assessing flow components: direct flow, retained flow, delayed ejection, and residual volume. This study aimed to identify LV hemodynamic inefficiencies in patients with PAF and normal systolic function. We hypothesized that the fraction of direct flow to the total end-diastolic volume would be reduced in patients with PAF compared with controls. Methods: We used 4-D LV flow component analysis to compare hemodynamics in 30 healthy controls and 50 PAF patients in sinus rhythm. Results: PAF subjects and healthy controls had similar LV mass, volume, and ejection fraction. Direct flow was lower in the PAF group than in the controls (44.5 ± 11.2% vs. 50.0 ± 12.2%, p = 0.042) while delayed ejection was higher in the PAF group (21.6 ± 5.6% vs. 18.6 ± 5.7%, p = 0.022). Conclusion: PAF patients demonstrated a relative reduction in direct flow and elevation in delayed ejection.
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Affiliation(s)
- Hansuk Kim
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.,Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, AB, Calgary, Canada
| | - Hana Sheitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, AB, Calgary, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute, University of Calgary, AB, Calgary, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Julio Garcia
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, AB, Calgary, Canada.,Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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26
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Chew DS, Manga S, Roberts A, Sumner GL, Kavanagh KM, Howarth AG, Lydell C, White JA, Cowan K, Rowlandson G, Xue J, Exner DV. A Novel High-Resolution Surface Electrocardiographic Method to Identify and Characterize Myocardial Scar: A Proof-of-Concept Study. CJC Open 2021; 3:1207-1213. [PMID: 34888504 PMCID: PMC8636230 DOI: 10.1016/j.cjco.2021.05.010] [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: 01/09/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background The placement of the left ventricular (LV) lead in an area free of myocardial scar is an important determinant of cardiac resynchronization therapy response. We sought to develop and validate a simple, practical, and novel electrocardiographic (ECG)-based approach to intraoperatively identify the presence of LV scar. We hypothesized that there would be a reduction in the measured amplitude of the LV pacing stimulus on the skin surface using a high-resolution (HR) ECG when pacing from LV regions with scar compared with regions without scar. We term this the ECG Amplitude Signal Evaluation (EASE) method. Methods Consecutive patients with ischemic LV systolic dysfunction and standard criteria for de novo cardiac resynchronization therapy implantation were prospectively enrolled. All underwent a preimplant contrast-enhanced cardiac magnetic resonance study to assess for scar. The average amplitude of the LV pacing impulse was sampled on HR surface ECG intraprocedurally and then compared with the cardiac magnetic resonance results. Results A total of 38 LV pacing sites were assessed among 13 recipients. The median voltage measured on the surface HR ECG in regions with scar was reduced by 41% (interquartile range, 17% to 63%), whereas there was no measurable change in voltage (interquartile range, 0 to 0%) in regions without scar compared with the maximal amplitude (Wilcoxon P < 0.0001). Conclusion The EASE method appears to be of potential value as a novel intraoperative tool to guide LV lead placement to regions free of scar. Future work is required to validate the utility of this method in a larger patient cohort.
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Affiliation(s)
- Derek S Chew
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Sharita Manga
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Roberts
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Glen L Sumner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Katherine M Kavanagh
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G Howarth
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Carmen Lydell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Karen Cowan
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | - Joel Xue
- GE Healthcare, Milwaukee, Wisconsin, USA
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Labib D, Dykstra S, Satriano A, Mikami Y, Prosia E, Flewitt J, Howarth AG, Lydell CP, Kolman L, Paterson DI, Oudit GY, Pituskin E, Cheung WY, Lee J, White JA. Prevalence and predictors of right ventricular dysfunction in cancer patients treated with cardiotoxic chemotherapy – a prospective cardiovascular magnetic resonance study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2878] [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
Background
Right ventricular (RV) function has an established incremental prognostic value in cardiomyopathy. Studies on cancer therapeutics-related cardiac dysfunction (CTRCD) primarily focused on the left ventricle (LV), with conflicting results from small studies dedicated to RV dysfunction.
Purpose
We sought to investigate the influence of chemotherapy on RV function relative to LV function using serial cardiac magnetic resonance (CMR).
Methods
Patients were enrolled as part of Cardiotoxicity Prevention Research Initiative (CAPRI) Registry aimed at evaluating CMR-based markers for surveillance of CTRCD. Patients underwent non-contrast CMR imaging prior to initiation of anthracyclines and/or trastuzumab and serially every 3 months during the first year, then annually thereafter. We included patients who had a baseline and ≥1 follow-up scan and excluded those with baseline LV ejection fraction (EF)<50%, providing 320 patients completing 1,453 CMR studies. Cine images were analysed to calculate chamber volumes indexed to body surface area and EF. We defined LV CTRCD using CMR modality specific criteria of a drop in LV EF ≥5% from baseline to <57%; RV CTRCD as a drop ≥5% to <49% in females and <47% in males. We used linear mixed models to study the changes in ventricular volumes and EF with time.
Results
The majority of patients were females (80%), had breast cancer (68%) or lymphoma (32%), with a mean age of 52.7±13 years. Figure 1 shows temporal changes in mean ventricular volumes and function over the first year. Mean changes in RV function followed those of the LV, with the nadir of EF and maximum of volumes occurring at 6 months. Respective values for mean decrease in LV and RV EF at this time point versus baseline were 4.1 and 2.9% (p<0.001). Concomitant mean increase in indexed RV end-diastolic (ED) and end-systolic (ES) volumes were 1.6 and 2.7 ml/m2 (p=0.2 and <0.001). There was significant interaction of chemotherapy regimen with time for RV volumes (p=0.001 and 0.003), but not RV EF (p=0.7), with worst changes occurring with combined anthracyclines and trastuzumab. In all, 70 (22%) and 28 (9%) patients met criteria for LV and RV CTRCD, respectively. Among those who developed RV CTRCD, 10 had persistently normal LV function. Figure 2 shows the results of logistic regression to predict RV CTRCD. Significant univariable predictors included combined chemotherapy regimen and baseline LV and RV volumes and LV EF. Adjusting for age, sex, and chemotherapy regimen, baseline RV ED volume remained associated with RV CTRCD (odds ratio 1.6; p=0.005).
Conclusion
In this large study, RV volumes and function were similarly influenced by chemotherapy versus comparable LV-based measures. Using similar threshold criteria, the incidence of RV CTRCD was lower than for LV CTRCD; however, one third of those who develop RV CTRCD showed normal LV function. Future studies are warranted to study the prognostic influence of RV injury in cancer patients.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Alberta InnovatesGenome Alberta Figure 1. Temporal changes in LV & RV functionFigure 2. Predictors of RV CTRCD
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Affiliation(s)
- D Labib
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - S Dykstra
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - A Satriano
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - Y Mikami
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - E Prosia
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - J Flewitt
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - A G Howarth
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - C P Lydell
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - L Kolman
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - D I Paterson
- University of Alberta, Department of Medicine, Edmonton, Canada
| | - G Y Oudit
- University of Alberta, Department of Medicine, Edmonton, Canada
| | - E Pituskin
- University of Alberta, Department of Oncology, Edmonton, Canada
| | - W Y Cheung
- University of Calgary, Department of Oncology, Calgary, Canada
| | - J Lee
- University of Calgary, Departments of Community Health Sciences & Cardiac Sciences, Calgary, Canada
| | - J A White
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
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Xu L, Pagano J, Chow K, Oudit GY, Haykowsky MJ, Mikami Y, Howarth AG, White JA, Howlett JG, Dyck JRB, Anderson TJ, Ezekowitz JA, Thompson RB, Paterson DI. Cardiac remodelling predicts outcome in patients with chronic heart failure. ESC Heart Fail 2021; 8:5352-5362. [PMID: 34569184 PMCID: PMC8712825 DOI: 10.1002/ehf2.13626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023] Open
Abstract
Aims Surveillance imaging is often used to detect remodelling, a change in cardiac geometry, and/or function; however, there are limited data in patients with chronic heart failure (HF). We sought to characterize cardiac remodelling in patients with chronic HF and evaluate its association with outcome. Methods and results A prospective cohort of patients at risk for HF or with chronic HF underwent cardiac magnetic resonance (CMR) at baseline and 1 year. Ventricular function, volumes, mass, left atrial volume, global longitudinal strain, and myocardial scar were measured. The primary outcome was a composite of death or cardiovascular hospitalization up to 5 years from the 1 year scan. Cox regression was used to identify 1 year CMR predictors of outcome after adjusting for baseline risk. A total of 262 patients (median age 68 years, 57% males) including 96 at risk for HF, 97 with HF and preserved ejection fraction, and 69 with HF and reduced ejection fraction were included. In the patients with HF, 55 events were identified during follow‐up. After adjustment for baseline clinical risk, Cox proportion hazard regressions only identified 1 year change in left ventricular (LV) mass index as a CMR predictor of outcome, adjusted hazard ratio 1.21 (1.02, 1.44) per 10% increase, P = 0.031. Cardiac remodelling defined as a 1 year change in LV mass index ≥15% was observed in 35% of patients with HF. Patients with adverse remodelling of LV mass index had more events on Kaplan–Meier analyses compared to those with no remodelling, log‐rank P = 0.004 for overall cohort, P = 0.035 for heart failure with preserved ejection fraction and P = 0.035 for heart failure and reduced ejection fraction. Conclusions Cardiac remodelling is common during serial CMR assessment of patients with chronic HF. Change in LV mass predicted long‐term outcomes whereas change in left ventricular ejection fraction did not.
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Affiliation(s)
- Lingyu Xu
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Pagano
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yoko Mikami
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G Howarth
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan G Howlett
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jason R B Dyck
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Todd J Anderson
- Libin Cardiovascular Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - D Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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29
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Putko BN, Savu A, Kaul P, Ezekowitz J, Dyck JR, Anderson TJ, White JA, Paterson DI, Thompson RB, Oudit GY. Left atrial remodelling, mid-regional pro-atrial natriuretic peptide, and prognosis across a range of ejection fractions in heart failure. Eur Heart J Cardiovasc Imaging 2021; 22:220-228. [PMID: 32356860 DOI: 10.1093/ehjci/jeaa041] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/19/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS Measures of structural and functional remodelling of the left atrium (LA) are emerging as useful biomarkers in heart failure (HF). We hypothesized that LA volume and its contribution to stroke volume (SV) would predict a composite endpoint of HF hospitalization or death in patients with HF. METHODS AND RESULTS We recruited 57 controls and 86 patients with HF, including preserved and reduced left ventricular ejection fraction (LVEF). Cardiac magnetic resonance imaging was used to evaluate LA volumes and contribution to LV SV. Plasma mid-region pro-atrial natriuretic peptide (MR-proANP) was evaluated. LA volume was negatively correlated with LVEF (P = 0.001) and positively correlated with LV mass in HFrEF (P < 0.001) but not in HFpEF. LA volume at end-diastole was associated with the composite endpoint in HFrEF (hazard ratio 1.26, 95% confidence interval 1.01-1.54; P = 0.044), but not HFpEF (1.06, 0.85-1.30; P = 0.612), per 10 mL/m increase. Active contribution to SV was negatively associated with the composite endpoint in HFpEF (0.32, 0.14-0.66; P = 0.001), but not HFrEF (0.91, 0.38-2.1; P = 0.828) per 10% increase. MR-proANP was associated with the composite endpoint in HFpEF (1.46, 1.03-1.94; P = 0.034), but not in HFrEF (1.14, 0.88-1.37; P = 0.278), per 100 pM increase. CONCLUSION We found different relationships between LA remodelling and biomarkers in HFrEF and HFpEF. Our results support the hypothesis that the pathophysiologic underpinnings of HFpEF and HFrEF are different, and atrial remodelling encompasses distinct components for each HF subtype.
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Affiliation(s)
- Brendan N Putko
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Anamaria Savu
- Canadian VIGOUR Centre, University of Alberta, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Padma Kaul
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada.,Canadian VIGOUR Centre, University of Alberta, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Justin Ezekowitz
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada.,Canadian VIGOUR Centre, University of Alberta, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Jason R Dyck
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9
| | - James A White
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 1403-29 Street NW, Calgary, AB, Canada, T2N 2T9
| | - D Ian Paterson
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street NW, Edmonton, Alberta, T6G 2V2, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, 2C2 Walter C Mackenzie Health Sciences Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2R7, Canada.,Department of Physiology, University of Alberta, 7-55 Medical Sciences Building, 8613-114 Street NW, Edmonton, Alberta, T6G 2H7, Canada
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30
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Geeraert P, Jamalidinan F, Fatehi Hassanabad A, Sojoudi A, Bristow M, Lydell C, Fedak PW, White JA, Garcia J. Bicuspid aortic valve disease is associated with abnormal wall shear stress, viscous energy loss, and pressure drop within the ascending thoracic aorta: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26518. [PMID: 34190185 PMCID: PMC8257908 DOI: 10.1097/md.0000000000026518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 06/10/2021] [Indexed: 01/15/2023] Open
Abstract
Bicuspid aortic valve (BAV) disease has significant gaps in its clinical management practices. To highlight the potential utility of advanced hemodynamic biomarkers in strengthening BAV assessment, we used 4-dimentional flow magnetic resonance imaging to investigate altered hemodynamics in the ascending aorta (AAo).A total of 32 healthy controls and 53 age-matched BAV patients underwent cardiac magnetic resonance imaging at 3T, with cine imaging and 4D-flow. Analysis planes were placed along 3D-segmented aortas at the left ventricular outflow tract (LVOT), sinuses of Valsalva, mid-ascending aorta (MAA), and proximal to the first aortic branch. Locations were analyzed for aortic diameter (normalized to body surface area), pressure drop (PD), viscous energy loss (EL), and wall shear stress (WSS) sub-vectors (axial wall shear stress, circumferential wall shear stress [WSSC], magnitude wall shear stress). Student's t tests, or non-parametric equivalents, compared parameters between cohorts. Univariable and multivariable analyses explored the associations of AAo diameter with hemodynamics within the BAV cohort.Compared to control cohort, BAV patients showed significantly greater PD (MAA: 9.5 ± 8.0 vs 2.8 ± 2.4 mm Hg; P < .01), EL (from LVOT-AA1: 7.39 ± 4.57 mW vs 2.90 ± 1.07 mW; P < .01), and WSSC (MAA: 0.3 ± 0.1 vs 0.2 ± 0.06 Pa; P ≤ .01) throughout the AAo. Correlational analyses revealed an inverse association between AAo diameter and both magnitude wall shear stress and axial wall shear stress.BAV patients exhibited increased PD, EL, and WSSC in the AAo, and an inverse association between AAo diameter and WSS sub-vectors. This demonstrated the impact of PD, EL, and WSS in BAV disease and the importance of altered hemodynamics in aortic remodelling.
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Affiliation(s)
- Patrick Geeraert
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
- Stephenson Cardiac Imaging Centre, University of Calgary
- Libin Cardiovascular Institute
| | - Fatemehsadat Jamalidinan
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
- Stephenson Cardiac Imaging Centre, University of Calgary
- Libin Cardiovascular Institute
| | - Ali Fatehi Hassanabad
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
| | | | | | - Carmen Lydell
- Department of Cardiac Sciences
- Diagnostic Imaging, University of Calgary
| | | | - James A. White
- Department of Cardiac Sciences
- Stephenson Cardiac Imaging Centre, University of Calgary
| | - Julio Garcia
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
- Stephenson Cardiac Imaging Centre, University of Calgary
- Libin Cardiovascular Institute
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
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Mikami Y, Cornhill A, Dykstra S, Satriano A, Hansen R, Flewitt J, Seib M, Rivest S, Sandonato R, Lydell CP, Howarth AG, Heydari B, Merchant N, Fine N, White JA. Right ventricular insertion site fibrosis in a dilated cardiomyopathy referral population: phenotypic associations and value for the prediction of heart failure admission or death. J Cardiovasc Magn Reson 2021; 23:79. [PMID: 34134712 PMCID: PMC8210339 DOI: 10.1186/s12968-021-00761-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/05/2020] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is increasingly recognized as a heterogenous disease with distinct phenotypes on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging. While mid-wall striae (MWS) fibrosis is a widely recognized phenotypic risk marker, other fibrosis patterns are prevalent but poorly defined. Right ventricular (RV) insertion (RVI) site fibrosis is commonly seen, but without objective criteria has been considered a non-specific finding. In this study we developed objective criteria for RVI fibrosis and studied its clinical relevance in a large cohort of patients with DCM. METHODS We prospectively enrolled 645 DCM patients referred for LGE-CMR. All underwent standardized imaging protocols and baseline health evaluations. LGE images were blindly scored using objective criteria, inclusive of RVI site and MWS fibrosis. Associations between LGE patterns and CMR-based markers of adverse chamber remodeling were evaluated. Independent associations of LGE fibrosis patterns with the primary composite clinical outcome of heart failure admission or death were determined by multivariable analysis. RESULTS The mean age was 56 ± 14 (28% female) with a mean left ventricular (LV) ejection fraction (LVEF) of 37%. At a median of 1061 days, 129 patients (20%) experienced the primary outcome. Any abnormal LGE was present in 306 patients (47%), inclusive of 274 (42%) meeting criteria for RVI site fibrosis and 167 (26%) for MWS fibrosis. All with MWS fibrosis showed RVI site fibrosis. Solitary RVI site fibrosis was associated with higher bi-ventricular volumes [LV end-systolic volume index (78 ± 39 vs. 66 ± 33 ml/m2, p = 0.01), RV end-diastolic volume index (94 ± 28 vs. 84 ± 22 ml/m2 (p < 0.01), RV end-systolic volume index (56 ± 26 vs. 45 ± 17 ml/m2, p < 0.01)], lower bi-ventricular function [LVEF 35 ± 12 vs. 39 ± 10% (p < 0.01), RV ejection fraction (RVEF) 43 ± 12 vs. 48 ± 10% (p < 0.01)], and higher extracellular volume (ECV). Patient with solitary RVI site fibrosis experienced a non-significant 1.4-fold risk of the primary outcome, increasing to a significant 2.6-fold risk when accompanied by MWS fibrosis. CONCLUSIONS RVI site fibrosis in the absence of MWS fibrosis is associated with bi-ventricular remodelling and intermediate risk of heart failure admission or death. Our study findings suggest RVI site fibrosis to be pre-requisite for the incremental development of MWS fibrosis, a more advanced phenotype associated with greater LV remodeling and risk of clinical events.
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Affiliation(s)
- Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Aidan Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Reis Hansen
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Michelle Seib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada.
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Ian Paterson D, White JA, Butler CR, Connelly KA, Guerra PG, Hill MD, James MT, Kirpalani A, Lydell CP, Roifman I, Sarak B, Sterns LD, Verma A, Wan D, Crean AM, Grosse-Wortmann L, Hanneman K, Leipsic J, Manlucu J, Nguyen ET, Sandhu RK, Villemaire C, Wald RM, Windram J. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society. Can J Cardiol 2021; 37:835-847. [PMID: 34154798 DOI: 10.1016/j.cjca.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.
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Affiliation(s)
| | - D Ian Paterson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - James A White
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Craig R Butler
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Guerra
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Michael D Hill
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anish Kirpalani
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carmen P Lydell
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Idan Roifman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bradley Sarak
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laurence D Sterns
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Wan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie Manlucu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Elsie T Nguyen
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Roopinder K Sandhu
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Villemaire
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rachel M Wald
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Windram
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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Labib D, Satriano A, Dykstra S, Hansen R, Mikami Y, Guzzardi DG, Slavikova Z, Feuchter P, Flewitt J, Rivest S, Sandonato R, Lydell CP, Howarth AG, Kolman L, Clarke B, Paterson DI, Oudit GY, Pituskin E, Cheung WY, Lee J, White JA. Effect of Active Cancer on the Cardiac Phenotype: A Cardiac Magnetic Resonance Imaging-Based Study of Myocardial Tissue Health and Deformation in Patients With Chemotherapy-Naïve Cancer. J Am Heart Assoc 2021; 10:e019811. [PMID: 33878890 PMCID: PMC8200726 DOI: 10.1161/jaha.120.019811] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Indexed: 01/11/2023]
Abstract
Background The overlap between cancer and cardiovascular care continues to expand, with intersections emerging before, during, and following cancer therapies. To date, emphasis has been placed on how cancer therapeutics influence downstream cardiac health. However, whether active malignancy itself influences chamber volumes, function, or overall myocardial tissue health remains uncertain. We sought to perform a comprehensive cardiovascular magnetic resonance‐based evaluation of cardiac health in patients with chemotherapy‐naïve cancer with comparison with a healthy volunteer population. Methods and Results Three‐hundred and eighty‐one patients with active breast cancer or lymphoma before cardiotoxic chemotherapy exposure were recruited in addition to 102 healthy volunteers. Both cohorts underwent standardized cardiovascular magnetic resonance imaging with quantification of chamber volumes, ejection fraction, and native myocardial T1. Left ventricular mechanics were incrementally assessed using three‐dimensional myocardial deformation analysis, providing global longitudinal, circumferential, radial, and principal peak‐systolic strain amplitude and systolic strain rate. The mean age of patients with cancer was 53.8±13.4 years; 79% being women. Despite similar left ventricular ejection fraction, patients with cancer showed smaller chambers, increased strain amplitude, and systolic strain rate in both conventional and principal directions, and elevated native T1 versus sex‐matched healthy volunteers. Adjusting for age, sex, hypertension, and diabetes mellitus, the presence of cancer remained associated with these cardiovascular magnetic resonance parameters. Conclusions The presence of cancer is independently associated with alterations in cardiac chamber size, function, and objective markers of tissue health. Dedicated research is warranted to elucidate pathophysiologic mechanisms underlying these findings and to explore their relevance to the management of patients with cancer referred for cardiotoxic therapies.
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Affiliation(s)
- Dina Labib
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Cardiovascular Medicine Cairo University Cairo Egypt
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Reis Hansen
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - David G Guzzardi
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Zdenka Slavikova
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Diagnostic Imaging Cumming School of Medicine University of Calgary Alberta Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Brian Clarke
- Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada
| | - D Ian Paterson
- Department of Medicine University of Alberta Edmonton Alberta Canada.,Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada
| | - Gavin Y Oudit
- Department of Medicine University of Alberta Edmonton Alberta Canada.,Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada
| | - Edith Pituskin
- Department of Oncology University of Alberta Edmonton Alberta Canada
| | - Winson Y Cheung
- Departments of Medicine and Oncology Cumming School of Medicine University of Calgary Alberta Canada
| | - Joon Lee
- Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada.,Department of Community Health Sciences Cumming School of Medicine University of Calgary Alberta Canada
| | - James A White
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Diagnostic Imaging Cumming School of Medicine University of Calgary Alberta Canada.,Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada
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Purmah Y, Lei LY, Dykstra S, Mikami Y, Cornhill A, Satriano A, Flewitt J, Rivest S, Sandonato R, Seib M, Lydell CP, Howarth AG, Heydari B, Merchant N, Bristow M, Fine N, Gaztanaga J, White JA. Right Ventricular Ejection Fraction for the Prediction of Major Adverse Cardiovascular and Heart Failure-Related Events: A Cardiac MRI Based Study of 7131 Patients With Known or Suspected Cardiovascular Disease. Circ Cardiovasc Imaging 2021; 14:e011337. [PMID: 33722059 DOI: 10.1161/circimaging.120.011337] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/02/2023]
Abstract
BACKGROUND There is increasing evidence that right ventricular ejection fraction (RVEF) may provide incremental value to left ventricular (LV) ejection fraction for the prediction of major adverse cardiovascular events. To date, generalizable utility for RVEF quantification in patients with cardiovascular disease has not been established. Using a large prospective clinical outcomes registry, we investigated the prognostic value of RVEF for the prediction of major adverse cardiovascular events- and heart failure-related outcomes. METHODS Seven thousand one hundred thirty-one consecutive patients with known or suspected cardiovascular disease undergoing cardiovascular magnetic resonance imaging were prospectively enrolled. Multichamber volumetric quantification was performed by standardized operational procedures. Patients were followed for the primary composite outcome of all-cause death, survived cardiac arrest, admission for heart failure, need for transplantation or LV assist device, acute coronary syndrome, need for revascularization, stroke, or transient ischemic attack. A secondary, heart failure focused outcome of heart failure admission, need for transplantation/LV assist device or death was also studied. RESULTS Mean age was 54±15 years. The mean LV ejection fraction was 55±14% (range 6%-90%) with a mean RVEF of 54±10% (range 9%-87%). At a median follow-up of 908 days, 870 (12%) patients experienced the primary composite outcome and 524 (7%) the secondary outcome. Each 10% drop in RVEF was associated with a 1.3-fold increased risk of the primary outcome (P<0.001) and 1.5-fold increased risk of the secondary outcome (P<0.001). RVEF was an independent predictor following comprehensive covariate adjustment, inclusive of LV ejection fraction. Patients with an RVEF<40% experienced a 3.1-fold risk of the primary outcome (P<0.001) with a 1-year cumulative event rate of 22% versus 7% above this cutoff. CONCLUSIONS RVEF is a powerful and independent predictor of major adverse cardiac events with broad generalizability across patients with known or suspected cardiovascular disease. These findings support migration towards biventricular phenotyping for the classification of risk in clinical practice. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04367220.
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Affiliation(s)
- Yanish Purmah
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Lucy Y Lei
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Aidan Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Michelle Seib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Michael Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Nowell Fine
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Juan Gaztanaga
- Department of Medicine, New York University Winthrop, Mineola (J.G.)
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
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Garcia J, Beckie K, Hassanabad AF, Sojoudi A, White JA. Aortic and mitral flow quantification using dynamic valve tracking and machine learning: Prospective study assessing static and dynamic plane repeatability, variability and agreement. JRSM Cardiovasc Dis 2021; 10:2048004021999900. [PMID: 33717471 PMCID: PMC7923984 DOI: 10.1177/2048004021999900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/02/2021] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background Blood flow is a crucial measurement in the assessment of heart valve disease. Time-resolved flow using magnetic resonance imaging (4 D flow MRI) can provide a comprehensive assessment of heart valve hemodynamics but it relies in manual plane analysis. In this study, we aimed to demonstrate the feasibility of automate the detection and tracking of aortic and mitral valve planes to assess blood flow from 4 D flow MRI. Methods In this prospective study, a total of n = 106 subjects were enrolled: 19 patients with mitral disease, 65 aortic disease patients and 22 healthy controls. Machine learning was employed to detect aortic and mitral location and motion in a cine three-chamber plane and a perpendicular projection was co-registered to the 4 D flow MRI dataset to quantify flow volume, regurgitant fraction, and a peak velocity. Static and dynamic plane association and agreement were evaluated. Intra- and inter-observer, and scan-rescan reproducibility were also assessed. Results Aortic regurgitant fraction was elevated in aortic valve disease patients as compared with controls and mitral valve disease patients (p < 0.05). Similarly, mitral regurgitant fraction was higher in mitral valve patients (p < 0.05). Both aortic and mitral total flow were high in aortic patients. Static and dynamic were good (r > 0.6, p < 0.005) for aortic total flow and peak velocity, and mitral peak velocity and regurgitant fraction. All measurements showed good inter- and intra-observer, and scan-rescan reproducibility. Conclusion We demonstrated that aortic and mitral hemodynamics can efficiently be quantified from 4 D flow MRI using assisted valve detection with machine learning.
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Affiliation(s)
- Julio Garcia
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Stephenson Cardiac Imaging Centre, University of Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Kailey Beckie
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Stephenson Cardiac Imaging Centre, University of Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Ali F Hassanabad
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Alireza Sojoudi
- Circle Cardiovascular Imaging, Advanced Technologies, Calgary, AB, Canada
| | - James A White
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.,Stephenson Cardiac Imaging Centre, University of Calgary, AB, Canada
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Elharram M, Hillier E, Hawkins S, Mikami Y, Heydari B, Merchant N, White JA, Anderson T, Friedrich MG, Pilote L. Regional Heterogeneity in the Coronary Vascular Response in Women With Chest Pain and Nonobstructive Coronary Artery Disease. Circulation 2021; 143:764-766. [PMID: 33587662 DOI: 10.1161/circulationaha.120.052520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Malik Elharram
- Departments of Medicine (M.E., E.H., M.G.F., L.P.), McGill University, Montreal, Quebec, Canada.,Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada (M.E., E.H., S.H., L.P.)
| | - Elizabeth Hillier
- Departments of Medicine (M.E., E.H., M.G.F., L.P.), McGill University, Montreal, Quebec, Canada.,Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada (M.E., E.H., S.H., L.P.).,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (E.H.)
| | - Selwynne Hawkins
- Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada (M.E., E.H., S.H., L.P.)
| | - Yoko Mikami
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada (Y.M., B.H., N.M., J.A.W., T.A.).,Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (Y.M., B.H., N.M., J.A.W., T.A.)
| | - Bobak Heydari
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada (Y.M., B.H., N.M., J.A.W., T.A.).,Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (Y.M., B.H., N.M., J.A.W., T.A.)
| | - Naeem Merchant
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada (Y.M., B.H., N.M., J.A.W., T.A.).,Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (Y.M., B.H., N.M., J.A.W., T.A.)
| | - James A White
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada (Y.M., B.H., N.M., J.A.W., T.A.).,Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (Y.M., B.H., N.M., J.A.W., T.A.)
| | - Todd Anderson
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada (Y.M., B.H., N.M., J.A.W., T.A.).,Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (Y.M., B.H., N.M., J.A.W., T.A.)
| | - Matthias G Friedrich
- Departments of Medicine (M.E., E.H., M.G.F., L.P.), McGill University, Montreal, Quebec, Canada.,Diagnostic Radiology (M.G.F.), McGill University, Montreal, Quebec, Canada
| | - Louise Pilote
- Departments of Medicine (M.E., E.H., M.G.F., L.P.), McGill University, Montreal, Quebec, Canada.,Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada (M.E., E.H., S.H., L.P.)
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37
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Zhang Q, Werys K, Popescu IA, Biasiolli L, Ntusi NAB, Desai M, Zimmerman SL, Shah DJ, Autry K, Kim B, Kim HW, Jenista ER, Huber S, White JA, McCann GP, Mohiddin SA, Boubertakh R, Chiribiri A, Newby D, Prasad S, Radjenovic A, Dawson D, Schulz-Menger J, Mahrholdt H, Carbone I, Rimoldi O, Colagrande S, Calistri L, Michels M, Hofman MBM, Anderson L, Broberg C, Andrew F, Sanz J, Bucciarelli-Ducci C, Chow K, Higgins D, Broadbent DA, Semple S, Hafyane T, Wormleighton J, Salerno M, He T, Plein S, Kwong RY, Jerosch-Herold M, Kramer CM, Neubauer S, Ferreira VM, Piechnik SK. Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study. Int J Cardiol 2021; 330:251-258. [PMID: 33535074 PMCID: PMC7994017 DOI: 10.1016/j.ijcard.2021.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/28/2020] [Accepted: 01/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials. PURPOSE To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use. METHODS MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites. RESULTS T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R2 > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions. CONCLUSIONS The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Iulia A Popescu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Bette Kim
- Mount Sinai West Hospital; Icahn School of Medicine at Mount Sinai, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Canada
| | - Gerry P McCann
- Department of cardiovascular sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, UK
| | - Saidi A Mohiddin
- Inherited Cardiovascular Diseases, Barts Heart Centre, London, UK
| | - Redha Boubertakh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Amedeo Chiribiri
- King's College London and Guy's and St Thomas' NHS Foundation Trust, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, College of Life Sciences and Medicine, University of Aberdeen, UK
| | | | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | | | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Michelle Michels
- Erasmus MC, department of cardiology, Rotterdam, the Netherlands
| | - Mark B M Hofman
- dept. Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lisa Anderson
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | | | | | | | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | | | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Scott Semple
- Edinburgh Imaging, Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | - Taigang He
- The Cardiology Clinical Academic Group (CAG), St George's University of London, St George's University Hospitals NHS Foundation Trust, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | | | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Xu L, Pagano JJ, Haykowksy MJ, Ezekowitz JA, Oudit GY, Mikami Y, Howarth A, White JA, Dyck JRB, Anderson T, Paterson DI, Thompson RB. Layer-specific strain in patients with heart failure using cardiovascular magnetic resonance: not all layers are the same. J Cardiovasc Magn Reson 2020; 22:81. [PMID: 33267877 PMCID: PMC7713324 DOI: 10.1186/s12968-020-00680-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/20/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Global longitudinal strain (GLS), most commonly measured at the endocardium, has been shown to be superior to left ventricular (LV) ejection fraction (LVEF) for the identification of systolic dysfunction and prediction of outcomes in heart failure (HF). We hypothesized that strains measured at different myocardial layers (endocardium = ENDO, epicardium = EPI, average = AVE) will have distinct diagnostic and predictive performance for patients with HF. METHODS Layer-specific GLS, layer-specific global circumferential strain (GCS) and global radial strain (GRS) were evaluated by cardiovascular magnetic resonance imaging (CMR) feature tracking in the Alberta HEART study. A total of 453 subjects consisted of healthy controls (controls, n = 77), at-risk for HF (at-risk, n = 143), HF with preserved ejection fraction (HFpEF, n = 87), HF with mid-range ejection fraction (HFmrEF, n = 88) and HF with reduced ejection fraction (HFrEF, n = 58). For outcomes analysis, CMR-derived imaging parameters were adjusted with a base model that included age and N-terminal prohormone of b-type natriuretic peptide (NT-proBNP) to test their independent association with 5-year all-cause mortality. RESULTS GLS_EPI distinguished all groups with preserved LVEF (controls - 16.5 ± 2.4% vs. at-risk - 15.5 ± 2.7% vs. HFpEF - 14.1 ± 3.0%, p < 0.001) while GLS_ENDO and all GCS (all layers) were similar among these groups. GRS was reduced in HFpEF (41.1 ± 13.8% versus 48.9 ± 10.7% in controls, p < 0.001) and the difference between GLS_EPI and GLS_ENDO were significantly larger in HFpEF as compared to controls. Within the preserved LVEF groups, reduced GRS and GLS_EPI were significantly associated with increased LV mass (LVM) and LVM/LV end-diastolic volume EDV (concentricity). In multivariable analysis, only GLS_AVE and GRS predicted 5-year all-cause mortality (all ps < 0.05), with the strongest association with 5-year all-cause mortality by Akaike Information Criterion analysis and significant incremental value for outcomes prediction beyond LVEF or GLS_ENDO by the likelihood ratio test. CONCLUSION Global strains measured on endocardium, epicardium or averaged across the wall thickness are not equivalent for the identification of systolic dysfunction or outcomes prediction in HF. The endocardium-specific strains were shown to have poorest all-around performance. GLS_AVE and GRS were the only CMR parameters to be significantly associated with 5-year all-cause mortality in multivariable analysis. GLS_EPI and GRS, as well as the difference in endocardial and epicardial strains, were sensitive to systolic dysfunction among HF patients with normal LVEF (> 55%), in whom lower strains were associated with increased concentricity.
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Affiliation(s)
- Lingyu Xu
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, Alberta,, T6G 2V2, Canada
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Joseph J Pagano
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, Alberta,, T6G 2V2, Canada
| | - Mark J Haykowksy
- College of Nursing and Health Innovation, The University of Texas Arlington, Arlington, USA
| | - Justin A Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, Canada
- Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
| | - Andrew Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, Canada
- Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, Canada
- Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
| | - Jason R B Dyck
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Todd Anderson
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - D Ian Paterson
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, Alberta,, T6G 2V2, Canada.
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Farrag NA, Lochbihler A, White JA, Ukwatta E. Evaluation of fully automated myocardial segmentation techniques in native and contrast-enhanced T1-mapping cardiovascular magnetic resonance images using fully convolutional neural networks. Med Phys 2020; 48:215-226. [PMID: 33131085 DOI: 10.1002/mp.14574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/08/2019] [Revised: 07/28/2020] [Accepted: 10/25/2020] [Indexed: 11/07/2022] Open
Abstract
PURPOSE T1-mapping cardiac magnetic resonance (CMR) imaging permits noninvasive quantification of myocardial fibrosis (MF); however, manual delineation of myocardial boundaries is time-consuming and introduces user-dependent variability for such measurements. In this study, we compare several automated pipelines for myocardial segmentation of the left ventricle (LV) in native and contrast-enhanced T1-maps using fully convolutional neural networks (CNNs). METHODS Sixty patients with known MF across three distinct cardiomyopathy states (20 ischemic (ICM), 20 dilated (DCM), and 20 hypertrophic (HCM)) underwent a standard CMR imaging protocol inclusive of cinematic (CINE), late gadolinium enhancement (LGE), and pre/post-contrast T1 imaging. Native and contrast-enhanced T1-mapping was performed using a shortened modified Look-Locker imaging (shMOLLI) technique at the basal, mid-level, and/or apex of the LV. Myocardial segmentations in native and post-contrast T1-maps were performed using three state-of-the-art CNN-based methods: standard U-Net, densely connected neural networks (Dense Nets), and attention networks (Attention Nets) after dividing the dataset using fivefold cross validation. These direct segmentation techniques were compared to an alternative registration-based segmentation method, wherein spatially corresponding CINE images are segmented automatically using U-Net, and a nonrigid registration technique transforms and propagates CINE contours to the myocardial regions of T1-maps. The methodologies were validated in 125 native and 100 contrast-enhanced T1-maps using standard segmentation accuracy metrics. Pearson correlation coefficient r and Bland-Altman analysis were used to compare the computed global T1 values derived by manual, U-Net, and CINE registration methodologies. RESULTS The U-Net-based method yielded optimal results in myocardial segmentation of native, contrast-enhanced, and CINE images compared to Dense Nets and Attention Nets. The direct U-Net-based method outperformed the CINE registration-based method in native T1-maps, yielding Dice similarity coefficient (DSC) of 82.7 ± 12% compared to 81.4 ± 6.9% (P < 0.0001). However, in contrast-enhanced T1-maps, the CINE-registration-based method outperformed direct U-Net segmentation, yielding DSC of 77.0 ± 9.6% vs 74.2 ± 18% across all patient groups (P = 0.0014) and specifically 73.2 ± 7.3% vs 65.5 ± 18% in the ICM patient group. High linear correlation of global T1 values was demonstrated in Pearson analysis of the U-Net-based technique and the CINE-registration technique in both native T1-maps (r = 0.93, P < 0.0001 and r = 0.87, P < 0.0001, respectively) and contrast-enhanced T1-maps (r = 0.93, P < 0.0001 and r = 0.98, P < 0.0001, respectively). CONCLUSIONS The direct U-Net-based myocardial segmentation technique provided accurate, fully automated segmentations in native and contrast-enhanced T1-maps. Myocardial borders can alternatively be segmented from spatially matched CINE images and applied to T1-maps via deformation and propagation through a modality-independent neighborhood descriptor (MIND). The direct U-Net approach is more efficient in myocardial segmentation of native T1-maps and eliminates cross-technique dependence. However, the CINE-registration-based technique may be more appropriate for contrast-enhanced T1-maps and/or for patients with dense regions of replacement fibrosis, such as those with ICM.
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Affiliation(s)
- Nadia A Farrag
- Department of Systems and Computer Engineering, Carleton University, 1125 Colonel By Drive, Mackenzie 4456, Ottawa, ON, K1S5B6, Canada
| | - Aidan Lochbihler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - James A White
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Eranga Ukwatta
- School of Engineering, University of Guelph, Guelph, ON, N1G 2W1, Canada
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40
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Satriano A, Afzal Y, Sarim Afzal M, Fatehi Hassanabad A, Wu C, Dykstra S, Flewitt J, Feuchter P, Sandonato R, Heydari B, Merchant N, Howarth AG, Lydell CP, Khan A, Fine NM, Greiner R, White JA. Neural-Network-Based Diagnosis Using 3-Dimensional Myocardial Architecture and Deformation: Demonstration for the Differentiation of Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2020; 7:584727. [PMID: 33304928 PMCID: PMC7693650 DOI: 10.3389/fcvm.2020.584727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/17/2020] [Accepted: 10/09/2020] [Indexed: 12/24/2022] Open
Abstract
The diagnosis of cardiomyopathy states may benefit from machine-learning (ML) based approaches, particularly to distinguish those states with similar phenotypic characteristics. Three-dimensional myocardial deformation analysis (3D-MDA) has been validated to provide standardized descriptors of myocardial architecture and deformation, and may therefore offer appropriate features for the training of ML-based diagnostic tools. We aimed to assess the feasibility of automated disease diagnosis using a neural network trained using 3D-MDA to discriminate hypertrophic cardiomyopathy (HCM) from its mimic states: cardiac amyloidosis (CA), Anderson–Fabry disease (AFD), and hypertensive cardiomyopathy (HTNcm). 3D-MDA data from 163 patients (mean age 53.1 ± 14.8 years; 68 females) with left ventricular hypertrophy (LVH) of known etiology was provided. Source imaging data was from cardiac magnetic resonance (CMR). Clinical diagnoses were as follows: 85 HCM, 30 HTNcm, 30 AFD, and 18 CA. A fully-connected-layer feed-forward neural was trained to distinguish HCM vs. other mimic states. Diagnostic performance was compared to threshold-based assessments of volumetric and strain-based CMR markers, in addition to baseline clinical patient characteristics. Threshold-based measures provided modest performance, the greatest area under the curve (AUC) being 0.70. Global strain parameters exhibited reduced performance, with AUC under 0.64. A neural network trained exclusively from 3D-MDA data achieved an AUC of 0.94 (sensitivity 0.92, specificity 0.90) when performing the same task. This study demonstrates that ML-based diagnosis of cardiomyopathy states performed exclusively from 3D-MDA is feasible and can distinguish HCM from mimic disease states. These findings suggest strong potential for computer-assisted diagnosis in clinical practice.
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Affiliation(s)
| | | | | | - Ali Fatehi Hassanabad
- Division of Cardiology, School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cody Wu
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada
| | - Steven Dykstra
- Division of Cardiology, School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada.,Division of Cardiology, School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | | | - Bobak Heydari
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.,Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada.,Division of Cardiology, School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.,Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Aneal Khan
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
| | - Nowell M Fine
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Russell Greiner
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada.,Alberta Machine Learning Institute, Edmonton, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Center, Calgary, AB, Canada.,Division of Cardiology, School of Medicine, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
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41
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Trpkov C, MacMullan P, Feuchter P, Kachra R, Heydari B, Merchant N, Bristow MS, White JA. Rapid Response to Cytokine Storm Inhibition Using Anakinra in a Patient With COVID-19 Myocarditis. CJC Open 2020; 3:210-213. [PMID: 33073222 PMCID: PMC7550126 DOI: 10.1016/j.cjco.2020.10.003] [Citation(s) in RCA: 9] [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: 08/02/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
A 62-year-old woman with coronavirus disease 2019 developed acute respiratory failure and cardiogenic shock in the setting of a systemic hyperinflammatory state and apparent ST-elevation myocardial infarction. Cardiac magnetic resonance imaging showed fulminant acute myocarditis with severe left ventricular dysfunction. Treatment with the recombinant interleukin-1 receptor antagonist anakinra and dexamethasone resulted in rapid clinical improvement, reduction in serum inflammatory markers, and a marked recovery in cardiac magnetic resonance--based markers of inflammation and contractile dysfunction. The patient was subsequently discharged from the hospital. Emerging evidence supports use of anti-inflammatory therapies, including anakinra and dexamethasone, in severe cases of coronavirus disease 2019.
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Affiliation(s)
- Cvetan Trpkov
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul MacMullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Rahim Kachra
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bobak Heydari
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Miller RJH, Mikami Y, Heydari B, Wilton SB, James MT, Howarth AG, White JA, Lydell CP. Sex-specific relationships between patterns of ventricular remodelling and clinical outcomes. Eur Heart J Cardiovasc Imaging 2020; 21:983-990. [DOI: 10.1093/ehjci/jeaa164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Abstract
Abstract
Aims
Left ventricular hypertrophy (LVH) is the most common form of myocardial remodelling and predicts adverse outcomes in patients with coronary artery disease (CAD). However, sex-specific prevalence and prognostic significance of LVH patterns are poorly understood. We investigated the sex-specific influence of LVH pattern on clinical outcomes in patients undergoing cardiovascular magnetic resonance (CMR) and coronary angiography following adjustment for co-morbidities including CAD burden.
Methods and results
Patients undergoing CMR and coronary angiography between 2005 and 2013 were included. Volumetric measurements of left ventricular (LV) mass with classification of concentric vs. eccentric remodelling patterns were determined from CMR cine images. Multivariable Cox analysis was performed to assess independent associations with the primary outcome of all-cause mortality. In total, 3754 patients were studied (mean age 59.3 ± 13.1 years), including 1039 (27.7%) women. Women were more likely to have concentric remodelling (8.1% vs. 2.1%, P < 0.001), less likely to have eccentric hypertrophy (15.1% vs. 26.8%, P < 0.001) and had a similar prevalence of concentric hypertrophy (6.1 vs. 5.2%, P = 0.296) compared to men. At a median follow-up of 3.7 years, 315 (8.4%) patients died. Following adjustment including CAD burden, concentric hypertrophy was associated with increased all-cause mortality in women [adjusted hazard ratio (HR) 3.48, P < 0.001] and men (adjusted HR 2.57, P < 0.001). Eccentric hypertrophy was associated with all-cause mortality only in women (adjusted HR 1.78, P = 0.047).
Conclusion
Patterns of LV remodelling differ by sex and LVH and provides prognostic information in both men and women. Our findings support the presence of sex-specific factors influencing LV remodelling.
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Affiliation(s)
- Robert J H Miller
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthew T James
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Department of Cardiac, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
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Howlett JG, Sharma N, Alemayehu WG, Dyck JRB, Anderson T, Fine N, Becker H, White JA, Paterson DI, Thompson RB, Oudit GY, Haykowsky MJ, Ezekowitz JA. Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction. ESC Heart Fail 2020; 7:2725-2733. [PMID: 32592541 PMCID: PMC7524210 DOI: 10.1002/ehf2.12863] [Citation(s) in RCA: 7] [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: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS The aim of this study is to determine factors associated with long-term recovery of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF) and if further recovery also occurs in this group. METHODS AND RESULTS Among 621 participants enrolled in the Alberta Heart Failure Etiology and Analysis Team (HEART) Study, 316 with Stage C HF underwent comprehensive imaging and biomarker testing at enrolment and at 1-year follow up. Using pre-enrolment data, HF with recovered EF (HFrecEF) was defined as an absolute improvement ≥5% in LVEF from the prior lowest LVEF value, with a final LVEF value > 35% at or prior to study baseline. Participants with all LVEF > 40% were included for comparison. Hospitalization-free survival to 5 years was performed. The median cohort age was 66 years, and time from diagnosis was 4 years; 82% were male patients. Of the 316 patients, 95 (30%) patients had HFrecEF and 56 (18%) patients pHFrEF. On multivariate analysis, only shorter duration of HF was predictive of HFrecEF status. Over 1 year, LVEF increased in the HFrecEF group 4.0% (0.15-7.90, P = 0.042) as compared with persistent HFrEF, who in turn demonstrated higher baseline serum high sensitivity Troponin-T with further increase at follow up 0.55(0.33-0.86, P = 0.011). No change in any parameter in the HFpEF/HFmrEF group at follow up was observed. CONCLUSIONS Patients with HFrecEF demonstrate evidence of additional late improvement in LVEF and unchanged troponin levels, in contrast to those with persistent HFrEF, where LVEF does not improve and serum troponin rises over time. These data help to inform mechanisms relating to late LV remodelling.
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Affiliation(s)
- Jonathan G Howlett
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nakul Sharma
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Wendimagegn G Alemayehu
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Todd Anderson
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nowell Fine
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Harald Becker
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - James A White
- Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - D Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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Svystonyuk DA, Mewhort HEM, Hassanabad AF, Heydari B, Mikami Y, Turnbull JD, Teng G, Belke DD, Wagner KT, Tarraf SA, DiMartino ES, White JA, Flewitt JA, Cheung M, Guzzardi DG, Kang S, Fedak PWM. Acellular bioscaffolds redirect cardiac fibroblasts and promote functional tissue repair in rodents and humans with myocardial injury. Sci Rep 2020; 10:9459. [PMID: 32528051 PMCID: PMC7289874 DOI: 10.1038/s41598-020-66327-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/28/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023] Open
Abstract
Coronary heart disease is a leading cause of death. Tissue remodeling and fibrosis results in cardiac pump dysfunction and ischemic heart failure. Cardiac fibroblasts may rebuild damaged tissues when prompted by suitable environmental cues. Here, we use acellular biologic extracellular matrix scaffolds (bioscaffolds) to stimulate pathways of muscle repair and restore tissue function. We show that acellular bioscaffolds with bioinductive properties can redirect cardiac fibroblasts to rebuild microvascular networks and avoid tissue fibrosis. Specifically, when human cardiac fibroblasts are combined with bioactive scaffolds, gene expression is upregulated and paracrine mediators are released that promote vasculogenesis and prevent scarring. We assess these properties in rodents with myocardial infarction and observe bioscaffolds to redirect fibroblasts, reduce tissue fibrosis and prevent maladaptive structural remodeling. Our preclinical data confirms that acellular bioscaffold therapy provides an appropriate microenvironment to stimulate pathways of functional repair. We translate our observations to patients with coronary heart disease by conducting a first-in-human observational cohort study. We show that bioscaffold therapy is associated with improved perfusion of infarcted myocardium, reduced myocardial scar burden, and reverse structural remodeling. We establish that clinical use of acellular bioscaffolds is feasible and offers a new frontier to enhance surgical revascularization of ischemic heart muscle.
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Affiliation(s)
- Daniyil A Svystonyuk
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Holly E M Mewhort
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bobak Heydari
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yoko Mikami
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jeannine D Turnbull
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Guoqi Teng
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darrell D Belke
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Karl T Wagner
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Samar A Tarraf
- Department of Civil Engineering, Libin Cardiovascular Institute and Centre for Bioengineering Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Elena S DiMartino
- Department of Civil Engineering, Libin Cardiovascular Institute and Centre for Bioengineering Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline A Flewitt
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Cheung
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - David G Guzzardi
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean Kang
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
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Alba AC, Gaztañaga J, Foroutan F, Thavendiranathan P, Merlo M, Alonso-Rodriguez D, Vallejo-García V, Vidal-Perez R, Corros-Vicente C, Barreiro-Pérez M, Pazos-López P, Perez-David E, Dykstra S, Flewitt J, Pérez-Rivera JÁ, Vazquez-Caamaño M, Katz SD, Sinagra G, Køber L, Poole J, Ross H, Farkouh ME, White JA. Prognostic Value of Late Gadolinium Enhancement for the Prediction of Cardiovascular Outcomes in Dilated Cardiomyopathy: An International, Multi-Institutional Study of the MINICOR Group. Circ Cardiovasc Imaging 2020; 13:e010105. [PMID: 32312112 DOI: 10.1161/circimaging.119.010105] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 12/12/2022]
Abstract
BACKGROUND Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). METHODS Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000-2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock. RESULTS We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. CONCLUSIONS In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.
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Affiliation(s)
- Ana Carolina Alba
- Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada (A.C.A., F.F. P.T., H.R., M.E.F.)
| | - Juan Gaztañaga
- Division of Cardiology, Department of Medicine, NYU Winthrop Hospital, Mineola, NY (J.G.)
| | - Farid Foroutan
- Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada (A.C.A., F.F. P.T., H.R., M.E.F.)
| | - Paaladinesh Thavendiranathan
- Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada (A.C.A., F.F. P.T., H.R., M.E.F.)
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Universita Degli Studi di Trieste, Trieste, Italy (M.M., G.S.)
| | | | - Victor Vallejo-García
- Department of Cardiology, Hospital Clínico Universitario de Salamanca, Spain (V.V.-G., M.B.-P.)
| | - Rafael Vidal-Perez
- Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo, Spain (R.V.-P.)
| | - Cecilia Corros-Vicente
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain (C.C.-V.)
| | - Manuel Barreiro-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Salamanca, Spain (V.V.-G., M.B.-P.)
| | - Pablo Pazos-López
- Department of Cardiology, Complejo Hospitalario Universitario de Vigo, Spain (P.P.-L.)
| | - Esther Perez-David
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain (E.P.-D.)
| | - Steven Dykstra
- Departments of Cardiac Sciences and Diagnostic Imaging, Libin Cardiovascular Institute of Alberta, Calgary, Canada (S.D., J.F., J.A.W.)
| | - Jacqueline Flewitt
- Departments of Cardiac Sciences and Diagnostic Imaging, Libin Cardiovascular Institute of Alberta, Calgary, Canada (S.D., J.F., J.A.W.)
| | | | | | - Stuart D Katz
- NYU Langone Health, Leon H. Charney Division of Cardiology, NY (S.D.K.)
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Universita Degli Studi di Trieste, Trieste, Italy (M.M., G.S.)
| | - Lars Køber
- Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Jeanne Poole
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (J.P.)
| | - Heather Ross
- Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada (A.C.A., F.F. P.T., H.R., M.E.F.)
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada (A.C.A., F.F. P.T., H.R., M.E.F.)
| | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Libin Cardiovascular Institute of Alberta, Calgary, Canada (S.D., J.F., J.A.W.)
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Fine NM, White JA, Jimenez-Zepeda V, Howlett JG. Determinants and Prognostic Significance of Serial Right Heart Function Changes in Patients With Cardiac Amyloidosis. Can J Cardiol 2020; 36:432-440. [DOI: 10.1016/j.cjca.2020.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
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Zabihollahy F, Rajchl M, White JA, Ukwatta E. Fully automated segmentation of left ventricular scar from 3D late gadolinium enhancement magnetic resonance imaging using a cascaded multi‐planar U‐Net (CMPU‐Net). Med Phys 2020; 47:1645-1655. [DOI: 10.1002/mp.14022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 12/06/2019] [Accepted: 01/10/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Fatemeh Zabihollahy
- Department of Systems and Computer Engineering Carleton University Ottawa ON Canada
| | - Martin Rajchl
- Department of Computing and Medicine Imperial College London London ON Canada
| | - James A. White
- Libin Cardiovascular Institute of Alberta University of Calgary Calgary AB Canada
| | - Eranga Ukwatta
- School of Engineering University of Guelph Guelph ON Canada
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Lei L, Satriano A, Magyar-Ng M, Mikami Y, Kalmady SV, Hoehn B, Dykstra S, Heydari B, Flewitt J, Merchant N, Howarth AG, Lydell CP, Greiner R, Fine NM, White JA. 4941Machine learning based automated diagnosis of ischemic vs non-ischemic dilated cardiomyopathy using 3D myocardial deformation analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background
Late Gadolinium Enhancement (LGE) imaging is a reference standard technique for the differentiation of ischemic cardiomyopathy (ICM) from non-ischemic dilated cardiomyopathy (NIDCM) in patients with heart failure and reduced ejection fraction (HFrEF). 3D myocardial deformation analysis (3D-MDA) offers highly reproducible phenotypic assessments of regional architecture and function that may provide value for artificial-intelligence-assisted cardiomyopathy diagnosis without need for LGE imaging.
Purpose
In this study, we trained and validated a machine-learning-based model to enable automated diagnosis of ischemic versus non-ischemic dilated cardiomyopathy exclusively using regional patterns of deformation among patients otherwise matched by age, sex and global contractile dysfunction.
Methods
100 ICM and 100 NIDCM patients matched for age, sex, and LVEF underwent standard cine SSFP and LGE imaging. Patient diagnoses were established using a combination of clinical and LGE-based criteria. 3D-MDA was performed using validated software (GIUSEPPE) to compute regional 3D strain measures at each cardiac phase in both conventional and principal strain directions. Principal Component Analysis (PCA) was performed on the composite 3D-MDA dataset. The first 20 components were chosen, accounting for approximately 65% of the population variance. Subsequently, a support-vector-machine-based algorithm was used with 10-fold cross-validation to discriminate ICM from NIDCM.
Results
Patients were 63±10 years (ICM: 63±10 years, NIDCM: 63±10 years, p=0.955), 74% male (ICM: 74%, NIDCM: 74%, p=1.000), and had a mean LVEF of 27±8% (ICM: 27±7%, NIDCM: 28±7%, p=0.688). Global time to peak strain was significantly shorter in ICM patients relative to NIDCM patients across all surfaces and in all directions (p<0.05). The highest single-variable Area Under the Curve (AUC) achieved for the classification of ICM versus NIDCM from global data was for minimum principal strain (ICM: 43.7±7.8, NIDCM: 48.3±7.5, p<0.001, AUC: 0.682) (Figure 1). However, a multi-feature machine-learning-based model exposed to all available regional 3D deformation data achieved an AUC of 0.903 (sensitivity 87.7%, specificity 75.5%).
Conclusions
Machine learning-based analyses of3D regionaldeformation patterns allows for robust discrimination of ICM versus NIDCM. Further expansion of the presented findings is planned on a wider, multi-centre cohort.
Acknowledgement/Funding
Dr. White was supported by an award from Heart and Stroke Foundation of Alberta. This study was funded in part by Calgary Health Trust.
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Affiliation(s)
- L Lei
- University of Calgary Foothills Hospital, Calgary, Canada
| | - A Satriano
- University of Calgary Foothills Hospital, Calgary, Canada
| | - M Magyar-Ng
- University of Calgary Foothills Hospital, Calgary, Canada
| | - Y Mikami
- University of Calgary Foothills Hospital, Calgary, Canada
| | - S V Kalmady
- University of Alberta, Computing Science, Edmonton, Canada
| | - B Hoehn
- University of Alberta, Computing Science, Edmonton, Canada
| | - S Dykstra
- University of Calgary Foothills Hospital, Calgary, Canada
| | - B Heydari
- University of Calgary Foothills Hospital, Calgary, Canada
| | - J Flewitt
- University of Calgary Foothills Hospital, Calgary, Canada
| | - N Merchant
- University of Calgary Foothills Hospital, Calgary, Canada
| | - A G Howarth
- University of Calgary Foothills Hospital, Calgary, Canada
| | - C P Lydell
- University of Calgary Foothills Hospital, Calgary, Canada
| | - R Greiner
- University of Alberta, Computing Science, Edmonton, Canada
| | - N M Fine
- University of Calgary Foothills Hospital, Calgary, Canada
| | - J A White
- University of Calgary Foothills Hospital, Calgary, Canada
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49
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Lydell CP, Mikami Y, Homer K, Peng M, Cornhill A, Rajagopalan A, Arasaratnam P, Cowan K, Roberts A, Sumner C, Heydari B, Howarth AG, Exner D, White JA. Left Atrial Function Using Cardiovascular Magnetic Resonance Imaging Independently Predicts Life-Threatening Arrhythmias in Patients Referred to Receive a Primary Prevention Implantable Cardioverter Defibrillator. Can J Cardiol 2019; 35:1149-1157. [PMID: 31472813 DOI: 10.1016/j.cjca.2019.04.015] [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] [Received: 09/13/2018] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In this study we aimed to investigate left atrial (LA) function, measured from routine cine cardiovascular magnetic resonance imaging, to determine its value for the prediction of sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator (ICD) shock in patients who received primary prevention ICD implantation. METHODS We studied 203 patients with ischemic or idiopathic nonischemic dilated cardiomyopathy who underwent cardiovascular magnetic resonance imaging before primary prevention ICD implantation. LA volumes were measured at end-diastole and end-systole from 4- and 2-chamber cine images, and LA emptying function (LAEF) calculated. Patients were followed for the primary composite end point of SCD or appropriate ICD shock. RESULTS Mean age was 61 ± 12 years with a mean left ventricular ejection fraction of 24 ± 7%. The mean LAEF was 27 ± 15% (range, 0.9%-73%). At a median follow-up of 1639 days, 35 patients (17%) experienced the primary composite outcome. LAEF was strongly associated with the primary outcome (P = 0.001); patients with an LAEF ≤ 30% experienced a cumulative event rate of 26.1% vs 5.7% (hazard ratio, 5.5; P < 0.001) in patients above this cutoff. This finding was maintained in multivariable analysis (hazard ratio, 4.7; P = 0.002) and was consistently shown in the ischemic and nonischemic dilated cardiomyopathy subgroups. CONCLUSIONS LAEF is a simple, powerful, and independent predictor of SCD in patients being referred for primary prevention ICD implantation.
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Affiliation(s)
- Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Kai Homer
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Mingkai Peng
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aidan Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Archa Rajagopalan
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Punitha Arasaratnam
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Karen Cowan
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Roberts
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Sumner
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek Exner
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Garcia J, Sheitt H, Bristow MS, Lydell C, Howarth AG, Heydari B, Prato FS, Drangova M, Thornhill RE, Nery P, Wilton SB, Skanes A, White JA. Left atrial vortex size and velocity distributions by 4D flow MRI in patients with paroxysmal atrial fibrillation: Associations with age and CHA
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‐VASc risk score. J Magn Reson Imaging 2019; 51:871-884. [DOI: 10.1002/jmri.26876] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Julio Garcia
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Department of RadiologyUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
- Libin Cardiovascular Institute of Alberta Calgary AB Canada
- Alberta Children's Hospital Research Institute
| | - Hana Sheitt
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
| | - Michael S. Bristow
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Department of MedicineUniversity of Calgary Calgary AB Canada
| | - Carmen Lydell
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Diagnostic ImagingUniversity of Calgary Calgary AB Canada
| | - Andrew G. Howarth
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
| | - Bobak Heydari
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
| | - Frank S. Prato
- Department of Medical BiophysicsSchulich School of Medicine & Dentistry, The University of Western Ontario London Ontario Canada
| | - Maria Drangova
- Department of Medical BiophysicsSchulich School of Medicine & Dentistry, The University of Western Ontario London Ontario Canada
- Imaging Research Laboratories, Robarts Research InstituteSchulich School of Medicine & Dentistry, The University of Western Ontario London Ontario Canada
| | | | - Pablo Nery
- Division of Cardiology, Department of MedicineUniversity of Ottawa Heart Institute Ottawa ON Canada
| | - Stephen B. Wilton
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
| | - Allan Skanes
- Department of MedicineUniversity of Western Ontario London ON Canada
| | - James A. White
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
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