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Suntratonpipat S, Pajunen K, Rosolowsky E, Escudero CA, Girgis R, Thompson RB, Pagano JJ, Tham EB. Cardiac MRI evaluation of aortic biophysical properties in paediatric Turner syndrome. Cardiol Young 2024:1-7. [PMID: 38606642 DOI: 10.1017/s1047951124000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Aortopathy in Turner syndrome is associated with aortic dilation, and the risk of dissection is increased when the aortic size index is ≥ 2-2.5 cm/m2. We evaluated the aortic biophysical properties in paediatric Turner syndrome using cardiac MRI to determine their relationship to aortic size index. METHODS Turner syndrome patients underwent cardiac MRI to evaluate ventricular function, aortic dimensions, and biophysical properties (aortic stiffness index, compliance, distensibility, pulse wave velocity, and aortic and left ventricular elastance). Spearman correlation examined correlations between these properties and aortic size index. Data was compared to 10 controls. RESULTS Of 25 Turner syndrome patients, median age 14.7 years (interquartile range: 11.0-16.8), height z score -2.7 (interquartile range: -2.92 - -1.54), 24% had a bicuspid aortic valve. Turner syndrome had increased diastolic blood pressure (p < 0.001) and decreased left ventricular end-diastolic (p < 0.001) and end-systolic (p = 0.002) volumes compared to controls. Median aortic size index was 1.81 cm/m2 (interquartile range: 1.45-2.1) and 7 had an aortic size index > 2 cm/m2. Aortic and left ventricular elastance were greater in Turner syndrome compared to controls (both p < 0.001). Increased aortic size index correlated with increased aortic elastance (r = 0.5, p = 0.01) and left ventricular elastance (r = 0.59, p = 0.002) but not aortic compliance. Higher ascending aortic areas were associated with increased aortic compliance (r = 0.44, p = 0.03) and left ventricular elastance (r = 0.49, p = 0.01). CONCLUSION Paediatric Turner syndrome with similar aortic size index to controls showed MRI evidence of abnormal aortic biophysical properties. These findings point to an underlying aortopathy and provide additional parameters that may aid in determining risk factors for aortic dissection.
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Affiliation(s)
- Somjate Suntratonpipat
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Kiera Pajunen
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Elizabeth Rosolowsky
- Division of Pediatric Endocrinology, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Carolina A Escudero
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Rose Girgis
- Division of Pediatric Endocrinology, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Joseph J Pagano
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Edythe B Tham
- Division of Pediatric Cardiology, Stollery Children's Hospital & Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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Heidari N, Kumaran K, Pagano JJ, Hornberger LK. Natural History of Secundum ASD in Preterm and Term Neonates: A Comparative Study. Pediatr Cardiol 2024; 45:710-721. [PMID: 38366300 DOI: 10.1007/s00246-023-03403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024]
Abstract
Atrial septal defects (ASDs) are common in neonates. Although past studies suggest ASDs ≥ 3 mm in term neonates (TNs) are less likely to close, there is paucity of data regarding the natural history in preterm neonates (PNs), information that would inform surveillance. We sought to compare spontaneous closure rates and need for intervention for ASDs in TNs/near term (≥ 36 weeks) versus PNs (< 36 weeks). We included all TNs and PNs who underwent echocardiography at ≤ 1 month between 2010 and 2018 in our institution with an ASD ≥ 3 mm, without major congenital heart disease, and with repeat echocardiogram(s). Spontaneous resolution was defined as size diminution to < 3 mm or closure. We included 156 TNs (mean gestational age at birth 38.6 ± 1.4 weeks) and 156 PNs (29.6 ± 3.7 weeks) with a mean age at follow-up of 16 ± 19 and 15 ± 21 months, respectively (p = 0.76). Based on maximum color Doppler diameter, in TNs, ASD resolution occurred in 95% of small (3-5 mm), 87% of moderate (5.1-8 mm), and 60% of large (> 8 mm) defects; whereas, in PNs, resolution occurred in 79% of small, 76% of moderate, and 33% of large ASDs. There was a significant association between size and ASD resolution in TNs (p = 0.003), but not PNs (p = 0.17). Overall, ASD resolution rate was higher in TNs (89%) versus PNs (78%) (p = 0.009), and fewer TNs (1%) compared to PNs (7%) required ASD intervention (p = 0.02). Most ASDs identified in TNs and PNs spontaneously resolve. PNs, however, demonstrate lower ASD resolution and higher intervention rates within all size groups. These data should inform follow-up of affected neonates.
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Affiliation(s)
- Negar Heidari
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada
| | - Kumar Kumaran
- Division of Neonatology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, Alberta, Canada
| | - Joseph J Pagano
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children's Health Research Institute, and the Stollery Children's Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada.
- Department of Obstetrics & Gynecology, Lois Hole Hospital for Women, Royal Alexandra Hospital, University of Alberta, 10245 111th Street Edmonton, Alberta, T5G 0B6, Canada.
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Khoury M, Harahsheh AS, Raghuveer G, Dahdah N, Lee S, Fabi M, Selamet Tierney ES, Portman MA, Choueiter NF, Elias M, Thacker D, Dallaire F, Orr WB, Harris TH, Norozi K, Truong DT, Khare M, Szmuszkovicz JR, Pagano JJ, Manlhiot C, Farid P, McCrindle BW. Obesity and Outcomes of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2023; 6:e2346829. [PMID: 38064213 PMCID: PMC10709775 DOI: 10.1001/jamanetworkopen.2023.46829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Objective To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C. Design, Setting, and Participants In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded. Main Outcomes and Measures Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups. Results Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD. Conclusions and Relevance In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.
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Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ashraf S Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, Ohio
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | | | - Nadine F Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Matthew Elias
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Frédéric Dallaire
- Department of Pediatrics, Universite de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, Ontario, Canada
| | | | - Manaswitha Khare
- University of California San Diego/Rady Children's Hospital San Diego
| | | | - Joseph J Pagano
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland
| | - Pedrom Farid
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Beaulieu D, Treit S, Pagano JJ, Beaulieu C, Thompson R. Cardiac Magnetic Resonance Imaging in Individuals With Prenatal Alcohol Exposure. CJC Pediatr Congenit Heart Dis 2023; 2:150-161. [PMID: 37969351 PMCID: PMC10642128 DOI: 10.1016/j.cjcpc.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/16/2023] [Indexed: 11/17/2023]
Abstract
Background Prenatal alcohol exposure (PAE) has teratogenic effects on numerous body systems including the heart. However, research magnetic resonance imaging (MRI) studies in humans with PAE have thus far been limited to the brain. This study aims to use MRI to examine heart structure and function, brain volumes, and body composition in children and adolescents with PAE. Methods Heart, brain, and abdominal 3T MRI of 17 children, adolescents, and young adults with PAE and 53 unexposed controls was acquired to measure: (1) left ventricular ejection fraction, end-diastolic volume, end-systolic volume, stroke volume, cardiac output, longitudinal strain, circumferential strain, and heart mass; (2) total brain, cerebellum, white matter, grey matter, caudate, thalamus, putamen, and globus pallidus volumes; and (3) subcutaneous fat, visceral fat, muscle fat, and muscle (body composition). Results Cardiac MRI revealed no abnormalities in the PAE group on evaluation by a paediatric cardiologist and by statistical comparison with a control group. Cardiac parameters in both groups were in line with previous reports, including expected sex- and age-related differences. Cerebellum, caudate, and globus pallidus volumes were all smaller. Body mass index and subcutaneous fat percent were higher in females with PAE relative to control females, but lower in males with PAE relative to control males. Conclusions Children with PAE did not have abnormalities in MRI-derived measures of cardiac structure or function despite smaller brain volumes and sex-specific differences in body composition relative to healthy controls.
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Affiliation(s)
- Danielle Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Treit
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph J. Pagano
- Division of Pediatric Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Greidanus PG, Pagano JJ, Escudero CA, Thompson R, Tham EB. Regional Elevation of Liver T1 in Fontan Patients. CJC Pediatr Congenit Heart Dis 2023; 2:134-142. [PMID: 37969352 PMCID: PMC10642140 DOI: 10.1016/j.cjcpc.2023.03.004] [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] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/08/2023] [Indexed: 11/17/2023]
Abstract
Background Fontan-associated liver disease (FALD) is characterized by hepatic congestion and progressive hepatic fibrosis in patients with the Fontan operation. This condition is generally clinically silent until late, necessitating techniques for early detection. Liver T1 mapping has been used to screen for FALD, but without consideration of regional variations in T1 values. Methods Liver T1 measured with a liver-specific T1 mapping sequence (PROFIT1) in Fontan patients was compared with cohorts of patients with biventricular congenital heart disease (BiV-CHD) and controls with normal cardiac function and anatomy. Results Liver T1 was significantly elevated in the Fontan cohort (n = 20) compared with patients with BiV-CHD (n = 12) and controls (n = 9) (781, 678, and 675 milliseconds, respectively; P < 0.001), with a consistent pattern of significantly elevated T1 values in the peripheral compared with central liver regions (ΔT1 = 54, 2, and 11 milliseconds; P < 0.001). PROFIT1 also yielded simultaneous T2∗ maps and fat fraction values that were similar in all groups. Fontan liver T1 values were also significantly elevated as compared with BiV-CHD and controls as measured with the cardiac (modified Look-Locker inversion) acquisitions (728, 583, and 583 milliseconds, respectively; P < 0.001) and values correlated with PROFIT1 liver T1 (R = 0.87, P < 0.001). Conclusions Fontan patients have globally increased liver T1 values and consistent spatial variations, with higher values in the peripheral liver regions as compared with spatially uniform values in BiV-CHD and controls. The spatial patterns may provide insight into the progression of FALD. Liver T1 mapping studies should include uniform spatial coverage to avoid bias based on slice locations in this population.
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Affiliation(s)
- Paul G. Greidanus
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph J. Pagano
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carolina A. Escudero
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Edythe B. Tham
- Division of Pediatric Cardiology, Stollery Children’s Hospital & Mazankowski Alberta Heart Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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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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Mawad W, Mertens L, Pagano JJ, Riesenkampff E, Reichert MJE, Mital S, Kantor PF, Greenberg M, Liu P, Nathan PC, Grosse-Wortmann L. Effect of anthracycline therapy on myocardial function and markers of fibrotic remodelling in childhood cancer survivors. Eur Heart J Cardiovasc Imaging 2021; 22:435-442. [PMID: 32535624 PMCID: PMC7984732 DOI: 10.1093/ehjci/jeaa093] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/01/2019] [Accepted: 05/07/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS Anthracyclines are a cornerstone of paediatric cancer treatment. We aimed to quantify myocardial cardiac magnetic resonance (CMR) native T1 (NT1) and extracellular volume fraction (ECV) as markers of fibrosis in a cohort of childhood cancer survivors (CCS). METHODS AND RESULTS A cohort of CCS in remission underwent CMR T1 mapping. Diastolic function was assessed by echocardiography. Results were compared to a cohort of normal controls of similar age and gender. Fifty-five CCS and 46 controls were included. Both groups had similar mean left ventricular (LV) NT1 values (999 ± 36 vs. 1007 ± 32 ms, P = 0.27); ECV was higher (25.6 ± 6.9 vs. 20.7 ± 2.4%, P = 0.003) and intracellular mass was lower (37.5 ± 8.4 vs. 43.3 ± 9.9g/m2, P = 0.02) in CCS. The CCS group had lower LV ejection fraction (EF) and LV mass index with otherwise normal diastolic function in all but one patient. The proportion of subjects with elevated ECV compared to controls did not differ between subgroups with normal or reduced LV EF (22% vs. 28%; P = 0.13) and no correlations were found between LVEF and ECV. While average values remained within normal range, mitral E/E' (6.6 ± 1.6 vs. 5.9 ± 0.9, P = 0.02) was higher in CCS. Neither NT1 nor ECV correlated with diastolic function indices or cumulative anthracycline dose. CONCLUSIONS There is evidence for mild diffuse extracellular volume expansion in some asymptomatic CCS; myocyte loss could be part of the mechanism, accompanied by subtle changes in systolic and diastolic function. These findings suggest mild myocardial damage and remodelling after anthracycline treatment in some CCS which requires continued monitoring.
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Affiliation(s)
- Wadi Mawad
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Centre, 1001 Decarie Blvd,Montreal, QC, H4A 3J1, Canada
| | - Luc Mertens
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Joseph J Pagano
- Department of Paedatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, T6G 2B7, AB, Canada
| | - Eugenie Riesenkampff
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Marjolein J E Reichert
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Seema Mital
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital Los Angeles, Keck's School of Medicine of University of South California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Mark Greenberg
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Peter Liu
- Department of Paedatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 01 Smyth Rd, Ottawa, K1H 8L1, ON, Canada
| | - Paul C Nathan
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
- Department of Pediatrics Doernbecher Children’s Hospital, Oregon Health and Science University, 700 SW Campus Drive, Portland, OR 97239, USA
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Kirkham AA, Pituskin E, Thompson RB, Mackey JR, Koshman SL, Jassal D, Pitz M, Haykowsky MJ, Pagano JJ, Chow K, Tsui AK, Ezekowitz JA, Oudit GY, Paterson DI. Cardiac and Cardiometabolic Phenotyping of Trastuzumab-Mediated Cardiotoxicity: a Secondary Analysis of the MANTICORE trial. Eur Heart J Cardiovasc Pharmacother 2021; 8:130-139. [PMID: 33605416 DOI: 10.1093/ehjcvp/pvab016] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/26/2020] [Accepted: 02/17/2021] [Indexed: 01/02/2023]
Abstract
AIMS An improved understanding of the pathophysiology of trastuzumab-mediated cardiotoxicity is required to improve outcomes of patients with HER2-positive breast cancer. We aimed to characterize the cardiac and cardiometabolic phenotype of trastuzumab-mediated toxicity and potential interactions with cardiac pharmacotherapy. METHODS AND RESULTS This study was an analysis of serial magnetic resonance imaging (MRI) and circulating biomarker data acquired from patients with HER2-positive early stage breast cancer participating in a randomized-controlled clinical trial for the pharmaco-prevention of trastuzumab-associated cardiotoxicity. Circulating biomarkers (B-type natriuretic peptide, troponin I, MMP-2 and -9, GDF-15, neuregulin-1 and IGF-1) and MRI of cardiac structure and function and abdominal fat distribution were acquired prior to trastuzumab, post-cycle 4 and post-cycle 17. Ninety-four participants (51±8 years) completed the study with 30 on placebo, 33 on perindopril, and 31 on bisoprolol. Post-cycle 4, global longitudinal strain (GLS) deteriorated from baseline in both placebo (+2.0±2.7%, p = 0.002) and perindopril (+0.9±2.5%, p = 0.04), but not with bisoprolol (-0.2±2.1%, p = 0.55). In all groups combined, extracellular volume fraction and GDF-15 increased post-cycle 4 (+1.3±4.4%, p = 0.004; +130±150%, p ≤ 0.001, respectively). However, no significant change in troponin I was detected throughout trastuzumab. In all groups combined, visceral and intermuscular fat volume increased post-cycle 4 (+7±17%, p = 0.02, +8±23%, p = 0.02, respectively), while muscle volume and IGF-1 decreased from post-cycle 4 to 17 (-2±10%, p = 0.008, -18±28%, p < 0.001, respectively). CONCLUSION Trastuzumab results in impaired cardiac function and early myocardial inflammation. Trastuzumab is also associated with deleterious changes to the cardiometabolic phenotype which may contribute to the increased cardiovascular risk in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Chicago, Illinois
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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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Pagano JJ, Yim D, Lam CZ, Yoo SJ, Seed M, Grosse-Wortmann L. Normative Data for Myocardial Native T1 and Extracellular Volume Fraction in Children. Radiol Cardiothorac Imaging 2020; 2:e190234. [PMID: 33778602 DOI: 10.1148/ryct.2020190234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Purpose To establish normative data for myocardial T1, including extracellular volume (ECV) fraction, in healthy children. Materials and Methods In this retrospective, single-center study, T1 mapping data were collected from 48 healthy pediatric patients (14 years ± 3 [standard deviation]; range, 9-18 years; 27 of 48 [56%] male) referred for cardiac screening 1.5-T MRI between 2014 and 2017. T1 relaxometry was performed using a 5(number of heartbeats [nHB])3 modified Look-Locker inversion recovery (MOLLI) sequence, where nHB was three to five heartbeats depending on the heart rate, and was repeated 15 minutes following the administration of 0.2 mmol per kilogram of body weight of gadobenate dimeglumine, with 19 patients receiving contrast material. T1 values were calculated using a curve-fitting algorithm on average region-of-interest signal and corrected for imperfect inversion pulse efficiency. Comparisons within patients were performed with paired Student t test, between groups with unpaired Student t test or Mann-Whitney U test, and linear regression was performed to examine for associations with other variables. Results Average native T1 was 1008 msec ± 31, with a nonsignificant increase in females (1017 msec ± 27 vs 1001 msec ± 33, P = .066). Average ECV was 20.8% ± 2.4, with a nonsignificant increase in values in females (21.7% ± 1.9 vs 20.0% ± 2.6, P = .123). T1 and ECV values were increased in the septum versus the free wall. Conclusion Normative data are presented for myocardial native T1 and ECV using the MOLLI T1 mapping sequence at 1.5 T.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Joseph J Pagano
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Deane Yim
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Christopher Z Lam
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Shi-Joon Yoo
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Mike Seed
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada (J.J.P.); Department of Paediatrics, Division of Cardiology (D.Y., S.J.Y., M.S., L.G.W.) and Department of Diagnostic Imaging (C.Z.L., S.J.Y., M.S., L.G.W.), The Hospital for Sick Children, University of Toronto, Toronto, Canada; and Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia (D.Y.)
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Thompson RB, Chow K, Mager D, Pagano JJ, Grenier J. Simultaneous proton density fat-fraction and R 2 ∗ imaging with water-specific T 1 mapping (PROFIT 1 ): application in liver. Magn Reson Med 2020; 85:223-238. [PMID: 32754942 DOI: 10.1002/mrm.28434] [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: 04/14/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe and validate a simultaneous proton density fat-fraction (PDFF) imaging and water-specific T1 mapping (T1(Water) ) approach for the liver (PROFIT1 ) with R 2 ∗ mapping and low sensitivity to B 1 + calibration or inhomogeneity. METHODS A multiecho gradient-echo sequence, with and without saturation preparation, was designed for simultaneous imaging of liver PDFF, R 2 ∗ , and T1(Water) (three slices in ~13 seconds). Chemical-shift-encoded MRI processing yielded fat-water separated images and R 2 ∗ maps. T1(Water) calculation utilized saturation and nonsaturation-recovery water-separated images. Several variable flip angle schemes across k-space (increasing flip angles in sequential RF pulses) were evaluated for minimization of T1 weighting, to reduce the B 1 + dependence of T1(Water) and PDFF (reduced flip angle dependence). T1(Water) accuracy was validated in mixed fat-water phantoms, with various PDFF and T1 values (3T). In vivo application was illustrated in five volunteers and five patients with nonalcoholic fatty liver disease (PDFF, T1(Water) , R 2 ∗ ). RESULTS A sin3 (θ) flip angle pattern (0 < θ < π/2 over k-space) yielded the largest PROFIT1 signal yield with negligible B 1 + dependence for both T1(Water) and PDFF. Mixed fat-water phantom experiments illustrated excellent agreement between PROFIT1 and gold-standard spectroscopic evaluation of PDFF and T1(Water) (<1% T1 error). In vivo PDFF, T1(Water) , and R 2 ∗ maps illustrated independence of the PROFIT1 values from B 1 + inhomogeneity and significant differences between volunteers and patients with nonalcoholic fatty liver disease for T1(Water) (927 ± 56 ms vs. 1033 ± 23 ms; P < .05) and PDFF (2.0% ± 0.8% vs. 13.4% ± 5.0%, P < .05). R 2 ∗ was similar between groups. CONCLUSION The PROFIT1 pulse sequence provides fast simultaneous quantification of PDFF, T1(Water) , and R 2 ∗ with minimal sensitivity to B 1 + miscalibration or inhomogeneity.
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Affiliation(s)
- Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Diana Mager
- Department of Agriculture Food and Nutrition Science, University of Alberta, Edmonton, AB, Canada
| | - Joseph J Pagano
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Justin Grenier
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
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Karur GR, Pagano JJ, Bradley T, Lam CZ, Seed M, Yoo SJ, Grosse-Wortmann L. Diffuse Myocardial Fibrosis in Children and Adolescents With Marfan Syndrome and Loeys-Dietz Syndrome. J Am Coll Cardiol 2019; 72:2279-2281. [PMID: 30360836 DOI: 10.1016/j.jacc.2018.07.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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Thompson RB, Chow K, Pagano JJ, Sekowski V, Michelakis ED, Tymchak W, Haykowsky MJ, Ezekowitz JA, Oudit GY, Dyck JRB, Kaul P, Savu A, Paterson DI. Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2019; 21:58. [PMID: 31511018 PMCID: PMC6739968 DOI: 10.1186/s12968-019-0567-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 03/15/2019] [Accepted: 07/23/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary edema is a cardinal feature of heart failure but no quantitative tests are available in clinical practice. The goals of this study were to develop a simple cardiovascular magnetic resonance (CMR) approach for lung water quantification, to correlate CMR derived lung water with intra-cardiac pressures and to determine its prognostic significance. METHODS Lung water density (LWD, %) was measured using a widely available single-shot fast spin-echo acquisition in two study cohorts. Validation Cohort: LWD was compared to left ventricular end-diastolic pressure or pulmonary capillary wedge pressure in 19 patients with heart failure undergoing cardiac catheterization. Prospective Cohort: LWD was measured in 256 subjects, including 121 with heart failure, 82 at-risk for heart failure and 53 healthy controls. Clinical outcomes were evaluated up to 1 year. RESULTS Within the validation cohort, CMR LWD correlated to invasively measured left-sided filling pressures (R = 0.8, p < 0.05). In the prospective cohort, mean LWD was 16.6 ± 2.1% in controls, 17.9 ± 3.0% in patients at-risk and 19.3 ± 5.4% in patients with heart failure, p < 0.001. In patients with or at-risk for heart failure, LWD > 20.8% (mean + 2 standard deviations of healthy controls) was an independent predictor of death, hospitalization or emergency department visit within 1 year, hazard ratio 2.4 (1.1-5.1, p = 0.03). CONCLUSIONS In patients with heart failure, increased CMR-derived lung water is associated with increased intra-cardiac filling pressures, and predicts 1 year outcomes. LWD could be incorporated in standard CMR scans.
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Affiliation(s)
- Richard B. Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Joseph J. Pagano
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Viktor Sekowski
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Evangelos D. Michelakis
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Wayne Tymchak
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Mark J. Haykowsky
- College of Nursing and Health Innovation, The University of Texas Arlington, Arlington, TX USA
| | - Justin A. Ezekowitz
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Canadian Vigour Centre, University of Alberta, Edmonton, Canada
| | - Gavin Y. Oudit
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Jason R. B. Dyck
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Padma Kaul
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Anamaria Savu
- Canadian Vigour Centre, University of Alberta, Edmonton, Canada
| | - D. Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- University of Alberta Hospital, MacKenzie Health Sciences Centre, 8440–112 street, 2C2.43 Walter C, Edmonton, Alberta T6G2B7 Canada
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Lam CZ, Pagano JJ, Yim D, Yoo SJ, Seed M, Grosse-Wortmann L. Mapping versus source methods for quantifying myocardial T1 in controls and in repaired tetralogy of Fallot: interchangeability and reproducibility in children. Pediatr Radiol 2019; 49:1152-1162. [PMID: 31190110 DOI: 10.1007/s00247-019-04428-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/03/2019] [Accepted: 05/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial T1 relaxometry can be performed by contouring on individual T1-weighted source images (source method) or on a single T1 map (mapping method). OBJECTIVE This study compares (a) agreement between native T1 and extracellular volume results of the two methods and (b) interobserver reproducibility of the two methods in children without heart disease and those with tetralogy of Fallot (TOF). MATERIALS AND METHODS We retrospectively analyzed pediatric patients (controls and those with repaired TOF) with cardiac magnetic resonance examinations including extracellular volume quantification using the modified Look-Locker inversion recovery (MOLLI) sequence. We compared native T1 and extracellular volume of the entire left ventricle and interventricular septum derived using the source and the mapping approaches. RESULTS In the control group (n=25, median age 14.0 years, interquartile range [IQR] 11.5-16.5 years), the mapping method produced lower native T1 values than the source method in the interventricular septum (mean difference ± standard deviation [SD] = 12±15 ms, P<0.001). In the TOF group (n=50, median age 13.3 years, IQR 9.9-15.0 years), the mapping method produced lower values for native T1 and extracellular volume in the interventricular septum (mean difference 9±14 ms and 0.6±1.1%, P<0.001). In 6-12% of the children, differences were >3 standard deviations from the mean difference. Interobserver reproducibility between the two methods by intraclass correlation coefficients were clinically equivalent. CONCLUSION T1 and extracellular volume values generated by the source and mapping methods show systematic differences and can vary significantly in an individual child, and thus cannot be used interchangeably in clinical practice. The source method might allow for easier detection and, in some cases, mitigation of artifacts that are not infrequent in children and can be difficult to appreciate on the T1 map.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada.
| | - Joseph J Pagano
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Deane Yim
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
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de Lange C, Reichert MJE, Pagano JJ, Seed M, Yoo SJ, Broberg CS, Lam CZ, Grosse-Wortmann L. Increased extracellular volume in the liver of pediatric Fontan patients. J Cardiovasc Magn Reson 2019; 21:39. [PMID: 31303178 PMCID: PMC6628496 DOI: 10.1186/s12968-019-0545-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 10/23/2018] [Accepted: 05/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with single ventricle physiology are at increased risk for developing liver fibrosis. Its extent and prevalence in children with bidirectional cavopulmonary connection (BCPC) and Fontan circulation are unclear. Extracellular volume fraction (ECV), derived from cardiovascular magnetic resonance (CMR) and T1 relaxometry, reflect fibrotic remodeling and/or congestion in the liver. The aim of this study was to investigate whether pediatric patients with single ventricle physiology experience increased native T1 and ECV as markers of liver fibrosis/congestion. METHODS Hepatic native T1 times and ECV, using a cardiac short axis modified Look-Locker inversion recovery sequence displaying the liver, were measured retrospectively in children with BCPC- and Fontan circulations and compared to pediatric controls. RESULTS Hepatic native T1 time were increased in Fontan patients (n = 62, 11.4 ± 4.4 years, T1 762 ± 64 ms) versus BCPC patients (n = 20, 2.8 ± 0.9 years, T1 645 ± 43 ms, p = 0.04). Both cohorts had higher T1 than controls (n = 44, 13.7 ± 2.9 years, T1 604 ± 54 ms, p < 0.001 for both). ECV was 41.4 ± 4.8% in Fontan and 36.4 ± 4.8% in BCPC patients, respectively (p = 0.02). In Fontan patients, T1 values correlated with exposure to cardiopulmonary bypass time (R = 0.3, p = 0.02), systolic and end diastolic volumes (R = 0.3, p = 0.04 for both) and inversely with oxygen saturations and body surface area (R = -0.3, p = 0.04 for both). There were no demonstrable associations of T1 or ECV with central venous pressure or age after Fontan. CONCLUSION Fontan and BCPC patients have elevated CMR markers suggestive of hepatic fibrosis and/or congestion, even at a young age. The tissue changes do not appear to be related to central venous pressures. TRIAL REGISTRATION Retrospectively registered data.
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Affiliation(s)
- Charlotte de Lange
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Division of Radiology and Nuclear medicine, Pediatric section, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Marjolein J. E. Reichert
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Joseph J. Pagano
- Department of Pediatrics, Division of Cardiology, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta Canada
| | - Mike Seed
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Shi-Joon Yoo
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Craig S. Broberg
- Knight Cardiovascular Institute, Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Christopher Z. Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
| | - Lars Grosse-Wortmann
- Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada
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Thompson RB, Pagano JJ, Chow K, Sekowski V, Paterson I, Ezekowitz J, Anderson T, Dyck JRB, Haykowsky MJ. Subclinical Pulmonary Edema Is Associated With Reduced Exercise Capacity in HFpEF and HFrEF. J Am Coll Cardiol 2019; 70:1827-1828. [PMID: 28958338 DOI: 10.1016/j.jacc.2017.07.787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
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Lam CZ, Pagano JJ, Gill N, Vidarsson L, de la Mora R, Seed M, Grosse-Wortmann L, Yoo SJ. Dual phase infusion with bolus tracking: technical innovation for cardiac and respiratory navigated magnetic resonance angiography using extracellular contrast. Pediatr Radiol 2019; 49:399-406. [PMID: 30443668 DOI: 10.1007/s00247-018-4293-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
This technical innovation paper describes a technique for performing cardiac-gated, respiratory-navigated cardiovascular magnetic resonance angiography using an extracellular gadolinium-based contrast agent at 1.5 Tesla (T) with a dual phase bolus injection and slow infusion technique.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Joseph J Pagano
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Navjot Gill
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Logi Vidarsson
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Regina de la Mora
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Kirkham A, Xu L, Wang H, Chow K, Pagano JJ, White J, Haykowsky MJ, Dyck JR, Ezekowitz JA, Oudit GY, Mackey JR, Thompson RB, Pituskin E, Paterson I. Abstract P1-03-07: Breast cancer diagnosis is associated with relative left ventricular hypertrophy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-03-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cardiac dysfunction is a major concern for patients with breast cancer (BC) receiving adjuvant therapy. Retrospective, cross-sectional echocardiographic data suggests that patients with cancer have reduced myocardial strain prior to cancer therapy exposure. Cardiac magnetic resonance (CMR) is the gold standard imaging modality for cardiac structure and function and can also evaluate myocardial micro-architecture with T1 mapping. We hypothesized that treatment naïve patients with early-stage BC (ESBC) have abnormal myocardial tissue characteristics on CMR.
Methods: Women with newly diagnosed ESBC were prospectively recruited for CMR prior to cancer drug treatment. Those with hypertension, diabetes mellitus or prior cancer treatments were excluded. Age and sex matched healthy controls were identified from a prior prospective study. All participants underwent a non-contrast CMR scan on a 1.5T magnet. Image acquisition included cines for cardiac structure and function as well as T1 mapping using saturation recovery single-shot acquisitions. Global longitudinal strain (GLS) was derived from cine images. Demographics and imaging metrics for healthy controls and patients were compared using two-sample t-test.
Results: 106 patients with ESBC, mean age 51±9, were included along with 55 matched healthy controls. Body mass index and systolic blood pressure were similar between groups, however resting heart rate was elevated in patients compared to controls, 77±11 vs 67±11 /min respectively, p<0.001 (Table 1). On CMR there was no difference in left ventricular volume or ejection fraction however global longitudinal strain was higher in patients compared to controls, -20.9±2.3 vs -19.9±3.7%, p=0.04 (Table 2). Left ventricular mass was higher compared to controls, 52±6 and 47±6 g/m2 respectively, p<0.001. However myocardial T1 was similar between groups, T1=1198±27ms for controls vs 1206±46ms for patients, p=0.42.
Conclusions: The cardiac phenotype of patients with ESBC is characterized by relative left ventricular hypertrophy with normal myocardial tissue. Further understanding of the mechanisms involved may provide insight into the cardiovascular risk associated with BC diagnosis.
Table 1.Demographics Healthy Controls (n=55)Breast Cancer (n=106)P valueAge, years (SD)52(14)51(9)0.49Body mass index, kg/m2 (SD)26(5)27(6)0.38Hypertension, number00NADiabetes Mellitus, number00NAReceptor status, number (%) NAER/PRNA92(87%) HER2NA74(70%) Triple negativeNA2(2%) Stage, number (%) NA1NA43(42%) 2NA41(38%) 3NA23(20%) Systolic blood pressure, mmHg (SD)127(15)124(13)0.19Heart rate, /min (SD)67(11)77(11)<0.001SD=standard deviation, NA=not applicable
Table 2.Cardiac Magnetic Resonance Healthy Controls (n=55)Breast Cancer (n=106)P valueLVEF, % (SD)62(4)62(5)0.91Indexed LVEDV, ml/m2 (SD)69(9)72(14)0.18Indexed LV mass, g/m2 (SD)47(6)52(6)<0.001LV mass/LVEDV (SD)0.69(0.08)0.74(0.13)0.002Indexed left atrial volume, ml/m2 (SD)40(9)37(10)0.21Global longitudinal strain, % (SD)-19.9(3.7)-20.9(2.3)0.04Myocardial T1, ms (SD)1198(27)1206(46)0.42SD=standard deviation, LVEF=left ventricular ejection fraction, LVEDV=left ventricular end-diastolic volume, LV=left ventricular
Citation Format: Kirkham A, Xu L, Wang H, Chow K, Pagano JJ, White J, Haykowsky MJ, Dyck JR, Ezekowitz JA, Oudit GY, Mackey JR, Thompson RB, Pituskin E, Paterson I. Breast cancer diagnosis is associated with relative left ventricular hypertrophy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-07.
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Affiliation(s)
- A Kirkham
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - L Xu
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - H Wang
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - K Chow
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - JJ Pagano
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - J White
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - MJ Haykowsky
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - JR Dyck
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - JA Ezekowitz
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - GY Oudit
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - JR Mackey
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - RB Thompson
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - E Pituskin
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
| | - I Paterson
- University of Alberta, Edmonton, AB, Canada; University of Calgary, Calgary, AB, Canada; The University of Texas Arlington, Arlington, TX
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Pagano JJ, Chow K, Paterson DI, Mikami Y, Schmidt A, Howarth A, White J, Friedrich MG, Oudit GY, Ezekowitz J, Dyck J, Thompson RB. Effects of age, gender, and risk-factors for heart failure on native myocardial T 1
and extracellular volume fraction using the SASHA sequence at 1.5T. J Magn Reson Imaging 2018. [DOI: 10.1002/jmri.26550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Joseph J. Pagano
- Department of Biomedical Engineering; University of Alberta; Edmonton AB Canada
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc; Chicago Illinois USA
| | - D. Ian Paterson
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - Anna Schmidt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - Andrew Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - James White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - Matthias G. Friedrich
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
- Department of Medicine; Heidelberg University; Heidelberg Germany
- Department of Radiology; Université de Montréal; Montréal QC Canada
- Departments of Medicine and Diagnostic Radiology; Mc;Gill University Health Centre; Montréal QC Canada
| | - Gavin Y. Oudit
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Justin Ezekowitz
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Jason Dyck
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Pediatrics; University of Alberta; Edmonton AB Canada
| | - Richard B. Thompson
- Department of Biomedical Engineering; University of Alberta; Edmonton AB Canada
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
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Pagano JJ, Chow K, Paterson DI, Mikami Y, Schmidt A, Howarth A, White J, Friedrich MG, Oudit GY, Ezekowitz J, Dyck J, Thompson RB. Effects of age, gender, and risk-factors for heart failure on native myocardial T1
and extracellular volume fraction using the SASHA sequence at 1.5T. J Magn Reson Imaging 2018; 48:1307-1317. [DOI: 10.1002/jmri.26160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/07/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Joseph J. Pagano
- Department of Biomedical Engineering; University of Alberta; Edmonton AB Canada
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc; Chicago Illinois USA
| | - D. Ian Paterson
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - Anna Schmidt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - Andrew Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - James White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta; Calgary AB Canada
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
| | - Matthias G. Friedrich
- Departments of Cardiac Sciences and Radiology; University of Calgary; Calgary AB Canada
- Department of Medicine; Heidelberg University; Heidelberg Germany
- Department of Radiology; Université de Montréal; Montréal QC Canada
- Departments of Medicine and Diagnostic Radiology; Mc;Gill University Health Centre; Montréal QC Canada
| | - Gavin Y. Oudit
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Justin Ezekowitz
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Jason Dyck
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
- Department of Pediatrics; University of Alberta; Edmonton AB Canada
| | - Richard B. Thompson
- Department of Biomedical Engineering; University of Alberta; Edmonton AB Canada
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton AB Canada
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Wang H, Xu L, Chow K, Pagano JJ, Schmidt A, White JA, Michelakis E, Ezekowitz J, Dyck J, Haykowsky M, Oudit GY, Thompson RB, Paterson I. Right ventricular remodeling and dysfunction among the spectrum of heart failure phenotypes. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032201 DOI: 10.1186/1532-429x-18-s1-p73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Pituskin E, Mackey JR, Koshman S, Jassal D, Pitz M, Haykowsky MJ, Pagano JJ, Chow K, Thompson RB, Vos LJ, Ghosh S, Oudit GY, Ezekowitz JA, Paterson DI. Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity. J Clin Oncol 2016; 35:870-877. [PMID: 27893331 DOI: 10.1200/jco.2016.68.7830] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The primary toxicity of trastuzumab therapy for human epidermal growth factor receptor 2-overexpressing (HER2-positive) breast cancer is dose-independent cardiac dysfunction. Angiotensin-converting enzyme inhibitors and β-blockers are recommended first-line agents for heart failure. We hypothesized that angiotensin-converting enzyme inhibitors and β-blockers could prevent trastuzumab-related cardiotoxicity. Patients and Methods In this double-blinded, placebo-controlled trial, patients with HER2-positive early breast cancer were randomly assigned to receive treatment with perindopril, bisoprolol, or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Patients underwent cardiac magnetic resonance imaging at baseline and post-cycle 17 for the determination of left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was evaluated as the change in indexed left ventricular end diastolic volume and LVEF. Results Thirty-three patients received perindopril, 31 received bisoprolol, and 30 received placebo. Baseline demographic, cancer, and cardiovascular profiles were similar between groups. Study drugs were well tolerated with no serious adverse events. After 17 cycles of trastuzumab, indexed left ventricular end diastolic volume increased in patients treated with perindopril (+7 ± 14 mL/m2), bisoprolol (+8 mL ± 9 mL/m2), and placebo (+4 ± 11 mL/m2; P = .36). In secondary analyses, trastuzumab-mediated decline in LVEF was attenuated in bisoprolol-treated patients (-1 ± 5%) relative to the perindopril (-3 ± 4%) and placebo (-5 ± 5%) groups ( P = .001). Perindopril and bisoprolol use were independent predictors of maintained LVEF on multivariable analysis. Conclusion Perindopril and bisoprolol were well tolerated in patients with HER2-positive early breast cancer who received trastuzumab and protected against cancer therapy-related declines in LVEF; however, trastuzumab-mediated left ventricular remodeling-the primary outcome-was not prevented by these pharmacotherapies.
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Affiliation(s)
- Edith Pituskin
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Mackey
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheri Koshman
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder Jassal
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark J Haykowsky
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph J Pagano
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelvin Chow
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard B Thompson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa J Vos
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sunita Ghosh
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gavin Y Oudit
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin A Ezekowitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D Ian Paterson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
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Thompson RB, Pagano JJ, Mathewson KW, Paterson I, Dyck JR, Kitzman DW, Haykowsky MJ. Differential Responses of Post-Exercise Recovery of Leg Blood Flow and Oxygen Uptake Kinetics in HFpEF versus HFrEF. PLoS One 2016; 11:e0163513. [PMID: 27701422 PMCID: PMC5049795 DOI: 10.1371/journal.pone.0163513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/09/2016] [Indexed: 12/03/2022] Open
Abstract
The goals of the current study were to compare leg blood flow, oxygen extraction and oxygen uptake (VO2) after constant load sub-maximal unilateral knee extension (ULKE) exercise in patients with heart failure with reduced ejection fraction (HFrEF) compared to those with preserved ejection fraction (HFpEF). Previously, it has been shown that prolonged whole body VO2 recovery kinetics are directly related to disease severity and all-cause mortality in HFrEF patients. To date, no study has simultaneously measured muscle-specific blood flow and oxygen extraction post exercise recovery kinetics in HFrEF or HFpEF patients; therefore it is unknown if muscle VO2 recovery kinetics, and more specifically, the recovery kinetics of blood flow and oxygen extraction at the level of the muscle, differ between HF phenotypes. Ten older (68±10yrs) HFrEF (n = 5) and HFpEF (n = 5) patients performed sub-maximal (85% of maximal weight lifted during an incremental test) ULKE exercise for 4 minutes. Femoral venous blood flow and venous O2 saturation were measured continuously from the onset of end-exercise, using a novel MRI method, to determine off-kinetics (mean response times, MRT) for leg VO2 and its determinants. HFpEF and HFrEF patients had similar end-exercise leg blood flow (1.1±0.6 vs. 1.2±0.6 L/min, p>0.05), venous saturation (42±12 vs. 41±11%, p>0.05) and VO2 (0.13±0.08 vs. 0.11±0.05 L/min, p>0.05); however HFrEF had significantly delayed recovery MRT for flow (292±135sec. vs 105±63sec., p = 0.004) and VO2 (95±37sec. vs. 47±15sec., p = 0.005) compared to HFpEF. Impaired muscle VO2 recovery kinetics following ULKE exercise differentiated HFrEF from HFpEF patients and suggests distinct underlying pathology and potential therapeutic approaches in these populations.
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Affiliation(s)
- Richard B. Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Joseph J. Pagano
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Kory W. Mathewson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Jason R. Dyck
- Department of Pediatrics and Pharmacology, University of Alberta, Edmonton, Canada
| | - Dalane W. Kitzman
- Cardiology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Mark J. Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, United States of America
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Pagano JJ, Chow K, Paterson I, Thompson RB. Aging and gender effects in native T1 and extracellular volume fraction assessment using SASHA. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032318 DOI: 10.1186/1532-429x-18-s1-q3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Thompson RB, Pagano JJ, Paterson I, Dyck J, Kitzman D, Haykowsky M. Differential responses of post-exercise recovery leg blood flow and oxygen uptake kinetics in HFPEF versus HFREF. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032387 DOI: 10.1186/1532-429x-18-s1-o9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Thompson RB, Chow K, Sekowski V, Michelakis E, Pagano JJ, Tymchak W, Haykowsky M, Ezekowitz J, Oudit GY, Dyck J, Paterson I. Quantification of pulmonary edema in heart failure using MRI: invasive validation and evaluation in HFpEF and HFrEF patients. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032371 DOI: 10.1186/1532-429x-18-s1-o49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cheng-Baron J, Chow K, Pagano JJ, Punithakumar K, Paterson DI, Oudit GY, Thompson RB. Quantification of circumferential, longitudinal, and radial global fractional shortening using steady-state free precession cines: a comparison with tissue-tracking strain and application in Fabry disease. Magn Reson Med 2014; 73:586-96. [PMID: 24634139 DOI: 10.1002/mrm.25166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/11/2014] [Accepted: 01/13/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Conventional calculation of myocardial strain requires tissue-tracking. A surrogate for strain called global fractional shortening (GFS) is proposed based on changes in dimensions of endocardial and epicardial surfaces without tissue-tracking. METHODS Three-dimensional endocardial and epicardial left ventricular surfaces traced at end-diastole and end-systole using conventional steady-state free precession cine images were used to calculate GFScc (circumferential), GFSll (longitudinal), and GFSrr (radial) using fractional length changes in each direction over the heart surface. GFS values were validated using finite element models (FEM) and in vivo using tagging-derived strains (εcc ,εll ,εrr ) in patients with a wide range of ejection fraction (EF) and diagnosis (n=32). GFS was also measured in 31 patients with Fabry disease and matched healthy controls. RESULTS GFS values were within 3% of average FEM-derived Lagrangian strains and had good agreement in vivo (GFScc =-14 ± 4%, εcc =-14 ± 4%, R(2) =0.85; GFSll =-12 ± 4%, εll =-12 ± 4%, R(2) =0.72; GFSrr =46 ± 21%). εrr could not be measured reliably from tagging. Compared with healthy controls with matched EF, patients with Fabry disease had significantly increased GFScc (Endo) (-28 ± 3% versus -25 ± 2%), decreased GFScc(Epi) (-10 ± 2% versus -11 ± 2%) and decreased GFSll for all components. CONCLUSION GFS yields similar values to conventionally measured strains without requiring tissue-tracking. Compared with controls, patients with Fabry disease have significant differences in several GFS components.
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Affiliation(s)
- June Cheng-Baron
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
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Pagano JJ, Chow K, Yang R, Thompson RB. Fat-water separated myocardial T1 mapping with IDEAL-T1 saturation recovery gradient echo imaging. J Cardiovasc Magn Reson 2014. [PMCID: PMC4045596 DOI: 10.1186/1532-429x-16-s1-p65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pagano JJ, Chow K, Khan A, Michelakis E, Paterson I, Oudit GY, Thompson RB. Reduced native right ventricular T1 in Anderson-Fabry disease as compared to patients with pulmonary hypertension. J Cardiovasc Magn Reson 2014. [PMCID: PMC4042516 DOI: 10.1186/1532-429x-16-s1-p2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Chow K, Flewitt JA, Green JD, Pagano JJ, Friedrich MG, Thompson RB. Saturation recovery single-shot acquisition (SASHA) for myocardial T
1
mapping. Magn Reson Med 2013; 71:2082-95. [DOI: 10.1002/mrm.24878] [Citation(s) in RCA: 263] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 06/18/2013] [Accepted: 06/18/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Kelvin Chow
- Department of Biomedical Engineering; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Canada
| | - Jacqueline A. Flewitt
- Stephenson Cardiovascular Centre; Libin Cardiovascular Institute of Alberta, University of Calgary; Calgary Canada
- Marvin Carsley CMR Centre; Montreal Heart Institute, Université de Montréal; Montreal Canada
| | | | - Joseph J. Pagano
- Department of Biomedical Engineering; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Canada
| | - Matthias G. Friedrich
- Stephenson Cardiovascular Centre; Libin Cardiovascular Institute of Alberta, University of Calgary; Calgary Canada
- Marvin Carsley CMR Centre; Montreal Heart Institute, Université de Montréal; Montreal Canada
| | - Richard B. Thompson
- Department of Biomedical Engineering; Faculty of Medicine and Dentistry; University of Alberta; Edmonton Canada
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Tham EB, Haykowsky MJ, Chow K, Spavor M, Kaneko S, Khoo NS, Pagano JJ, Mackie AS, Thompson RB. Diffuse myocardial fibrosis by T1-mapping in children with subclinical anthracycline cardiotoxicity: relationship to exercise capacity, cumulative dose and remodeling. J Cardiovasc Magn Reson 2013; 15:48. [PMID: 23758789 PMCID: PMC3688348 DOI: 10.1186/1532-429x-15-48] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 05/16/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The late cardiotoxic effects of anthracycline chemotherapy influence morbidity and mortality in the growing population of childhood cancer survivors. Even with lower anthracycline doses, evidence of adverse cardiac remodeling and reduced exercise capacity exist. We aim to examine the relationship between cardiac structure, function and cardiovascular magnetic resonance (CMR) tissue characteristics with chemotherapy dose and exercise capacity in childhood cancer survivors. METHODS Thirty patients (15 ± 3 years), at least 2 years following anthracycline treatment, underwent CMR, echocardiography, and cardiopulmonary exercise testing (peak VO(2)). CMR measured ventricular function, mass, T(1) and T(2) values, and myocardial extracellular volume fraction, ECV, a measure of diffuse fibrosis based on changes in myocardial T1 values pre- and post-gadolinium. Cardiac function was also assessed with conventional and speckle tracking echocardiography. RESULTS Patients had normal LVEF (59 ± 7%) but peak VO(2) was 17% lower than age-predicted normal values and were correlated with anthracycline dose (r = -0.49). Increased ECV correlated with decreased mass/volume ratio (r = -0.64), decreased LV wall thickness/height ratio (r = -0.72), lower peak VO(2)(r = -0.52), and higher cumulative dose (r = 0.40). Echocardiographic measures of systolic and diastolic function were reduced compared to normal values (p < 0.01), but had no relation to ECV, peak VO(2) or cumulative dose. CONCLUSIONS Myocardial T1 and ECV were found to be early tissue markers of ventricular remodeling that may represent diffuse fibrosis in children with normal ejection fraction post anthracycline therapy, and are related to cumulative dose, exercise capacity and myocardial wall thinning.
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Affiliation(s)
- Edythe B Tham
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Stollery Children’s Hospital, 4C2 Walter C Mackenzie Centre, 8440-112 Street, Edmonton, AB T6G 2B7, Canada
| | - Mark J Haykowsky
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Maria Spavor
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Sachie Kaneko
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Nee S Khoo
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Joseph J Pagano
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Andrew S Mackie
- Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
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Pagano JJ, Chow K, Paterson I, Thompson RB. Imaging contrast agent concentration and extracellular volume fraction in the right ventricle. J Cardiovasc Magn Reson 2012. [PMCID: PMC3305073 DOI: 10.1186/1532-429x-14-s1-o109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chow K, Flewitt J, Pagano JJ, Green JD, Friedrich MG, Thompson RB. T2-dependent errors in MOLLI T1 values: simulations, phantoms, and in-vivo studies. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304811 DOI: 10.1186/1532-429x-14-s1-p281] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pituskin E, Haykowsky M, Mackey JR, Thompson RB, Ezekowitz J, Koshman S, Oudit G, Chow K, Pagano JJ, Paterson I. Rationale and design of the Multidisciplinary Approach to Novel Therapies in Cardiology Oncology Research Trial (MANTICORE 101--Breast): a randomized, placebo-controlled trial to determine if conventional heart failure pharmacotherapy can prevent trastuzumab-mediated left ventricular remodeling among patients with HER2+ early breast cancer using cardiac MRI. BMC Cancer 2011; 11:318. [PMID: 21794114 PMCID: PMC3171383 DOI: 10.1186/1471-2407-11-318] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [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: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND MANTICORE 101 - Breast (Multidisciplinary Approach to Novel Therapies in Cardiology Oncology Research) is a randomized trial to determine if conventional heart failure pharmacotherapy (angiotensin converting enzyme inhibitor or beta-blocker) can prevent trastuzumab-mediated left ventricular remodeling, measured with cardiac MRI, among patients with HER2+ early breast cancer. METHODS/DESIGN One hundred and fifty-nine patients with histologically confirmed HER2+ breast cancer will be enrolled in a parallel 3-arm, randomized, placebo controlled, double-blind design. After baseline assessments, participants will be randomized in a 1:1:1 ratio to an angiotensin-converting enzyme inhibitor (perindopril), beta-blocker (bisoprolol), or placebo. Participants will receive drug or placebo for 1 year beginning 7 days before trastuzumab therapy. Dosages for all groups will be systematically up-titrated, as tolerated, at 1 week intervals for a total of 3 weeks. The primary objective of this randomized clinical trial is to determine if conventional heart failure pharmacotherapy can prevent trastuzumab-mediated left ventricular remodeling among patients with HER2+ early breast cancer, as measured by 12 month change in left ventricular end-diastolic volume using cardiac MRI. Secondary objectives include 1) determine the evolution of left ventricular remodeling on cardiac MRI in patients with HER2+ early breast cancer, 2) understand the mechanism of trastuzumab mediated cardiac toxicity by assessing for the presence of myocardial injury and apoptosis on serum biomarkers and cardiac MRI, and 3) correlate cardiac biomarkers of myocyte injury and extra-cellular matrix remodeling with left ventricular remodeling on cardiac MRI in patients with HER2+ early breast cancer. DISCUSSION Cardiac toxicity as a result of cancer therapies is now recognized as a significant health problem of increasing prevalence. To our knowledge, MANTICORE will be the first randomized trial testing proven heart failure pharmacotherapy in the prevention of trastuzumab-mediated cardiotoxicity. We expect the findings of this trial to provide important evidence in the development of guidelines for preventive therapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT01016886.
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Chiarenzelli JR, Scrudato RJ, Wunderlich ML, Pagano JJ. Combined steam distillation and electrochemical peroxidation (ECP) treatment of river sediment contaminated by PCBs. Chemosphere 2001; 45:1159-1165. [PMID: 11695629 DOI: 10.1016/s0045-6535(00)00569-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A combined treatment process utilizing steam distillation followed by electrochemical peroxidation (ECP) has been utilized to remove >90% of the polychlorinated biphenyls (PCBs) in St. Lawrence River sediment and destroy 95% of the PCBs recovered in the condensate. 2 l of condensate were collected by boiling 500 grams of sediment containing approximately 4.3 mg PCBs. Most of the PCBs (82.3%) were recovered as a small volume (<1 ml) of yellow oil floating on the condensate and coating glassware surfaces. The aqueous phase PCBs (182 microg/l) were destroyed (95%) by three sequential ECP treatments at 16.8 degrees C and pH 5, utilizing 1 ml of H2O2 (3%) and periodically reversed current (0.75-1.0 A @ 10 volts). Oxidation is primarily mediated by hydroxyl radicals produced by the reaction of hydrogen peroxide with electrochemically generated ferrous iron (Fenton's reagent). This work suggests steam extraction, in combination with advanced oxidation technologies, provides an effective treatment strategy for contaminated solids.
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Pagano JJ, Scrudato RJ, Roberts RN, Bemis JC. Reductive Dechlorination of PCB-Contaminated Sediments in an Anaerobic Bioreactor System. Environ Sci Technol 1995; 29:2584-2589. [PMID: 22191958 DOI: 10.1021/es00010a019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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