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Liu J, Li J, Xia C, He W, Li X, Shen S, Zhou X, Tong N, Peng L. The effect of hyperlipidemia and body fat distribution on subclinical left ventricular function in obesity: a cardiovascular magnetic resonance study. Cardiovasc Diabetol 2024; 23:120. [PMID: 38566090 PMCID: PMC10985902 DOI: 10.1186/s12933-024-02208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Obesity is often associated with multiple comorbidities. However, whether obese subjects with hyperlipidemia in the absence of other complications have worse cardiac indices than metabolically healthy obese subjects is unclear. Therefore, we aimed to determine the effect of hyperlipidemia on subclinical left ventricular (LV) function in obesity and to evaluate the association of cardiac parameters with body fat distribution. MATERIALS AND METHODS Ninety-two adults were recruited and divided into 3 groups: obesity with hyperlipidemia (n = 24, 14 males), obesity without hyperlipidemia (n = 25, 13 males), and c ntrols (n = 43, 25 males). LV strain parameters (peak strain (PS), peak diastolic strain rate (PDSR), peak systolic strain rate) derived from cardiovascular magnetic resonance tissue tracking were measured and compared. Dual-energy X-ray absorptiometer was used to measure body fat distribution. Correlations of hyperlipidemia and body fat distribution with LV strain were assessed by multivariable linear regression. RESULTS Obese individuals with preserved LV ejection fraction showed lower global LV longitudinal, circumferential, and radial PS and longitudinal and circumferential PDSR than controls (all P < 0.05). Among obese patients, those with hyperlipidemia had lower longitudinal PS and PDSR and circumferential PDSR than those without hyperlipidemia (- 12.8 ± 2.9% vs. - 14.2 ± 2.7%, 0.8 ± 0.1 s-1 vs. 0.9 ± 0.3 s-1, 1.2 ± 0.2 s-1 vs. 1.4 ± 0.2 s-1; all P < 0.05). Multivariable linear regression demonstrated that hyperlipidemia was independently associated with circumferential PDSR (β = - 0.477, P < 0.05) in obesity after controlling for growth differences, other cardiovascular risk factors, and central fat distribution. In addition, android fat had an independently negative relationship with longitudinal and radial PS (β = - 0.486 and β = - 0.408, respectively; all P < 0.05); and visceral fat was negatively associated with longitudinal PDSR (β = - 0.563, P < 0.05). Differently, gynoid fat was positively correlated with circumferential PS and PDSR and radial PDSR (β = 0.490, β = 0.481, and β = 0.413, respectively; all P < 0.05). CONCLUSION Hyperlipidemia is independently associated with subclinical LV diastolic dysfunction in obesity. Central fat distribution (android and visceral fat) has a negative association, while peripheral fat distribution (gynoid fat) has a positive association on subclinical LV function. These results suggest that appropriate management of hyperlipidemia may be beneficial for obese patients, and that the differentiation of fat distribution in different regions may facilitate the precise management of obese patients. Clinical trials registration Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).
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Affiliation(s)
- Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Jing Li
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Sumin Shen
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, 200126, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
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Yan H, Geng D, Zhao W, Li S, Du X, Zhang S, Wang H. Differences in intracranial atherosclerosis plaque between posterior circulation and anterior circulation on high-resolution magnetic resonance imaging: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107616. [PMID: 38316284 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107616] [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] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques (PCAPs) are distinct. We aimed to compare the differences in vulnerability, morphology, and distribution between ACAPs and PCAPs based on hign-resolution magnetic resonance imaging (HR-MRI). MATERIALS AND METHODS The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results. RESULTS There were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups. CONCLUSION There were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.
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Affiliation(s)
- Han Yan
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Dandan Geng
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Wannian Zhao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Shasha Li
- Hebei North University, Zhangjiakou, Hebei, China.
| | - Xiaomeng Du
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Shijing Zhang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China; Hebei North University, Zhangjiakou, Hebei, China.
| | - Hebo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China.
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Trinchillo A, Barchetti F, De Joanna G, Esposito M, Piccirillo G, Miniello S. A case of hemichorea associated with nonketotic hyperglycaemia: A new magnetic resonance spectroscopy (MRS) finding and possible future implications. Clin Physiol Funct Imaging 2024; 44:131-135. [PMID: 37961026 DOI: 10.1111/cpf.12865] [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] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Diabetic Striatopathy (DS) is a rare complication of a poor-controlled Diabetes Mellitus consisting of sudden onset of movement disorders. To date, there is still poor knowledge about the pathogenesis. CASE We describe a 79 year old men affected by sudden onset hemichoreic movements whose cause was a non-ketotic hyperglycaemia diagnosed despite the normal blood glucose levels thanks to brain CT and magnetic resonance imaging. Then, we introduce a new magnetic resonance spectroscopy (MRS) finding never described until today which allowed us to produce a new pathogenetic theory of a phenomenon still without definitive explanations. LITERATURE REVIEW We performed a review of DS cases using the Medline database and we extracted main data regarding imaging findings. CONCLUSIONS Thanks to our MRS we show new imaging findings never described until today, with a new pathogenetic explanation, since all the causative hypotheses produced during the past years have never found evidence.
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Affiliation(s)
- Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy
| | - Flavio Barchetti
- Neuroradiology Unit, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | | | - Marcello Esposito
- Department of Neurophysiology, A.O.R.N. A. Cardarelli, Naples, Italy
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Bergamaschi L, Foà A, Paolisso P, Renzulli M, Angeli F, Fabrizio M, Bartoli L, Armillotta M, Sansonetti A, Amicone S, Stefanizzi A, Rinaldi A, Niro F, Lovato L, Gherbesi E, Carugo S, Pasquale F, Casella G, Galiè N, Rucci P, Bucciarelli-Ducci C, Pizzi C. Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries. JACC Cardiovasc Imaging 2024; 17:149-161. [PMID: 37480903 DOI: 10.1016/j.jcmg.2023.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 12/05/2022] [Revised: 04/10/2023] [Accepted: 05/12/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) plays a pivotal diagnostic role in myocardial infarction with nonobstructive coronary arteries (MINOCA). To date, a prognostic stratification of these patients is still lacking. OBJECTIVES This study aims to assess the prognostic role of CMR in MINOCA. METHODS The authors assessed 437 MINOCA from January 2017 to October 2021. They excluded acute myocarditis, takotsubo syndromes, cardiomyopathies, and other nonischemic etiologies. Patients were classified into 3 subgroups according to the CMR phenotype: 1) presence of late gadolinium enhancement (LGE) and abnormal mapping (M) values (LGE+/M+); 2) regional ischemic injury with abnormal mapping and no LGE (LGE-/M+); and 3) nonpathological CMRs (LGE-/M-). The primary outcome was the presence of major adverse cardiovascular events (MACE). The mean follow-up was 33.7 ± 12.0 months and CMR was performed on average at 4.8 ± 1.5 days from the acute presentation. RESULTS The final cohort included 198 MINOCA; 116 (58.6%) comprised the LGE+/M+ group. During follow-up, MACE occurred significantly more frequently in MINOCA LGE+/M+ than in the LGE+/M- and normal-CMR (LGE-/M-) subgroups (20.7% vs 6.7% and 2.7%; P = 0.006). The extension of myocardial damage at CMR was significantly greater in patients who developed MACE. In multivariable Cox regression, %LGE was an independent predictor of MACE (HR: 1.123 [95% CI: 1.064-1.185]; P < 0.001) together with T2 mapping values (HR: 1.190 [95% CI: 1.145-1.237]; P = 0.001). CONCLUSIONS In MINOCA with early CMR execution, the %LGE and abnormal T2 mapping values were identified as independent predictors of adverse cardiac events at ∼3.0 years of follow-up. These parameters can be considered as high-risk markers in MINOCA.
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Affiliation(s)
- Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michele Fabrizio
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lorenzo Bartoli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabio Niro
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Pediatric and Adult CardioThoracic and Vascular, Onchoematologic and Emergency Radiology Unit
| | - Luigi Lovato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Pediatric and Adult CardioThoracic and Vascular, Onchoematologic and Emergency Radiology Unit
| | - Elisa Gherbesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department, Milan, Italy
| | - Ferdinando Pasquale
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust London, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Pontone G, Guaricci AI, Fusini L, Baggiano A, Guglielmo M, Muscogiuri G, Volpe A, Abete R, Aquaro G, Barison A, Bogaert J, Camastra G, Carigi S, Carrabba N, Casavecchia G, Censi S, Cicala G, De Cecco CN, De Lazzari M, Di Giovine G, Di Roma M, Dobrovie M, Focardi M, Gaibazzi N, Gismondi A, Gravina M, Lanzillo C, Lombardi M, Lorenzoni V, Lozano-Torres J, Martini C, Marzo F, Masi A, Memeo R, Moro C, Nese A, Palumbo A, Pavon AG, Pedrotti P, Marra MP, Pica S, Pradella S, Presicci C, Rabbat MG, Raineri C, Rodriguez-Palomares JF, Sbarbati S, Schoepf UJ, Squeri A, Sverzellati N, Symons R, Tat E, Timpani M, Todiere G, Valentini A, Varga-Szemes A, Masci PG, Schwitter J. Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry. JACC Cardiovasc Imaging 2023; 16:1387-1400. [PMID: 37227329 DOI: 10.1016/j.jcmg.2023.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. OBJECTIVES The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. METHODS A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. RESULTS During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). CONCLUSIONS The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.
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Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | | | - Raffaele Abete
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Giovanni Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Andrea Barison
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | | | - Samuela Carigi
- Department of Cardiology, Infermi Hospital, Rimini, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department, Careggi Hospital, Florence, Italy
| | - Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Censi
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Gloria Cicala
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Emory University, Atlanta, Georgia, USA
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | | | - Mauro Di Roma
- Radiology Department, Policlinico Casilino, Rome, Italy
| | - Monica Dobrovie
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Annalaura Gismondi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | | | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Jordi Lozano-Torres
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red-CV, CIBER CV, Spain
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Ambra Masi
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Memeo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Claudio Moro
- Department of Cardiology, ASST Monza, P.O. Desio, Italy
| | - Alberto Nese
- Dipartimento Neuro-Cardiovascolare, Ospedale Ca' Foncello Treviso, Treviso, Italy
| | - Alessandro Palumbo
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Giulia Pavon
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
| | - Patrizia Pedrotti
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Cristina Presicci
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois, USA; Edward Hines Jr VA Hospital, Hines, Illinois, USA
| | - Claudia Raineri
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - José F Rodriguez-Palomares
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red-CV, CIBER CV, Spain
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rolf Symons
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Emily Tat
- Loyola University of Chicago, Chicago, Illinois, USA
| | - Mauro Timpani
- U.O.C. Radiologia, "F. Spaziani" Hospital, Frosinone, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Juerg Schwitter
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland; Faculty of Medicine and Biology, University of Lausanne, UniL, Lausanne, Switzerland
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Pengyos S, Boonyasirinant T, Kaolawanich Y. Aortic stiffness effectively risk stratifies diabetic patients with suspected myocardial ischemia undergoing vasodilatory stress perfusion cardiac magnetic resonance. BMC Cardiovasc Disord 2023; 23:502. [PMID: 37817068 PMCID: PMC10566029 DOI: 10.1186/s12872-023-03532-0] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND AIMS Cardiovascular magnetic resonance (CMR) comprehensively assesses aortic stiffness and myocardial ischemia in a single examination. Aortic stiffness represents a subclinical marker of cardiovascular risk in the general population, including patients with diabetes mellitus. However, there is no prognostic data regarding aortic stiffness in patients with diabetes mellitus undergoing stress perfusion CMR. METHODS Consecutive patients with diabetes mellitus with suspected myocardial ischemia referred for adenosine stress perfusion CMR with aortic pulse wave velocity (PWV) during 2010-2013 were studied. The primary outcome was major adverse cardiovascular events (MACE), defined as the composite of cardiac mortality, nonfatal myocardial infarction (MI), hospitalization for heart failure, coronary revascularization (> 90 days post-CMR), and ischemic stroke. The secondary outcome was hard cardiac events, defined as the composite of cardiac mortality and nonfatal MI. RESULTS A total of 424 patients (median follow-up 7.2 years) were included. The mean PWV was 12.16 ± 6.28 m/s. MACE and hard cardiac events occurred in 26.8% and 9.4% of patients, respectively. Patients with elevated PWV (> 12.16 m/s) had a significantly higher incidence of MACE (HR 2.14 [95%CI 1.48, 3.09], p < 0.001) and hard cardiac events (HR 2.69 [95%CI 1.42, 5.10], p = 0.002) compared to those with non-elevated PWV. Multivariable analysis demonstrated that PWV independently predicts MACE (p = 0.003) and hard cardiac events (p = 0.01). Addition of PWV provided incremental prognostic value beyond clinical data, left ventricular mass index, myocardial ischemia, and late gadolinium enhancement in predicting MACE (incremental χ² 7.54, p = 0.006) and hard cardiac events (incremental χ² 5.99, p = 0.01). CONCLUSIONS Aortic stiffness measured by CMR independently predicts MACE and hard cardiac events and confers significant incremental prognostic value in patients with diabetes mellitus with suspected myocardial ischemia. Aortic stiffness measurement could potentially be considered as part of a stress perfusion CMR protocol to enhance risk prediction in patients with diabetes mellitus.
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Affiliation(s)
- Sukanda Pengyos
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
- Division of Cardiology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Thananya Boonyasirinant
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Russo F, Ambrosio L, Giannarelli E, Vorini F, Mallio CA, Quattrocchi CC, Vadalà G, Papalia R, Denaro V. Innovative quantitative magnetic resonance tools to detect early intervertebral disc degeneration changes: a systematic review. Spine J 2023; 23:1435-1450. [PMID: 37247638 DOI: 10.1016/j.spinee.2023.05.011] [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: 01/25/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is the leading cause of disability worldwide, with a tremendous socioeconomic burden. It is mainly caused by intervertebral disc degeneration (IDD), a progressive and age-related process. Due to its ability to accurately characterize intervertebral disc morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing IDD. Innovative quantitative MRI (qMRI) techniques able to detect the earliest signs of IDD have been increasingly reported. PURPOSE To systematically review available reports on the application of novel qMRI techniques to detect early IDD changes. STUDY DESIGN Systematic literature review. METHODS A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL and Cochrane databases was performed through January 21, 2023. Randomized and nonrandomized studies on innovative qMRI tools able to diagnose early biochemical and architectural IDD changes in patients with or without discogenic LBP were searched. Data on study population, follow-up time (when applicable) and MRI sequence used were recorded. The QUADAS-2 tool was utilized to assess the risk of bias of included studies. RESULTS A total of 39 articles published between 2005 and 2022 resulted from the search. All novel qMRI techniques showed an increased capacity to detect early IDD changes thanks to the ability to assess subtle alterations of water content, proteoglycan and glycosaminoglycan concentration, and increased levels of catabolic biomarkers compared to conventional MRI. CONCLUSIONS Innovative qMRI techniques have proven effective in identifying premature IDD changes. Further studies are needed to validate their application in wider populations and confirm their applicability in the clinical setting.
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Affiliation(s)
- Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Eugenio Giannarelli
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo A Mallio
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Gatterer C, Wollenweber T, Pichler V, Vraka C, Sunder-Plassmann G, Lenz M, Hengstenberg C, Hacker M, Loewe C, Graf S, Beitzke D. Detection of sympathetic denervation defects in Fabry disease by hybrid [ 11C]meta-hydroxyephedrine positron emission tomography and cardiac magnetic resonance. J Nucl Cardiol 2023; 30:1810-1821. [PMID: 36855009 PMCID: PMC10558396 DOI: 10.1007/s12350-023-03205-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Myocardial glycosphingolipid accumulation in patients with Fabry disease (FD) causes biochemical and structural changes. This study aimed to investigate sympathetic innervation in FD using hybrid cardiac positron emission tomography (PET)/magnetic resonance imaging (MRI). METHODS AND RESULTS Patients with different stages of Fabry disease were prospectively enrolled to undergo routine CMR at 1.5T, followed by 3T hybrid cardiac PET/MRI with [11C]meta-hydroxyephedrine ([11C]mHED). Fourteen patients with either no evidence of cardiac involvement (n = 5), evidence of left ventricular hypertrophy (LVH) (n = 3), or evidence of LVH and fibrosis via late gadolinium enhancement (LGE) (n = 6) were analyzed. Compared to patients without LVH, patients with LVH or LVH and LGE had lower median T1 relaxation times (ms) at 1.5 T (1007 vs. 889 vs. 941 ms, p = 0.003) and 3T (1290 vs. 1172 vs. 1184 p = .014). Myocardial denervation ([11C]mHED retention < 7%·min) was prevalent only in patients with fibrosis, where a total of 16 denervated segments was found in two patients. The respective area of denervation exceeded the area of LGE in both patients (24% vs. 36% and 4% vs. 32%). However, sympathetic innervation defects ([11C]mHED retention ≤ 9%·min) occurred in all study groups. Furthermore, a reduced sympathetic innervation correlated with an increased left ventricular mass (p = .034, rs = - 0.57) and a reduced global longitudinal strain (GLS) (p = 0.023, rs = - 0.6). CONCLUSION Hybrid cardiac PET/MR with [11C]mHED revealed sympathetic innervation defects, accompanied by impaired GLS, in early stages of Fabry disease. However, denervation is only present in patients with advanced stages of FD showing fibrosis on CMR.
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Affiliation(s)
- Constantin Gatterer
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Tim Wollenweber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Verena Pichler
- Division of Pharmaceutical Chemistry, Department of Pharmaceutical Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Max Lenz
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Senta Graf
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Magnocavallo M, Vetta G, Polselli M, Cauti FM, Parlavecchio A, Caminiti R, Crea P, Pannone L, Sorgente A, Chimenti C, Chierchia GB, Rossi P, Natale A, de Asmundis C, Bianchi S, Della Rocca DG. "Function follows form": Role of cardiac magnetic resonance for ventricular arrhythmia risk stratification in patients with cardiac sarcoidosis. J Cardiovasc Electrophysiol 2023; 34:1781-1784. [PMID: 37493490 DOI: 10.1111/jce.16020] [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: 03/23/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Cardiac involvement is common and may become clinically relevant in approximately 5%-10% of patients with systemic sarcoidosis. Although reduced left ventricular ejection fraction is a recognized predictor of mortality, recent studies have suggested an increased risk of ventricular arrhythmia (VAs) and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS) and evidence of late gadolinium enhancement-cardiac magnetic resonance (LGE-CMR), irrespective of the underlying left ventricular systolic function. We performed a meta-analysis to assess the correlation between VAs/SCD and presence of LGE-CMR in CS patients. METHODS We systematically searched Medline, Embase, and Cochrane electronic databases up to January 2, 2023, for studies enrolling patients with suspected or confirmed CS undergoing LGE-CMR. Clinical outcomes of interest included clinically relevant VAs, defined as sustained ventricular tachycardia, ventricular fibrillation, SCD, or aborted SCD during follow-up. The effect size was estimated using a random-effect model as risk ratio (RR) and relative 95% confidence interval (CI). RESULTS A total of 14 studies fulfilled the selection criteria and were included in the final analysis. Among 1273 patients, LGE was detected in 465 (36.5%; Group LGE+). Males accounted for 45.2% (95% CI: 40.5%-55.7%) of the total population and the average age was 56.8 (95% CI: 52.7%-60.9) years. A total of 104 (22.3%) of 465 LGE+ patients experienced a clinically relevant VA, compared to 6 (0.7%) of 808 LGE- ones. LGE+ was associated with a ninefold increased risk in life-threatening VAs (22.3% vs. 0.7%; RR = 9.52; 95% CI [5.18-17.49]; p < .0001) compared to patients without LGE (heterogeneity I2 = 0%). CONCLUSION In our meta-analysis, LGE+ in patients with CS was associated with a ninefold increased risk in life-threatening VAs compared to patients without LGE.
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Affiliation(s)
- Michele Magnocavallo
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
| | - Giampaolo Vetta
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Marco Polselli
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Filippo Maria Cauti
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Parlavecchio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Pasquale Crea
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Stefano Bianchi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Domenico G Della Rocca
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
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Choe J, Koo HJ, Ahn Y, Lee GD, Yang DH, Kang JW, Lee JE, Shin JH. Evaluation of Chylothorax Using Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography After Lung Cancer Surgery. Lymphat Res Biol 2023; 21:343-350. [PMID: 36880884 DOI: 10.1089/lrb.2022.0039] [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] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Background: To determine the role of dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) in the management of postoperative chylothorax after lung cancer surgery. Methods and Results: Between July 2017 and November 2021, patients who developed postoperative chylothorax following pulmonary resection and mediastinal lymph node dissection were assessed and those who underwent DCMRL for the evaluation of chyle leak were evaluated. The findings of DCMRL and conventional lymphangiography were compared. The incidence of postoperative chylothorax was 0.9% (50/5587). Among the patients with chylothorax, a total of 22 patients (44.0% [22/50]; mean age, 67.6 ± 7.9 years; 15 men) underwent DCMRL. Treatment outcomes were compared between patients with conservative management (n = 10) and those with intervention (n = 12). The patients demonstrated unilateral pleural effusion, ipsilateral to the operation site, and showed right-sided dominance. The most frequent site of thoracic duct injury showing contrast media leakage was visualized at the subcarinal level. No DCMRL-related complication occurred. DCMRL showed comparable performance to conventional lymphangiography in visualizing the central lymphatics, including cisterna chyli (DCMRL vs. conventional lymphangiography, 72.7% vs. 45.5%, p = 0.25) and thoracic duct (90.9% vs. 54.5%, p = 0.13), and in localizing thoracic duct injury (90.9% vs. 54.5%, p = 0.13). On follow-up, the amount of chest tube drainage after lymphatic intervention showed a significant difference over time from that after medical treatment only (p = 0.02). Conclusion: DCMRL can provide detailed information about the leak site and the central lymphatic anatomy in patients with chylothorax after lung cancer surgery. The findings of DCMRL can guide subsequent treatment planning for optimal outcomes.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ja Eun Lee
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology and University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Trajcheski T, Brovina L, Zafirova B, Josimovski S. Role of Cardiac Magnetic Resonance in Diagnosis and Treatment of Ball Thrombus in Left Atrium - Trust But Verify! - Case Report. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:185-188. [PMID: 37453113 DOI: 10.2478/prilozi-2023-0039] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Male patient with left atrial cardiac mass was in need of a quick diagnosis for individualized and effective treatment. Transthoracic echocardiography showed presence of а giant left atrial cardiac mass with atypical location for thrombus. Cardiac Magnetic Resonance (CMR) Imaging was performed for histological discrimination, and showed a large cardiac mass wall attached in the left atrium, homogeneous, with diameter of 3.4cm x 3.2cm. Late Gadolinium Enhancement sequences revealed black avascular tissue without signal, confirming the characterization of a thrombus. The patient refused hospital initiation of low molecular weight heparin treatment and started treatment with Rivaroxaban. Six weeks later he presented with NYHA class II, almost complete dissolving of the thrombus on CMR scan. Seven months from the initial CMR scan, echocardiography screen was done showing complete absence of the left atrial mass. With this case report we have demonstrated the significance of the CMR as one step further in the precise diagnostics of cardiac masses, solving critical clinical dilemma.
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Affiliation(s)
- Ted Trajcheski
- 1Department of Cardiology, American Hospital Pristina, Kosovo
| | - Lulzim Brovina
- 1Department of Cardiology, American Hospital Pristina, Kosovo
| | - Biljana Zafirova
- 2Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, RN Macedonia
| | - Saso Josimovski
- 1Department of Cardiology, American Hospital Pristina, Kosovo
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Marçal PC, Braggion-Santos MF, Wada DT, Santos MK, Moreira HT, Volpe GJ, Schmidt A. Cardiac Magnetic Resonance as an Etiological Diagnosis Tool in Recovered Sudden Cardiac Death or Unstable Ventricular Arrhythmia Patients. Arq Bras Cardiol 2023; 120:e20220411. [PMID: 37098988 PMCID: PMC10263419 DOI: 10.36660/abc.20220411] [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] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) has an increasing diagnostic relevance in survivors of sudden cardiac death (SCD) or unstable ventricular arrhythmia (UVA) in developed countries. OBJECTIVE To evaluate retrospectively the additional role of CMR in a developing country where few resources are available, and should be used more effectively. METHODS The study included SCD or UVA survivors admitted between 2009 and 2019 at a tertiary academic institution referred to CMR. Demographic, clinical, and laboratory data were collected from the medical records. CMR images and reports were reviewed and their impact on the final etiological diagnosis was determined. A descriptive analysis was performed and p<0.05 established as significant. RESULTS Sixty-four patients, 54.9±15.4 years old, and 42 (71.9%) males. Most events (81.3%) were out of the hospital and ventricular tachycardia was the most common rhythm. Cardiovascular medications were previously used by 55 patients, and beta-blockers were the most used medications (37.5%). Electrocardiogram had electrical inactive areas in 21.9% and all of them had fibrosis at CMR. Mean left ventricular ejection fraction (LVEF) was 44±14%, with 60.9% ≤50% and only 29.7% ≤35%. Late gadolinium enhancement was identified in 71.9%, with a transmural pattern in 43.8%. Chagas cardiomyopathy was the most common etiology (28.1%), followed by ischemic cardiomyopathy (17.2%). Among 26 without a previously identified etiology, CMR could define it (15 patients - 57%). CONCLUSION In accordance with previous studies in developed countries, CMR was capable of increasing etiological diagnosis and identifying the arrhythmogenic substrate, allowing better care in half of the underdiagnosed patients.
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Affiliation(s)
- Paula C. Marçal
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - Maria Fernanda Braggion-Santos
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - Danilo Tadao Wada
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoDepartamento de Imagens Médicas, Hematologia e OncologiaRibeirão PretoSPBrasilHospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Departamento de Imagens Médicas, Hematologia e Oncologia, Ribeirão Preto, SP – Brasil
| | - Marcel Koenigkam Santos
- Hospital das ClínicasFaculdade de Medicina de Ribeirão PretoDepartamento de Imagens Médicas, Hematologia e OncologiaRibeirão PretoSPBrasilHospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Departamento de Imagens Médicas, Hematologia e Oncologia, Ribeirão Preto, SP – Brasil
| | - Henrique Turin Moreira
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - Gustavo Jardim Volpe
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
| | - André Schmidt
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto – Centro de Cardiologia, Ribeirão Preto, SP – Brasil
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Raj K, Radhakrishnan DM, Bala P, Garg A, Das A, Shukla G, Goyal V, Srivastava AK. Electrophysiology and Magnetic Resonance Neurography Findings of Nontraumatic Ulnar Mononeuropathy From a Tertiary Care Center. J Clin Neuromuscul Dis 2022; 24:61-67. [PMID: 36409335 DOI: 10.1097/cnd.0000000000000419] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Ulnar nerve is frequently involved in mononeuropathies of the upper limb. Ulnar neuropathies have been diagnosed conventionally using clinical and electrophysiological findings. Physicians opt for nerve imaging in patients with ambiguous electrophysiological tests to gain additional information, identify etiology and plan management. OBJECTIVES The aim of this study was to describe the electrophysiological and the magnetic resonance neurography (MRN) findings in patients with nontraumatic ulnar neuropathy. METHODS All consecutive patients with suspected nontraumatic ulnar mononeuropathy were recruited; clinical assessment and electrophysiological studies (EPSs) were done in all. After EPS, patients with localization of lesion along the ulnar nerve underwent MRN. RESULTS All 39 patients recruited had clinical findings suggestive of ulnar neuropathy; Electrophysiological confirmation was possible in 36/39 (92.30%) patients. Localization of ulnar nerve lesion to elbow and wrist was possible in 27 (75%) and 9 (25%) patients, respectively. MRN was done in 22 patients; a lesion was identified in 19 of 22 (86.36%) ulnar nerves studied. Thickening and hyperintensity in T2 W/short TI inversion recovery images of ulnar nerve at the level of olecranon, suggesting ulnar neuropathy at elbow, was the commonest (8/22) imaging finding. CONCLUSIONS MRN acts as a complimentary tool to EPS for evaluating nontraumatic ulnar neuropathy. By identifying the etiology, MRN is likely to modify the management decision.
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Affiliation(s)
- Kishan Raj
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; and
| | - Divya M Radhakrishnan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; and
| | - Parthiban Bala
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; and
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; and
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; and
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14
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Thongprayoon C, Vuckovic I, Vaughan LE, Macura S, Larson NB, D’Costa MR, Lieske JC, Rule AD, Denic A. Nuclear Magnetic Resonance Metabolomic Profiling and Urine Chemistries in Incident Kidney Stone Formers Compared with Controls. J Am Soc Nephrol 2022; 33:2071-2086. [PMID: 36316097 PMCID: PMC9678037 DOI: 10.1681/asn.2022040416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The urine metabolites and chemistries that contribute to kidney stone formation are not fully understood. This study examined differences between the urine metabolic and chemistries profiles of first-time stone formers and controls. METHODS High-resolution 1H-nuclear magnetic resonance (NMR) spectroscopy-based metabolomic analysis was performed in 24-hour urine samples from a prospective cohort of 418 first-time symptomatic kidney stone formers and 440 controls. In total, 48 NMR-quantified metabolites in addition to 12 standard urine chemistries were assayed. Analysis of covariance was used to determine the association of stone former status with urine metabolites or chemistries after adjusting for age and sex and correcting for the false discovery rate. Gradient-boosted machine methods with nested cross-validation were applied to predict stone former status. RESULTS Among the standard urine chemistries, stone formers had lower urine oxalate and potassium and higher urine calcium, phosphate, and creatinine. Among NMR urine metabolites, stone formers had lower hippuric acid, trigonelline, 2-furoylglycine, imidazole, and citrate and higher creatine and alanine. A cross-validated model using urine chemistries, age, and sex yielded a mean AUC of 0.76 (95% CI, 0.73 to 0.79). A cross-validated model using urine chemistries, NMR-quantified metabolites, age, and sex did not meaningfully improve the discrimination (mean AUC, 0.78; 95% CI, 0.75 to 0.81). In this combined model, among the top ten discriminating features, four were urine chemistries and six NMR-quantified metabolites. CONCLUSIONS Although NMR-quantified metabolites did not improve discrimination, several urine metabolic profiles were identified that may improve understanding of kidney stone pathogenesis.
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Affiliation(s)
| | - Ivan Vuckovic
- Metabolomics Core, Mayo Clinic, Rochester, Minnesota
| | - Lisa E. Vaughan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Slobodan Macura
- Metabolomics Core, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas B. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Matthew R. D’Costa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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15
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Aquaro GD, Guidi B, Emdin M, Pucci A, Chiti E, Santurro A, Scopetti M, Biondi F, Maiese A, Turillazzi E, Camastra G, Faggioni L, Cioni D, Fineschi V, Neri E, Di Paolo M. Post-Mortem Cardiac Magnetic Resonance in Explanted Heart of Patients with Sudden Death. Int J Environ Res Public Health 2022; 19:ijerph192013395. [PMID: 36293989 PMCID: PMC9603042 DOI: 10.3390/ijerph192013395] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND We sought to evaluate the diagnostic accuracy of post-mortem cardiac magnetic resonance (PMCMR) of explanted hearts to detect the cardiac causes of sudden death. METHODS PMCMR was performed in formalin-fixed explanted hearts of 115 cases of sudden death. Histological sampling of myocardium was performed using two different approaches: (1) guideline-based sampling; (2) guideline-based plus PMCMR-driven sampling. RESULTS Forensic diagnosis of cardiac cause of death was ascertained in 72 (63%) patients. When the guideline-driven histological sampling was used, the PMCMR interpretation matched with final forensic diagnosis in 93 out of 115 cases (81%) with sensitivity of 88% (79-95%), specificity of 65% (47-80%), PPV of 84% (78-90%), NPV of 73% (58-84%), accuracy of 81% (72-88%), and AUC of 0.77 (0.68-0.84). When a PMCMR-driven approach was added to the guideline-based one, the matching increased to 102 (89%) cases with a PMCMR sensitivity of 89% (80-94%), a specificity of 86% (67-96%), PPV of 95% (89-98%), NPV of 73% (59-83%), accuracy of 89% (81-93%), and AUC of 0.88 (0.80-0.93). CONCLUSIONS PMCMR has high accuracy to identify the cardiac cause of sudden death and may be considered a valid auxilium for forensic diagnosis. PMCMR could improve histological diagnosis in conditions with focal myocardial involvement or demonstrating signs of myocardial ischemia.
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Affiliation(s)
| | | | - Michele Emdin
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Angela Pucci
- Department of Surgical, Clinical and Molecular Pathology and of Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Enrica Chiti
- Department of Surgical, Clinical and Molecular Pathology and of Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry-Scuola Medica Salernitana, University of Salerno, 84084 Fisciano, Italy
| | - Matteo Scopetti
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Federico Biondi
- Cardiology Department, University of Trieste, 34127 Trieste, Italy
| | - Aniello Maiese
- UO Medicina Legale, University of Pisa, 56126 Pisa, Italy
| | | | | | | | - Dania Cioni
- Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Emanuele Neri
- Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Marco Di Paolo
- UO Medicina Legale, University of Pisa, 56126 Pisa, Italy
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16
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Bulluck H, Carberry J, Carrick D, McCartney PJ, Maznyczka AM, Greenwood JP, Maredia N, Chowdhary S, Gershlick AH, Appleby C, Cotton JM, Wragg A, Curzen N, McEntegart M, Petrie MC, Eteiba H, Watkins S, Lindsay M, Mahrous A, Oldroyd KG, Berry C. A Noncontrast CMR Risk Score for Long-Term Risk Stratification in Reperfused ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15:431-440. [PMID: 35272808 DOI: 10.1016/j.jcmg.2021.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure. BACKGROUND A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI). METHODS The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score. RESULTS There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score. CONCLUSIONS This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).
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Affiliation(s)
- Heerajnarain Bulluck
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; University of East Anglia, Norwich, United Kingdom; Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | | | - Peter J McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Annette M Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Neil Maredia
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Saqib Chowdhary
- South Manchester Hospitals NHS Trust, Manchester, United Kingdom
| | | | - Clare Appleby
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - James M Cotton
- Royal Wolverhampton University Hospital NHS Trust, Wolverhampton, United Kingdom
| | - Andrew Wragg
- Barts and the London Hospital, London, United Kingdom
| | - Nick Curzen
- University Hospital Southampton Foundation Trust, Southampton, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mark C Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mitchell Lindsay
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
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17
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Anagnostopoulos I, Kousta M, Kossyvakis C, Lakka E, Paraskevaidis NT, Schizas N, Alexopoulos N, Deftereos S, Giannopoulos G. The prognostic role of late gadolinium enhancement on cardiac magnetic resonance in patients with nonischemic cardiomyopathy and reduced ejection fraction, implanted with cardioverter defibrillators for primary prevention. A systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 63:523-530. [PMID: 34218421 DOI: 10.1007/s10840-021-01027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic events in patients with nonischemic cardiomyopathy (NICM), while others have questioned the role of left ventricular ejection fraction (LVEF) as a sole predictor of future events. OBJECTIVES To evaluate the role of LGE on CMR in identifying patients with NICM and reduced LVEF for whom a benefit from defibrillator implantation for primary prevention is not anticipated, thus they are mainly exposed to potential risks. METHODS Major electronic databases were searched for studies reporting the incidence of appropriate device therapy (ADT), sudden cardiac death (SCD), and cardiac death based on the presence of LGE on CMR, among patients with NICM and reduced LVEF, implanted with a cardioverter defibrillator for primary prevention. RESULTS Eleven studies (1652 patients, 947 with LGE) were included in the final analysis. LGE presence was strongly associated with ADT (logOR: 1.95, 95%CI: 1.21-2.69) and cardiac death (logOR: 0.91, 95%CI: 0.14-1.68), but not with SCD (logOR: 0.26, 95%CI: -1.09-1.6). Diagnostic accuracy analysis demonstrated that contrast enhancement is a sensitive marker of future ADT and cardiac death (93%, 95%CI: 85.8-96.7%; 82.9%, 95%CI: 70.6-90.7%; respectively), with moderate specificity ( 44%, 95%CI: 27.2-62.6%; 37.7%, 95%CI: 23.4-54.6%; respectively). CONCLUSION LGE is a highly sensitive predictor of ADT and cardiac death in NICM patients implanted with a defibrillator for primary prevention. However, due to moderate specificity, derivation of a cutoff with adequate predictive values and probably a multifactorial approach are needed to improve discrimination of patients who will not benefit from ICDs.
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Affiliation(s)
- Ioannis Anagnostopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece.
| | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
| | - Eleni Lakka
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
| | | | - Nikolaos Schizas
- Department of Cardiothoracic Surgery, Evangelismos Hospital, Athens, Greece
| | | | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas,", 154 Mesogion Avenue, 11527, Athens, Greece
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18
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Digel I, Kurulgan E, Linder P, Kayser P, Porst D, Braem GJ, Zerlin K, Artmann GM, Artmann AT. Decrease in extracellular collagen crosslinking after NMR magnetic field application in skin fibroblasts. Med Biol Eng Comput 2007; 45:91-7. [PMID: 17203317 DOI: 10.1007/s11517-006-0144-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 12/11/2006] [Indexed: 11/29/2022]
Abstract
Although biological effects of electromagnetic fields were investigated intensively, there is still no agreement on the significance of their effects. The underlying mechanisms and therapeutic importance are still mostly unknown too. In this study, primary cultures of human dermal fibroblasts were exposed to magnetic field at nuclear magnetic resonance (NMR) conditions for in total 5 days and 4 h/day. Among the investigated parameters were: cell proliferation rate, cell morphology, total protein concentration as well as content of skin-specific collagen types I, III, IV. NMR exposure induced distinct changes both in cellular and extracellular components. The extracellular matrix (ECM) of NMR-exposed cells had less cross-linked collagen. In particular, the increase of collagen of the soluble fraction was at 17.2 +/- 2.9% for type I, 27.0 +/- 1.86% for type III, 17.3 +/- 1.46% for type IV (N = 6). In the absence of resonance frequency, the effects of magnetic field on ECM were less profound.
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Affiliation(s)
- I Digel
- Department of Biomedical Engineering, Laboratory of Cell Biophysics, Aachen University of Applied Sciences, Ginsterweg 1, 52428, Juelich, Germany.
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Abstract
This paper considers the exposure of humans to static magnetic fields due to magnetic resonance imaging (MRI) procedures. It briefly introduces the types of magnetic fields associated with MRI. It then discusses trends in the number of people exposed to MRI, the field strength of the magnets used in MRI, and the types of applications of MRI. It also considers the types of staff who are exposed to magnetic fields due to MRI, and the alternative techniques that would be used in the absence of MRI.
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Affiliation(s)
- P A Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD UK.
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20
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Piruzyan LA, Piruzyan AL. Nuclear gamma-resonance electron paramagnetic dialysis: implications for experimental biology and medicine. Dokl Biol Sci 2004; 397:284-7. [PMID: 15508575 DOI: 10.1023/b:dobs.0000039693.87155.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- L A Piruzyan
- Center of Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, ul. Kosygina 4, Moscow, 119991 Russia
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21
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Di Costanzo A, Trojsi F, Tosetti M, Giannatempo GM, Nemore F, Piccirillo M, Bonavita S, Tedeschi G, Scarabino T. High-field proton MRS of human brain. Eur J Radiol 2004; 48:146-53. [PMID: 14680905 DOI: 10.1016/j.ejrad.2003.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 08/11/2003] [Accepted: 08/13/2003] [Indexed: 10/27/2022]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) of the brain reveals specific biochemical information about cerebral metabolites, which may support clinical diagnoses and enhance the understanding of neurological disorders. The advantages of performing 1H-MRS at higher field strengths include better signal to noise ratio (SNR) and increased spectral, spatial and temporal resolution, allowing the acquisition of high quality, easily quantifiable spectra in acceptable imaging times. In addition to improved measurement precision of N-acetylaspartate, choline, creatine and myo-inositol, high-field systems allow the high-resolution measurement of other metabolites, such as glutamate, glutamine, gamma-aminobutyric acid, scyllo-inositol, aspartate, taurine, N-acetylaspartylglutamate, glucose and branched amino acids, thus extending the range of metabolic information. However, these advantages may be hampered by intrinsic field-dependent technical difficulties, such as decreased T2 signal, chemical shift dispersion errors, J-modulation anomalies, increased magnetic susceptibility, eddy current artifacts, limitations in the design of homogeneous and sensitive radiofrequency (RF) coils, magnetic field instability and safety issues. Several studies demonstrated that these limitations could be overcome, suggesting that the appropriate optimization of high-field 1H-MRS would expand the application in the fields of clinical research and diagnostic routine.
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Affiliation(s)
- Alfonso Di Costanzo
- Department of Neurological Sciences, Second University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy.
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22
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Affiliation(s)
- M P Laderoute
- Blood Zoonotics Unit, Blood Safety Surveillance and Health Care Acquired Infections Division, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Health Canada, Tunney's Pasture AL 0601E2, Ottawa, Ontario Canada K1A 0L2
- Blood Zoonotics Unit, Blood Safety Surveillance and Health Care Acquired Infections Division, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, Health Canada, Tunney's Pasture AL 0601E2, Ottawa, Ontario Canada K1A 0L2. E-mail:
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23
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Romano A, Rosa N, Bifani M, Della Corte M, Iaccarino G. An unusual intaocular foreign body. Ophthalmic Surg Lasers Imaging 2003; 34:348-9. [PMID: 12875470] [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] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
An unusual foreign body in a 60-year-old man with ocular siderosis is described. A surgical needle was found in the eye after magnetic resonance imaging was performed for cerebral ischemia. As a general precaution in patients who have undergone any kind of surgery, it might be better to perform a plain x-ray before performing magnetic resonance imaging to identify such foreign bodies.
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Affiliation(s)
- Antonio Romano
- Eye Department, Second University of Naples, Naples, Italy
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24
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Aldinucci C, Garcia JB, Palmi M, Sgaragli G, Benocci A, Meini A, Pessina F, Rossi C, Bonechi C, Pessina GP. The effect of strong static magnetic field on lymphocytes. Bioelectromagnetics 2003; 24:109-17. [PMID: 12524677 DOI: 10.1002/bem.10071] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether static electromagnetic fields (EMFs) at a flux density of 4.75 T, generated by an NMR apparatus (NMRF), could promote movements of Ca2+, cell proliferation, and the eventual production of proinflammatory cytokines in human peripheral blood mononuclear cells (PBMC) as well as in Jurkat cells, after exposure to the field for 1 h. The same study was also performed after activation of cells with 5 mg/ml phytohaemagglutinin (PHA). Our results clearly demonstrate that static NMRF exposure has neither proliferative, nor activating, nor proinflammatory effects on both normal and PHA activated PBMC. Moreover, the concentration of interleukin-1beta, interleukin-2, interleukin-6, interferon, and tumour necrosis factor alpha (TNFalpha) remained unvaried in exposed cells. Exposure of Jurkat cells statistically decreased the proliferation and the proliferation indexes, which 24 and 48 h after exposure were 0.7 +/- 0.29 and 0.87 +/- 0.12, respectively. Moreover, in Jurkat cells the [Ca2+]i was higher than in PBMC and was reduced significantly to about one half after exposure. This is consistent with the decrease of proliferation and with the low levels of IL-2 measured. On the whole, our data suggest that NMRF exposure failed to affect the physiologic behaviour of normal lymphomonocytes. Instead in Jurkat cells, by changing the properties of cell membranes, NMRF can influence Ca2+ transport processes, and hence Ca2+ homeostasis with improvement of proliferation.
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de Certaines JD, Cathelineau G. Safety aspects and quality assessment in MRI and MRS: a challenge for health care systems in Europe. J Magn Reson Imaging 2001; 13:632-8. [PMID: 11276110 DOI: 10.1002/jmri.1089] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite advances in international cooperation, the application of the safety regulations of different countries remains an important challenge for manufacturers and health care workers in the European Union. Rapid technological development during the last 20 years, and the still controversial nature of certain potential effects of magnetic or electromagnetic fields, make the task particularly difficult for MRI and MRS. As the relevant literature is rather extensive, the present work will limit its goals to four questions: 1) How is MRI and MRS safety regulation managed within the European Union? 2) Concerning direct potential physiological effects, what is presently well known and controlled, and, conversely, what are the remaining open (and often controversial) questions? 3) As metallic implants are probably the main risk in routine MRI, what regulatory strategy is in progress in Europe? 4) As indirect risks related to artifacts must not be underestimated, what European programs have been developed for quality assessment in MRI and MRS? In all of these fields, evidence is provided demonstrating the need for a mutual recognition of common standards for the European Union and the United States.
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Affiliation(s)
- J D de Certaines
- Eugène Marquis Cancer Institute, Biomedical NMR Laboratory, Rennes, France.
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McDonald JC. The power of the spoken word. Radiat Prot Dosimetry 2001; 95:99-100. [PMID: 11572649 DOI: 10.1093/oxfordjournals.rpd.a006541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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27
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Robertson NM, Diaz-Gomez M, Condon B. Estimation of torque on mechanical heart valves due to magnetic resonance imaging including an estimation of the significance of the Lenz effect using a computational model. Phys Med Biol 2000; 45:3793-807. [PMID: 11131200 DOI: 10.1088/0031-9155/45/12/320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mitral and aortic valve replacement is a procedure which is common in cardiac surgery. Some of these replacement valves are mechanical and contain moving metal parts. Should the patient in whom such a valve has been implanted be involved in magnetic resonance imaging, there is a possible dangerous interaction between the moving metal parts and the static magnetic field due to the Lenz effect. Mathematical models of two relatively common forms of single-leaflet valves have been derived and the magnitude of the torque which opposes the motion of the valve leaflet has been calculated for a valve disc of solid metal. In addition, a differential model of a ring-strengthener valve type has been considered to determine the likely significance of the Lenz effect in the context of the human heart. For common magnetic field strengths at present, i.e. 1 to 2 T, the effect is not particularly significant. However, there is a marked increase in back pressure as static magnetic field strength increases. There are concerns that, since field strengths in the range 3 to 4 T are increasingly being used, the Lenz effect could become significant. At 5 to 10 T the malfunction of the mechanical heart valve could cause the heart to behave as though it is diseased. For unhealthy or old patients this could possibly prove fatal.
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28
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Abstract
Magnetic resonance imaging is used routinely with much success for various problems in different medical disciplines. However, the patient is exposed to static as well as to time-dependent magnetic fields and radiofrequency electromagnetic fields. In 1997 the Strahlenschutzkommission, the German Radiological Protection Commission, passed a recommendation on the use of magnetic resonance in medical diagnostics. In this recommendation basic values related to thresholds for physiological effects and limits for restricted and unrestricted use are given. In the following the aim and applicability of this recommendation are discussed, as well as the thresholds and different limits for the static magnetic fields, the gradient fields and the radio-frequency fields. Additionally, advice is given for the protection of high-risk patients, personnel, and the general public, together with further safety advice as well as recommendations for users and manufacturers.
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Affiliation(s)
- J H Bernhardt
- Bundesamt für Strahlenschutz, Institut für Strahlenhygiene, Oberschleissheim
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Mahdi A, Gowland PA, Mansfield P, Coupland RE, Lloyd RG. The effects of static 3.0 T and 0.5 T magnetic fields and the echo-planar imaging experiment at 0.5 T on E. coli. Br J Radiol 1994; 67:983-7. [PMID: 8000843 DOI: 10.1259/0007-1285-67-802-983] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Various mutant strains of Escherichia coli have been exposed to a homogeneous static magnetic field of either 0.5 T or 3.0 T and to the time varying magnetic fields found in echo-planar imaging experiments. No evidence of increased DNA damage was detected, even with bacterial strains disabled for DNA repair.
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Affiliation(s)
- A Mahdi
- Department of Genetics, University of Nottingham, UK
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30
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Hrnjak M, Giser A. [Basics of protection during use of magnetic resonance in medicine]. VOJNOSANIT PREGL 1992; 49:236-41. [PMID: 1529596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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31
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Affiliation(s)
- T W Athey
- Center for Devices and Radiological Health, Food and Drug Administration, Rockville, Maryland 20857
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32
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Abstract
NMR imaging (MRI) and spectroscopy have been applied to an increasing number of patients and volunteers for 10 years. The field strength has increased by a factor of 10 since 1979 and the switched gradients have increased by over a factor of 10 since 1980. RF absorbed power has increased by almost a factor of 10 in many studies due to both the increase in frequency and the increase in duty cycle associated with new RF pulse protocols. Even with these increases, all available evidence argues that the clinical procedures offer no hazards to human subjects. Known hazards associated with flying ferromagnetic objects, internal prostheses, and wires or metal objects in contact with the skin of patients can be avoided. Although hazards are not expected for the present procedures, emerging methods using fast scan strategies and higher frequency RF of the higher fields will require a closer vigilance and will demand continuing experimental and theoretical work such as detailed in this symposium.
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Affiliation(s)
- T F Budinger
- Lawrence Berkeley Laboratory, University of California, Berkeley 94720
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34
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Limits on patient and volunteer exposure during clinical magnetic resonance diagnostic procedures. Recommendations for the practical application of the Board's statement. Ann N Y Acad Sci 1992; 649:376-98. [PMID: 1580516 DOI: 10.1111/j.1749-6632.1992.tb49635.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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35
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Prato FS, Kavaliers M, Ossenkopp KP, Carson JJ, Drost DJ, Frappier JR. Extremely low frequency magnetic field exposure from MRI/MRS procedures. Implications for patients (acute exposures) and operational personnel (chronic exposures). Ann N Y Acad Sci 1992; 649:44-58. [PMID: 1580517 DOI: 10.1111/j.1749-6632.1992.tb49595.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F S Prato
- Department of Nuclear Medicine and Magnetic Resonance, London, Ontario, Canada
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36
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Berkowitz BA, Wilson CA, Hatchell DL, London RE. Quantitative determination of the partial oxygen pressure in the vitrectomized rabbit eye in vivo using 19F NMR. Magn Reson Med 1991; 21:233-41. [PMID: 1745122 DOI: 10.1002/mrm.1910210208] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have quantitatively determined the PO2 within the vitreous space of the vitrectomized rabbit eye in vivo using 19F NMR and perfluorotributylamine (FTBA). The results of the present work are in good agreement with previous measurements of PO2 within the nonvitrectimized rabbit eye obtained using oxygen microelectrodes. In this study, good precision and accuracy were achieved by: (1) having minimal flow effects present, (2) optimizing the signal-to-noise through the use of neat FTBA and surface coil transmission and detection, and (3) performing an inversion-recovery pulse sequence, with adiabatic pulses, to optimize the dynamic range of the T1 experiment. Possible deleterious effects on the measured T1 due to the vitreal temperature gradient are discussed. To the best of our knowledge the results of this study demonstrate, for the first time, a quantitative determination of intraocular PO2 in vivo using 19F NMR and FTBA.
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Affiliation(s)
- B A Berkowitz
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709
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37
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Behr KP, Tiffe HW, Hinz KH, Lüders H, Friederichs M, Ryll M, Hundeshagen H. [The effect of magnetic resonance treatment on chicken embryos]. Dtsch Tierarztl Wochenschr 1991; 98:149-52. [PMID: 1829672] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nuclear Magnetic Resonance (NMR) is of increasing diagnostic importance especially in human medicine. To evaluate possible side effects of this technology, embryonated chicken eggs were used as a model. Different fields (static magnetic field [1 oder 4 T], variable magnetic field [gradient] or high frequency field) were applied before the beginning and at the fifth day of incubation for different times (18.8, 37.6, 56 or 75.1 min, resp.). According to the criteria embryo-mortality, hatching-rate or vitality of the chickens, influences of the NMR-treatment were not observed.
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Affiliation(s)
- K P Behr
- Klinik für Geflügel, Tierärztlichen Hochschule Hannover
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38
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Honour LC. Enthusiasm for MRI 'P Chem' reservations. Hosp Pract (Off Ed) 1989; 24:17. [PMID: 2536041 DOI: 10.1080/21548331.1989.11703638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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39
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Orcutt N, Gandhi OP. A 3-D impedance method to calculate power deposition in biological bodies subjected to time varying magnetic fields. IEEE Trans Biomed Eng 1988; 35:577-83. [PMID: 3049307 DOI: 10.1109/10.4590] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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40
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Abstract
Nowadays, anaesthetists often have to deal with pacemaker patients. All the problems encountered in the anaesthetic management of such patients are discussed in this paper: the pacemaker, specific risks linked to the pacemaker, monitoring of such patients, and temporary pacing. The preoperative assessment of pacemaker function is an absolute necessity. The technical characteristics of the pacemaker can be found in the patient's booklet. The clinical history should reveal a possible malfunction (syncopes). The underlying cardiac disease should be known, as it will have repercussions on the anaesthetic and surgical risks. An electrocardiogram and measurement of blood electrolytes must be carried out. There are three major risks linked to the pacemaker during surgery: 1) the loss of pacing by threshold (drugs, dyskaliemia); threshold (drugs, dyskalemia); 2) ventricular fibrillation (the intracardiac electrode conducting the electrocautery currents); 3) reprogramming or damaging of the pacemaker by electrocautery, cardioversion or nuclear magnetic resonance. The only mandatory monitoring of these patients is the electrocardioscope. Other monitoring techniques will be dictated by the underlying cardiac disease or the surgery planned. Temporary pacing is indicated in the same conditions as permanent pacing. However the intracardiac electrode can be displaced by moving the patient; the efficacy of pacing must therefore be continuously checked. During cardiac surgery, with cardiopulmonary bypass, conduction disturbances can occur. Temporary pacing electrodes should therefore be sewn onto the ventricular epicardium for the duration of the surgery; atrial electrodes should be added if sinus troubles can be expected. Oesophageal pacing is possible in the operating theatre because it is easily and rapidly set up: a bipolar oesophageal electrode linked to an external pacer can speed up the heart (atrial dysfunction) or slow down a tachycardia. An oesophageal electrocardiogram can also be carried out with this electrode. Swan-Ganz catheters can be also used for temporary pacing: either with two pairs of electrodes, atrial and ventricular respectively--this system being useful in a patient who does not move--or with a newer system where a single small electrode is introduced into the right ventricle by a special lumen in the Swan-Ganz catheter. Although external pacing was historically the first technique to be developed, it was abandoned because of the muscle pains it gave. Recently, a new technique of external pacing, with large electrodes and longer stimuli, has been developed for use in emergency situations.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- J P Caramella
- Département d'Anesthésie Réanimation, Hôpital de Vittel
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41
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42
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Abstract
The effect of MR on pacemakers used to stimulate the carotid sinus and on patients with pacemakers has been investigated. There was no evidence of any harm to the patient or the implant. The implant caused considerable artifacts on the images.
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43
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Sprawls P. Managing the magnetic environment. Adm Radiol 1987; 6:42-3. [PMID: 10283272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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44
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De Crescenzo S, Scialfa G, Tosi G. [Risks from magnetic fields and radiowaves in equipment for magnetic resonance tomography]. Radiol Med 1987; 73:551-6. [PMID: 3602485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The use of Nuclear Magnetic Resonance Imaging for diagnostic purposes requires a careful analysis of potential risks for workers, patients and public. Aim of this work is a review of the most important biological effects produced by static magnetic fields, radiofrequency fields and field gradients. It's common opinion in fact that the use of magnetic and radiofrequency fields instead of ionizing radiations fields is a safety warranty for patients and workers. Biological experiments in small animals and microorganisms show that also in this case some risks may be expected, due to the trend to employ as much high as possible magnetic fields (and therefore radiofrequency fields). The available data show that the normally used magnetic and radiofrequency fields are below the threshold for somatic effects but denote the necessity of a careful risks/benefit analysis for some patients groups (pacemakers and small surgical metallic implants carriers) and the need of extended and deep studies to specify a possible synergy of different physical agents and incidental oncogenic and teratogenic consequence on the patient.
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45
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Shivers RR, Kavaliers M, Teskey GC, Prato FS, Pelletier RM. Magnetic resonance imaging temporarily alters blood-brain barrier permeability in the rat. Neurosci Lett 1987; 76:25-31. [PMID: 3587744 DOI: 10.1016/0304-3940(87)90186-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Exposure to a short (23.2 min) standard clinical magnetic resonance imaging (MRI) procedure elicits a temporary dysfunction of the blood-brain barrier in rats. Monitoring of the increased permeability of rat brain frontal cortex microvessels with the protein tracer horseradish peroxidase and freeze-fracture electron microscopy, revealed an amplified vesicle-mediated transport of tracer across the microvessel endothelium to the albuminal basal lamina and extracellular compartment of the brain parenchyma. Recovery of normal blood-brain function, as evidenced by exclusion of protein tracer from subendothelial basal lamina and neuropil extracellular milieu, was complete 15-30 min following cessation of the MRI exposure. These findings raise the possibility that exposure to clinical MRI procedures may also temporarily alter central blood-brain permeability in human subjects.
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46
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Prasad N, Lotzová E, Thornby JI, Madewell JE, Ford JJ, Bushong SC. Effects of MR imaging on murine natural killer cell cytotoxicity. AJR Am J Roentgenol 1987; 148:415-7. [PMID: 3492122 DOI: 10.2214/ajr.148.2.415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To determine the effect of MR imaging on the immune system, 21 male C57BL/6 X DBA/2 F1 mice were exposed to MR imaging at a field strength of 0.15 T for 2 hr. Another nine mice (controls) were sham exposed for the same amount of time. Mice were sacrificed and their spleens removed 24, 72, and 144 hr after the exposure (MR or sham). Spleen cell suspensions were passed over nylon wool columns and then used as effector cells in a short-term natural killer cell cytotoxicity assay with 51Cr-labeled YAC-1 cells as target cells. The results showed no evidence of decreased cytotoxicity due to exposure to MR. On the contrary, at all three times after exposure and for all target-to-effector cell ratios, mean cytotoxicity was greater for MR-exposed groups than for sham-exposed groups. The results show that MR exposure has no adverse effect on the immune system, as evidenced by natural killer cell activity.
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47
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Abstract
Successful corneal transplantation was accomplished following metabolic phosphorus magnetic resonance analysis. Four cat corneas were analyzed using phosphorus-31 magnetic resonance following storage in modified McCarey-Kaufman (M-K) medium for 24 h. Corneas were re-stored in M-K medium and transplanted 24 h after MR analysis. Four control corneas (contralateral eye, no magnetic resonance analysis performed) were also transplanted following storage in M-K medium under identical conditions. Successful corneal transplantation was accomplished with minimal ATP tissue levels. Corneas stored for 48 h maintained a pH of 7.3. The phosphorus-31 spectral modulus, which is the ratio of the high-energy phosphates to the low-energy phosphates, was calculated using the spectral integral (range, 0.49-0.77). No difference in endothelial cell density or morphology was detected between corneas following magnetic resonance analysis and control corneas when evaluated by specular microscopy.
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Affiliation(s)
- J H Lass
- Division of Ophthalmology, Case Western Reserve Univerity, Cleveland, Ohio
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48
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Abstract
A taste aversion test was used to evaluate possible toxic effects of magnetic resonance imaging (MRI). Thirty male Sprague-Dawley rats were randomly assigned to four groups: Group One (n = 10) received 30 minutes exposure inside the MRI scanner; Group Two (n = 10) received a sham exposure to the MRI scanner; Group Three (n = 5) was injected with 0.15 M lithium chloride; and Group Four (n = 5) was injected with vehicle. All groups were given 10 minutes access to a 0.1% saccharin solution immediately prior to their respective treatment. The rats treated with lithium chloride displayed a taste aversion to the saccharin solution upon subsequent testing over an eight day period. The two control groups (Two and Four) and the rats exposed to MRI did not display any aversion to the saccharin solution. These results are compared to other studies that have shown that magnetic fields can influence biological systems.
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49
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Abstract
Potential effects of MRI exposure on aspects of human cognition were investigated out of concern that possible safety hazards associated with the procedure may exist. One hundred and fifty-seven volunteer subjects were randomly assigned to either an imaged, sham-imaged or nonimaged control condition. The following psychological tests were administered in a double blind procedure at pretreatment, post-treatment and follow-up time periods: the Wechsler Adult Intelligence Scale-Revised (Digit Span, Block Design and Digit Symbol), the Wechsler Memory Scale Paired Associate Learning test, the Benton Revised Visual Retention test, the Vandenberg Mental Rotation test, the Sternberg memory scanning paradigm and the State Anxiety Inventory. The overall analysis of results indicated that MRI at 0.15 T has no significant effect upon the cognitive functions assessed.
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50
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Widder DJ. Risk of ferromagnetic ocular foreign bodies in MR. AJNR Am J Neuroradiol 1987; 8:571. [PMID: 3111225 PMCID: PMC8331892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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