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Tat E, Ball C, Camren GP, Wroblewski I, Dajani KA, Goldberg A, Kinno M, Sanagala T, Syed MA, Wilber DJ, Rabbat M. Impact of late gadolinium enhancement extent, location, and pattern on ventricular tachycardia and major adverse cardiac events in patients with ischemic vs. non-ischemic cardiomyopathy. Front Cardiovasc Med 2022; 9:1026215. [PMID: 36330014 PMCID: PMC9622951 DOI: 10.3389/fcvm.2022.1026215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Left ventricular late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) has been associated with increased risk for life-threatening ventricular tachyarrhythmias. The differences in association between LGE characteristics and prognosis in patients with ischemic (ICM) vs. non-ischemic (NICM) cardiomyopathy is incompletely understood. Methods A total of 168 consecutive patients who underwent CMR imaging with either ICM or NICM were included in our study. LGE extent, location and pattern were examined for association to the primary endpoint of ventricular tachycardia (VT) and secondary endpoint of major adverse cardiac events (MACE). Results Of 68 (41%) patients with ICM and 97 (59%) patients with NICM, median LGE mass was 15% (IQR 9–28) for the ICM group and 10% (IQR 6–15) for the NICM group. On multivariate analysis for both groups, LGE characteristics were prognostic while LVEF was not. In patients with ICM, septal and apical segment LGE, and involvement of multiple walls predicted both endpoints on multivariate analysis. LGE extent (≥median) and inferior wall LGE independently predicted the primary endpoint. In patients with NICM, anterior, inferior and apical segment LGE, and involvement of multiple walls predicted both endpoints on multivariate analysis. LGE extent (≥median, number of LGE segments, LGE stratified per 5% increase) and midwall LGE were independent predictors of the primary endpoint. Conclusions Although LGE was an independent predictor of prognosis in both groups, LGE extent, location, and pattern characteristics were more powerful correlates to worse outcomes in patients with NICM than ICM.
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Affiliation(s)
- Emily Tat
- Department of Internal Medicine, Columbia University Medical Center, New York, NY, United States
| | - Caroline Ball
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Gerald P. Camren
- Department of Radiology, Loyola University Medical Center, Maywood, IL, United States
| | - Igor Wroblewski
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Khaled A. Dajani
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Ari Goldberg
- Department of Radiology, Loyola University Medical Center, Maywood, IL, United States
| | - Menhel Kinno
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Thriveni Sanagala
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Mushabbar A. Syed
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - David J. Wilber
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Mark Rabbat
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
- *Correspondence: Mark Rabbat
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Longitudinal assessment of structural phenotype in Brugada syndrome using cardiac magnetic resonance imaging. Heart Rhythm O2 2022; 4:34-41. [PMID: 36713046 PMCID: PMC9877394 DOI: 10.1016/j.hroo.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Despite historically being considered a channelopathy, subtle structural changes have been reported in Brugada syndrome (BrS) on histopathology and cardiac magnetic resonance (CMR) imaging. It is not known if these structural changes progress over time. Objective The study sought to assess if structural changes in BrS evolve over time with serial CMR assessment and to investigate the utility of parametric mapping techniques to identify diffuse fibrosis in BrS. Methods Patients with a diagnosis of BrS based on international guidelines and normal CMR at least 3 years prior to the study period were invited to undergo repeat CMR. CMR images were analyzed de novo and compared at baseline and follow-up. Results Eighteen patients with BrS (72% men; mean age at follow-up 47.4 ± 8.9 years) underwent serial CMR with an average of 5.0 ± 1.7 years between scans. No patients had late gadolinium enhancement (LGE) on baseline CMR, but 4 (22%) developed LGE on follow-up, typically localized to the right ventricular (RV) side of the basal septum. RV end-systolic volume increased over time (P = .04) and was associated with a trend toward reduction in RV ejection fraction (P = .07). Four patients showed a reduction in RV ejection fraction >10%. There was no evidence of diffuse myocardial fibrosis observed on parametric mapping. Conclusions Structural changes may evolve over time with development of focal fibrosis, evidenced by LGE on CMR in a significant proportion of patients with BrS. These findings have implications for our understanding of the pathological substrate in BrS and the longitudinal evaluation of patients with BrS.
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Huang W, Sun R, Liu W, Xu R, Zhou Z, Bai W, Hou R, Xu H, Guo Y, Yu L, Ye L. Prognostic Value of Late Gadolinium Enhancement in Left Ventricular Noncompaction: A Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12102457. [PMID: 36292149 PMCID: PMC9600954 DOI: 10.3390/diagnostics12102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Current diagnostic criteria for left ventricular noncompaction (LVNC) may be poorly related to adverse prognosis. Late gadolinium enhancement (LGE) is a predictor of major adverse cardiovascular events (MACE), but risk stratification of LGE in patients with LVNC remains unclear. We retrospectively analyzed the clinical and cardiovascular magnetic resonance (CMR) data of 75 patients from three institutes and examined the correlation between different LGE types and MACE based on the extent, pattern (including a specific ring-like pattern), and locations of LGE in LVNC. A total of 51 patients (68%) presented LGE. A specific ring-like pattern was observed in 9 (12%). MACE occurred in 29 (38.7%) at 4.3 years of follow-up (interquartile range: 2.1−5.7 years). The adjusted hazard ratio (HR) for patients with ring-like LGE were 6.10 (95% CI, 1.39−26.75, p < 0.05). Free-wall or mid-wall LGE was associated with an increased risk of MACE after adjustment (HR 2.85, 95% CI, 1.31−6.21; HR 4.35, 95% CI, 1.23−15.37, respectively, p < 0.05). The risk of MACE in LVNC significantly increased when the LGE extent was greater than 7.5% and ring-like, multiple segments, and free-wall LGE were associated with MACE. These results suggest the value of LGE risk stratification in patients with LVNC.
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Affiliation(s)
- Wei Huang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Ran Sun
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Wenbin Liu
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
| | - Rong Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Ziqi Zhou
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Wei Bai
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Ruilai Hou
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Huayan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610017, China
| | - Li Yu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610017, China
- Correspondence: (L.Y.); (L.Y.)
| | - Lu Ye
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu 610017, China
- Correspondence: (L.Y.); (L.Y.)
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Amin RJ, Morris-Rosendahl D, Edwards M, Tayal U, Buchan R, Hammersley DJ, Jones RE, Gati S, Khalique Z, Almogheer B, Pennell DJ, Baksi AJ, Pantazis A, Ware JS, Prasad SK, Halliday BP. The addition of genetic testing and cardiovascular magnetic resonance to routine clinical data for stratification of etiology in dilated cardiomyopathy. Front Cardiovasc Med 2022; 9:1017119. [PMID: 36277766 PMCID: PMC9582287 DOI: 10.3389/fcvm.2022.1017119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Guidelines recommend genetic testing and cardiovascular magnetic resonance (CMR) for the investigation of dilated cardiomyopathy (DCM). However, the incremental value is unclear. We assessed the impact of these investigations in determining etiology. Methods Sixty consecutive patients referred with DCM and recruited to our hospital biobank were selected. Six independent experts determined the etiology of each phenotype in a step-wise manner based on (1) routine clinical data, (2) clinical and genetic data and (3) clinical, genetic and CMR data. They indicated their confidence (1-3) in the classification and any changes to management at each step. Results Six physicians adjudicated 60 cases. The addition of genetics and CMR resulted in 57 (15.8%) and 26 (7.2%) changes in the classification of etiology, including an increased number of genetic diagnoses and a reduction in idiopathic diagnoses. Diagnostic confidence improved at each step (p < 0.0005). The number of diagnoses made with low confidence reduced from 105 (29.2%) with routine clinical data to 71 (19.7%) following the addition of genetics and 37 (10.3%) with the addition of CMR. The addition of genetics and CMR led to 101 (28.1%) and 112 (31.1%) proposed changes to management, respectively. Interobserver variability showed moderate agreement with clinical data (κ = 0.44) which improved following the addition of genetics (κ = 0.65) and CMR (κ = 0.68). Conclusion We demonstrate that genetics and CMR, frequently changed the classification of etiology in DCM, improved confidence and interobserver variability in determining the diagnosis and had an impact on proposed management.
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Affiliation(s)
- Ravi J. Amin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Deborah Morris-Rosendahl
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Clinical Genetics and Genomics Laboratory, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mat Edwards
- Clinical Genetics and Genomics Laboratory, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Upasana Tayal
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rachel Buchan
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Daniel J. Hammersley
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Richard E. Jones
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Sabiha Gati
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Zohya Khalique
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Batool Almogheer
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
| | - Arun John Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Antonis Pantazis
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - James S. Ware
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Sanjay K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Brian P. Halliday
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- National Heart Lung Institute, Imperial College, London, United Kingdom
- Department of Inherited Cardiovascular Conditions, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Velcea AE, Mihaila Baldea S, Nicula AI, Vinereanu D. The role of multimodality imaging in the selection for implantable cardioverter-defibrillators in heart failure: A narrative review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1066-1072. [PMID: 35899916 DOI: 10.1002/jcu.23281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Advanced pharmacologic and interventional therapies have improved survival in heart failure. Implantable cardioverter-defibrillators (ICD) have been shown to reduce mortality in patients with heart failure, but the benefit appears to be uneven in this population. We reviewed the evidence showing the benefit of ICD therapy in heart failure patients, the main issues arising from these studies, and the possible answers for a better risk stratification. In addition, we showed that multimodality imaging could improve patient selection for the implantation of ICDs, in both primary and secondary prevention, beyond the selection using only the left ventricular ejection fraction, by concentrating on arrhythmic substrate.
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Affiliation(s)
- Andreea Elena Velcea
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
| | - Sorina Mihaila Baldea
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
| | - Alina Ioana Nicula
- Radiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Dragos Vinereanu
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
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Stolfo D, Fabris E, Lund LH, Savarese G, Sinagra G. From mid-range to mildly reduced ejection fraction heart failure: A call to treat. Eur J Intern Med 2022; 103:29-35. [PMID: 35710614 DOI: 10.1016/j.ejim.2022.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022]
Abstract
The historical classification of heart failure (HF) has considered two distinct subgroups, HF with reduced ejection fraction (HFrEF), generally classified as EF below 40%, and HF with preserved ejection fraction (HFpEF) variably classified as EF above 40%, 45% or 50%. One of the principal reasons behind this distinction was related to presence of effective therapy in HFrEF, but not in HFpEF. Recently the expanding knowledge in the specific subgroup of patient with a LVEF between 41% and 49% and the potential benefit of new therapies and of those used in patients with LVEF below 40%, has led to rename this group as HF with mildly reduced EF (HFmrEF). In this review we discuss the reasons behind this modification, we summarize the main characteristics of HFmrEF the similarities and differences with the two other EF categories, and finally we provide a comprehensive overview of the current available evidence supporting the treatment of patients with HFmrEF.
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Affiliation(s)
- Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Enrico Fabris
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy.
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Rajinthan P, Gardey K, Boccalini S, Si-Mohammed S, Dulac A, Berger C, Placide L, Delinière A, Mewton N, Chevalier P, Bessière F. CMR - Late gadolinium enhancement characteristics associated with monomorphic ventricular arrhythmia in patients with non-ischemic cardiomyopathy. Indian Pacing Electrophysiol J 2022; 22:225-230. [PMID: 35931352 PMCID: PMC9463474 DOI: 10.1016/j.ipej.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Priyanka Rajinthan
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Kevin Gardey
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Sara Boccalini
- Radiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue Du Doyen Lépine, 69394 LYON Cedex 03, Hospices Civils de Lyon, France
| | - Salim Si-Mohammed
- Radiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue Du Doyen Lépine, 69394 LYON Cedex 03, Hospices Civils de Lyon, France; Creatis, UMR CNRS 5220, INSERM U 1044, Université Claude Bernard Lyon 1, France
| | - Arnaud Dulac
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Clothilde Berger
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Leslie Placide
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Antoine Delinière
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Nathan Mewton
- Centre d'investigation Clinique, Hôpital Cardiologique Louis Pradel, 28 Avenue Du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Philippe Chevalier
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France
| | - Francis Bessière
- Cardiac Electrophysiology Department, Hôpital Cardiologique Louis Pradel, 28 Avenue du Doyen Lépine, 69394, Lyon Cedex 03, Hospices Civils de Lyon, France; LabTau, INSERM U 1032, Université Claude Bernard Lyon 1, France.
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Xie E, Sung E, Saad E, Trayanova N, Wu KC, Chrispin J. Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death. Front Cardiovasc Med 2022; 9:884767. [PMID: 36072882 PMCID: PMC9441865 DOI: 10.3389/fcvm.2022.884767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of mortality, comprising approximately half of all deaths from cardiovascular disease. In the US, the majority of SCD (85%) occurs in patients with ischemic cardiomyopathy (ICM) and a subset in patients with non-ischemic cardiomyopathy (NICM), who tend to be younger and whose risk of mortality is less clearly delineated than in ischemic cardiomyopathies. The conventional means of SCD risk stratification has been the determination of the ejection fraction (EF), typically via echocardiography, which is currently a means of determining candidacy for primary prevention in the form of implantable cardiac defibrillators (ICDs). Advanced cardiac imaging methods such as cardiac magnetic resonance imaging (CMR), single-photon emission computerized tomography (SPECT) and positron emission tomography (PET), and computed tomography (CT) have emerged as promising and non-invasive means of risk stratification for sudden death through their characterization of the underlying myocardial substrate that predisposes to SCD. Late gadolinium enhancement (LGE) on CMR detects myocardial scar, which can inform ICD decision-making. Overall scar burden, region-specific scar burden, and scar heterogeneity have all been studied in risk stratification. PET and SPECT are nuclear methods that determine myocardial viability and innervation, as well as inflammation. CT can be used for assessment of myocardial fat and its association with reentrant circuits. Emerging methodologies include the development of "virtual hearts" using complex electrophysiologic modeling derived from CMR to attempt to predict arrhythmic susceptibility. Recent developments have paired novel machine learning (ML) algorithms with established imaging techniques to improve predictive performance. The use of advanced imaging to augment risk stratification for sudden death is increasingly well-established and may soon have an expanded role in clinical decision-making. ML could help shift this paradigm further by advancing variable discovery and data analysis.
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Affiliation(s)
- Eric Xie
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric Sung
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Elie Saad
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Natalia Trayanova
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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59
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Gassanov N, Mutallimov M, Caglayan E, Erdmann E, Er F. ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator. J Cardiol 2022; 80:573-577. [PMID: 35985868 DOI: 10.1016/j.jjcc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients. METHODS WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events. RESULTS Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001-1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006-1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias. After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers. CONCLUSIONS ECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.
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Affiliation(s)
- Natig Gassanov
- Department of Internal Medicine II, Klinikum Idar-Oberstein, Idar-Oberstein, Germany.
| | - Mirza Mutallimov
- Department of Internal Medicine II, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Evren Caglayan
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Erland Erdmann
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Fikret Er
- Department of Internal Medicine I, Klinikum Gütersloh, Gütersloh, Germany
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Fenski M, Grandy TH, Viezzer D, Kertusha S, Schmidt M, Forman C, Schulz-Menger J. Isotropic 3D compressed sensing (CS) based sequence is comparable to 2D-LGE in left ventricular scar quantification in different disease entities. Int J Cardiovasc Imaging 2022; 38:1837-1850. [PMID: 35243574 PMCID: PMC10509092 DOI: 10.1007/s10554-022-02571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
The goal of this study was to evaluate a three-dimensional compressed sensing (3D-CS) LGE prototype sequence for the detection and quantification of myocardial fibrosis in patients with chronic myocardial infarction (CMI) and myocarditis (MYC) compared with a 2D-LGE standard. Patients with left-ventricular LGE due to CMI (n = 33) or MYC (n = 20) were prospectively recruited. 2D-LGE and 3D-CS images were acquired in random order at 1.5 Tesla. 3D-CS short axis (SAX) images were reconstructed corresponding to 2D SAX images. LGE was quantitatively assessed on patient and segment level using semi-automated threshold methods. Image quality (4-point scoring system), Contrast-ratio (CR) and acquisition times were compared. There was no significant difference between 2D and 3D sequences regarding global LGE (%) (CMI [2D-LGE: 11.4 ± 7.5; 3D-LGE: 11.5 ± 8.5; p = 0.99]; MYC [2D-LGE: 27.0 ± 15.7; 3D-LGE: 26.2 ± 13.1; p = 0.70]) and segmental LGE-extent (p = 0.63). 3D-CS identified papillary infarction in 5 cases which was not present in 2D images. 2D-LGE acquisition time was shorter (2D: median: 06:59 min [IQR: 05:51-08:18]; 3D: 14:48 min [12:45-16:57]). 3D-CS obtained better quality scores (2D: 2.06 ± 0.56 vs. 3D: 2.29 ± 0.61). CR did not differ (p = 0.63) between basal and apical regions in 3D-CS images but decreased significantly in 2D apical images (CR basal: 2D: 0.77 ± 0.11, 3D: 0.59 ± 0.10; CR apical: 2D: 0.64 ± 0.17, 3D: 0.53 ± 0.11). 3D-LGE shows high congruency with standard LGE and allows better identification of small lesions. However, the current 3D-CS LGE sequence did not provide PSIR reconstruction and acquisition time was longer.
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Affiliation(s)
- Maximilian Fenski
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Thomas Hiroshi Grandy
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Darian Viezzer
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Stela Kertusha
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
| | | | | | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Huang W, Xu R, Zhou B, Lin C, Guo Y, Xu H, Guo X. Clinical Manifestations, Monitoring, and Prognosis: A Review of Cardiotoxicity After Antitumor Strategy. Front Cardiovasc Med 2022; 9:912329. [PMID: 35757327 PMCID: PMC9226336 DOI: 10.3389/fcvm.2022.912329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/23/2022] [Indexed: 12/24/2022] Open
Abstract
The development of various antitumor drugs has significantly improved the survival of patients with cancer. Many first-line chemotherapy drugs are cytotoxic and the cardiotoxicity is one of the most significant effects that could leads to poor prognosis and decreased survival rate. Cancer treatment include traditional anthracycline drugs, as well as some new targeted drugs such as trastuzumab and ICIs. These drugs may directly or indirectly cause cardiovascular injury through different mechanisms, and lead to increasing the risk of cardiovascular disease or accelerating the development of cardiovascular disease. Cardiotoxicity is clinically manifested by arrhythmia, decreased cardiac function, or even sudden death. The cardiotoxicity caused by traditional chemotherapy drugs such as anthracyclines are significantly known. The cardiotoxicity of some new antitumor drugs such like immune checkpoint inhibitors (ICIs) is also relatively clear and requiring further observation and verification. This review is focused on major three drugs with relatively high incidence of cardiotoxicity and poor prognosis and intended to provide an update on the clinical complications and outcomes of these drugs, and we innovatively summarize the monitoring status of survivors using these drugs and discuss the biomarkers and non-invasive imaging features to identify early cardiotoxicity. Finally, we summarize the prevention that decreasing antitumor drugs-induced cardiotoxicity.
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Affiliation(s)
- Wei Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rong Xu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Bin Zhou
- Laboratory of Molecular Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Center for Translational Medicine, Ministry of Education, Clinical Research Center for Birth Defects of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chao Lin
- Department of Hematology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yingkun Guo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Huayan Xu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xia Guo
- Department of Hematology, West China Second University Hospital, Sichuan University, Chengdu, China
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62
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McGurk KA, Halliday BP. Dilated cardiomyopathy - details make the difference. Eur J Heart Fail 2022; 24:1197-1199. [PMID: 35717623 DOI: 10.1002/ejhf.2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kathryn A McGurk
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, London, UK.,Cardiovascular Research Centre at Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, London, UK
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Cornhill AK, Dykstra S, Satriano A, Labib D, Mikami Y, Flewitt J, Prosio E, Rivest S, Sandonato R, Howarth AG, Lydell C, Eastwood CA, Quan H, Fine N, Lee J, White JA. Machine Learning Patient-Specific Prediction of Heart Failure Hospitalization Using Cardiac MRI-Based Phenotype and Electronic Health Information. Front Cardiovasc Med 2022; 9:890904. [PMID: 35783851 PMCID: PMC9245012 DOI: 10.3389/fcvm.2022.890904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart failure (HF) hospitalization is a dominant contributor of morbidity and healthcare expenditures in patients with systolic HF. Cardiovascular magnetic resonance (CMR) imaging is increasingly employed for the evaluation of HF given capacity to provide highly reproducible phenotypic markers of disease. The combined value of CMR phenotypic markers and patient health information to deliver predictions of future HF events has not been explored. We sought to develop and validate a novel risk model for the patient-specific prediction of time to HF hospitalization using routinely reported CMR variables, patient-reported health status, and electronic health information.MethodsStandardized data capture was performed for 1,775 consecutive patients with chronic systolic HF referred for CMR imaging. Patient demographics, symptoms, Health-related Quality of Life, pharmacy, and routinely reported CMR features were provided to both machine learning (ML) and competing risk Fine-Gray-based models (FGM) for the prediction of time to HF hospitalization.ResultsThe mean age was 59 years with a mean LVEF of 36 ± 11%. The population was evenly distributed between ischemic (52%) and idiopathic non-ischemic cardiomyopathy (48%). Over a median follow-up of 2.79 years (IQR: 1.59–4.04) 333 patients (19%) experienced HF related hospitalization. Both ML and competing risk FGM based models achieved robust performance for the prediction of time to HF hospitalization. Respective 90-day, 1 and 2-year AUC values were 0.87, 0.83, and 0.80 for the ML model, and 0.89, 0.84, and 0.80 for the competing risk FGM-based model in a holdout validation cohort. Patients classified as high-risk by the ML model experienced a 34-fold higher occurrence of HF hospitalization at 90 days vs. the low-risk group.ConclusionIn this study we demonstrated capacity for routinely reported CMR phenotypic markers and patient health information to be combined for the delivery of patient-specific predictions of time to HF hospitalization. This work supports an evolving migration toward multi-domain data collection for the delivery of personalized risk prediction at time of diagnostic imaging.
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Affiliation(s)
- Aidan K. Cornhill
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Easter Prosio
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Carmen Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Cathy A. Eastwood
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- *Correspondence: James A. White,
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Ishidoya Y, Ranjan R. Using MRI to predict ventricular tachycardia recurrence and provide guidance for ablation? Heart Rhythm 2022; 19:1611-1612. [PMID: 35690251 DOI: 10.1016/j.hrthm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Yuki Ishidoya
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah.
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Mirelis JG, Escobar-Lopez L, Ochoa JP, Espinosa MÁ, Villacorta E, Navarro M, Masnou GC, Mora-Ayestarán N, Barriales-Villa R, Mogollón-Jiménez MV, García-Pinilla JM, García-Granja PE, Climent V, Palomino-Doza J, García-Álvarez A, Álvarez-Barredo M, Borrego EC, Ripoll-Vera T, Peña-Peña ML, Rodríguez-González E, Gallego-Delgado M, Carrillo JG, Fernández-Ávila A, Rodríguez-Palomares JF, Brugada R, Bayes-Genis A, Dominguez F, García-Pavía P. Combination of late gadolinium enhancement and genotype improves prediction of prognosis in non-ischemic dilated cardiomyopathy. Eur J Heart Fail 2022; 24:1183-1196. [PMID: 35485241 PMCID: PMC9546008 DOI: 10.1002/ejhf.2514] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/15/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Aims Genotype and left ventricular scar on cardiac magnetic resonance (CMR) are increasingly recognized as risk markers for adverse outcomes in non‐ischaemic dilated cardiomyopathy (DCM). We investigated the combined influence of genotype and late gadolinium enhancement (LGE) in assessing prognosis in a large cohort of patients with DCM. Methods and results Outcomes of 600 patients with DCM (53.3 ± 14.1 years, 66% male) who underwent clinical CMR and genetic testing were retrospectively analysed. The primary endpoints were end‐stage heart failure (ESHF) and malignant ventricular arrhythmias (MVA). During a median follow‐up of 2.7 years (interquartile range 1.3–4.9), 24 (4.00%) and 48 (8.00%) patients had ESHF and MVA, respectively. In total, 242 (40.3%) patients had pathogenic/likely pathogenic variants (positive genotype) and 151 (25.2%) had LGE. In survival analysis, positive LGE was associated with MVA and ESHF (both, p < 0.001) while positive genotype was associated with ESHF (p = 0.034) but not with MVA (p = 0.102). Classification of patients according to genotype (G+/G−) and LGE presence (L+/L−) revealed progressively increasing events across L−/G−, L−/G+, L+/G− and L+/G+ groups and resulted in optimized MVA and ESHF prediction (p < 0.001 and p = 0.001, respectively). Hazard ratios for MVA and ESHF in patients with either L+ or G+ compared with those with L−/G− were 4.71 (95% confidence interval: 2.11–10.50, p < 0.001) and 7.92 (95% confidence interval: 1.86–33.78, p < 0.001), respectively. Conclusion Classification of patients with DCM according to genotype and LGE improves MVA and ESHF prediction. Scar assessment with CMR and genotyping should be considered to select patients for primary prevention implantable cardioverter‐defibrillator placement.
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Affiliation(s)
- Jesús G Mirelis
- Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Luis Escobar-Lopez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Juan Pablo Ochoa
- Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - María Ángeles Espinosa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Villacorta
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Inherited Cardiac Diseases Unit. Department of Cardiology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain.,Departament of Medicine, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Marina Navarro
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART).,Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Guillem Casas Masnou
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Inherited Cardiovascular Diseases Unit. Department of Cardiology. Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nerea Mora-Ayestarán
- Department of Cardiology, Área del Corazón, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Roberto Barriales-Villa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Inherited Cardiac Diseases Unit. Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | | | - José M García-Pinilla
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Malaga, Spain
| | - Pablo Elpidio García-Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Vicente Climent
- Inherited Cardiovascular Diseases Unit. Department of Cardiology. Hospital General Universitario de Alicante, Institute of Health and Biomedical Research, Alicante, Spain
| | - Julian Palomino-Doza
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
| | - Ana García-Álvarez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Departament, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María Álvarez-Barredo
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Xenética Cardiovascular, Instituto de investigación Sanitaria de Santiago, Unidad de Cardiopatías Familiares, Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Eva Cabrera Borrego
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Tomás Ripoll-Vera
- Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario Son Llatzer & IdISBa, Palma de Mallorca, Spain
| | - María Luisa Peña-Peña
- Inherited Cardiac Diseases Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - María Gallego-Delgado
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Inherited Cardiac Diseases Unit. Department of Cardiology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
| | - Josefa González Carrillo
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART).,Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Ana Fernández-Ávila
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José F Rodríguez-Palomares
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Inherited Cardiovascular Diseases Unit. Department of Cardiology. Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Brugada
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Department of Cardiology, Hospital Univesitari Dr. Josep Trueta, Girona, Spain
| | - Antoni Bayes-Genis
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Heart Institute. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Pablo García-Pavía
- Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain.,CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART).,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Spain
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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67
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De Angelis G, De Luca A, Merlo M, Nucifora G, Rossi M, Stolfo D, Barbati G, De Bellis A, Masè M, Santangeli P, Pagnan L, Muser D, Sinagra G. Prevalence and prognostic significance of ischemic late gadolinium enhancement pattern in non-ischemic dilated cardiomyopathy. Am Heart J 2022; 246:117-124. [PMID: 35045326 DOI: 10.1016/j.ahj.2022.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Typical late gadolinium enhancement (LGE) patterns in dilated cardiomyopathy (DCM) include intramyocardial and subepicardial distribution. However, the ischemic pattern of LGE (subendocardial and transmural) has also been reported in DCM without coronary artery disease (CAD), but its correlates and prognostic significance are still not known. On these bases, this study sought to describe the prevalence and prognostic significance of the ischemic LGE pattern in DCM. METHODS A total of 611 DCM patients with available cardiac magnetic resonance were retrospectively analyzed. A composite of all-cause-death, major ventricular arrhythmias (MVAs), heart transplantation (HTx) or ventricular assist device (VAD) implantation was the primary outcome of the study. Secondary outcomes were a composite of sudden cardiac death or MVAs and a composite of death for refractory heart failure, HTx or VAD implantation. RESULTS Ischemic LGE was found in 7% of DCM patients without significant CAD or history of myocardial infarction, most commonly inferior/inferolateral/anterolateral. Compared to patients with non-ischemic LGE, those with ischemic LGE had higher prevalence of hypertension and atrial fibrillation or flutter. Ischemic LGE was associated with worse long-term outcomes compared to non-ischemic LGE (36% vs 23% risk of primary outcome events at 5 years respectively, P = .006), and remained an independent predictor of primary outcome after adjustment for clinically and statistically significant variables (adjusted hazard ratio 2.059 [1.055-4.015], P = .034 with respect to non-ischemic LGE). CONCLUSIONS The ischemic pattern of LGE is not uncommon among DCM patients without CAD and is independently associated with worse long-term outcomes.
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Affiliation(s)
- Giulia De Angelis
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Antonio De Luca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy.
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Gaetano Nucifora
- Cardiac Imaging Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maddalena Rossi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Annamaria De Bellis
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Marco Masè
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lorenzo Pagnan
- Radiology Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Cardiology Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
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Arsenos P, Gatzoulis KA, Tsiachris D, Dilaveris P, Sideris S, Sotiropoulos I, Archontakis S, Antoniou CK, Kordalis A, Skiadas I, Toutouzas K, Vlachopoulos C, Tousoulis D, Tsioufis K. Arrhythmic risk stratification in ischemic, non-ischemic and hypertrophic cardiomyopathy: A two-step multifactorial, electrophysiology study inclusive approach. World J Cardiol 2022; 14:139-151. [PMID: 35432775 PMCID: PMC8968455 DOI: 10.4330/wjc.v14.i3.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/28/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Annual arrhythmic sudden cardiac death ranges from 0.6% to 4% in ischemic cardiomyopathy (ICM), 1% to 2% in non-ischemic cardiomyopathy (NICM), and 1% in hypertrophic cardiomyopathy (HCM). Towards a more effective arrhythmic risk stratification (ARS) we hereby present a two-step ARS with the usage of seven non-invasive risk factors: Late potentials presence (≥ 2/3 positive criteria), premature ventricular contractions (≥ 30/h), non-sustained ventricular tachycardia (≥ 1episode/24 h), abnormal heart rate turbulence (onset ≥ 0% and slope ≤ 2.5 ms) and reduced deceleration capacity (≤ 4.5 ms), abnormal T wave alternans (≥ 65μV), decreased heart rate variability (SDNN < 70ms), and prolonged QTc interval (> 440 ms in males and > 450 ms in females) which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step. In the second step, these intermediate-risk patients undergo a programmed ventricular stimulation (PVS) for the detection of inducible, truly high-risk ICM and NICM patients, who will benefit from an implantable cardioverter defibrillator. For HCM patients, we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | | | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Ilias Sotiropoulos
- Department of Cardiology, Hippokration Hospital, Athens 11527, Attika, Greece
| | | | | | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Ioannis Skiadas
- Fifth Department of Cardiology, Hygeia Hospital, Marousi 15123, Attika, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
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Corbo MD, Vitale E, Pesolo M, Casavecchia G, Gravina M, Pellegrino P, Brunetti ND, Iacoviello M. Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11061519. [PMID: 35329848 PMCID: PMC8955301 DOI: 10.3390/jcm11061519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.
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Affiliation(s)
- Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Maurizio Pesolo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Matteo Gravina
- University Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy;
| | - Pierluigi Pellegrino
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
- Correspondence: or
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Ismail TF, Strugnell W, Coletti C, Božić-Iven M, Weingärtner S, Hammernik K, Correia T, Küstner T. Cardiac MR: From Theory to Practice. Front Cardiovasc Med 2022; 9:826283. [PMID: 35310962 PMCID: PMC8927633 DOI: 10.3389/fcvm.2022.826283] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading single cause of morbidity and mortality, causing over 17. 9 million deaths worldwide per year with associated costs of over $800 billion. Improving prevention, diagnosis, and treatment of CVD is therefore a global priority. Cardiovascular magnetic resonance (CMR) has emerged as a clinically important technique for the assessment of cardiovascular anatomy, function, perfusion, and viability. However, diversity and complexity of imaging, reconstruction and analysis methods pose some limitations to the widespread use of CMR. Especially in view of recent developments in the field of machine learning that provide novel solutions to address existing problems, it is necessary to bridge the gap between the clinical and scientific communities. This review covers five essential aspects of CMR to provide a comprehensive overview ranging from CVDs to CMR pulse sequence design, acquisition protocols, motion handling, image reconstruction and quantitative analysis of the obtained data. (1) The basic MR physics of CMR is introduced. Basic pulse sequence building blocks that are commonly used in CMR imaging are presented. Sequences containing these building blocks are formed for parametric mapping and functional imaging techniques. Commonly perceived artifacts and potential countermeasures are discussed for these methods. (2) CMR methods for identifying CVDs are illustrated. Basic anatomy and functional processes are described to understand the cardiac pathologies and how they can be captured by CMR imaging. (3) The planning and conduct of a complete CMR exam which is targeted for the respective pathology is shown. Building blocks are illustrated to create an efficient and patient-centered workflow. Further strategies to cope with challenging patients are discussed. (4) Imaging acceleration and reconstruction techniques are presented that enable acquisition of spatial, temporal, and parametric dynamics of the cardiac cycle. The handling of respiratory and cardiac motion strategies as well as their integration into the reconstruction processes is showcased. (5) Recent advances on deep learning-based reconstructions for this purpose are summarized. Furthermore, an overview of novel deep learning image segmentation and analysis methods is provided with a focus on automatic, fast and reliable extraction of biomarkers and parameters of clinical relevance.
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Affiliation(s)
- Tevfik F. Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Wendy Strugnell
- Queensland X-Ray, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Chiara Coletti
- Magnetic Resonance Systems Lab, Delft University of Technology, Delft, Netherlands
| | - Maša Božić-Iven
- Magnetic Resonance Systems Lab, Delft University of Technology, Delft, Netherlands
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | | | - Kerstin Hammernik
- Lab for AI in Medicine, Technical University of Munich, Munich, Germany
- Department of Computing, Imperial College London, London, United Kingdom
| | - Teresa Correia
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Centre of Marine Sciences, Faro, Portugal
| | - Thomas Küstner
- Medical Image and Data Analysis (MIDAS.lab), Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
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71
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Zhou ZQ, He WC, Li X, Bai W, Huang W, Hou RL, Wang YN, Guo YK. Comparison of cardiovascular magnetic resonance characteristics and clinical prognosis in left ventricular noncompaction patients with and without arrhythmia. BMC Cardiovasc Disord 2022; 22:25. [PMID: 35109817 PMCID: PMC8812199 DOI: 10.1186/s12872-022-02470-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular noncompaction (LVNC) is a rare type of cardiomyopathy, and one of its clinical manifestations is arrhythmia. Cardiovascular magnetic resonance (CMR) is valuable for the diagnosis and prognosis of LVNC. However, studies are lacking on the use of CMR for LVNC patients with arrhythmia. This study aimed to characterize and compare CMR features and prognosis in LVNC patients with and without arrhythmia. METHODS Eighty-four LVNC patients diagnosed by CMR were enrolled retrospectively in this study. Clinical data, arrhythmia characteristics, and CMR parameters were collected. Patients were divided into different groups according to the arrhythmia characteristics and CMR manifestations for statistical analysis and comparison. Ventricular tachycardia (VT), ventricular fibrillation (Vf), ventricular flutter (VFL), III° atrioventricular block (III° AVB), Wolff-Parkinson-White syndrome (WPW) and ventricular escape (VE) were defined as malignant arrhythmias and benign arrhythmias included premature ventricular contraction, atrial premature beats, atrial fibrillation, supraventricular tachycardia, supraventricular premature beat, bundle branch block, atrial flutter and sinus tachycardia. The outcome events were defined as a composition event of cardiac death, rehospitalization for heart failure, heart transplantation, and implantation of an implantable cardioverter defibrillator (ICD). RESULTS Sixty-seven LVNC patients (79.76%) mainly presented with arrhythmia, including premature ventricular beat (33 patients [27.73%]), bundle branch block (14 patients [11.77%]), electrocardiogram waveform changes (18 patients [15.13%]), and ventricular tachycardia (11 patients [9.24%]). The cardiac function and structure parameters had no significant difference among the nonarrhythmia group, benign arrhythmia group, and malignant arrhythmia group. However, the presence of late gadolinium enhancement (LGE) was higher in the malignant arrhythmia group than in the other two groups (p = 0.023). At a mean follow-up of 46 months, cardiac events occurred in twenty-three patients (46.94%). Kaplan-Meier analysis showed that there was no statistically significant difference in prognosis among the nonarrhythmia, benign, and malignant arrhythmia groups, but the patients with arrhythmia and association with LGE + or left ventricular ejection fraction (LVEF) < 30% had a higher risk than patients with LGE- or LVEF > 30% (LGE +, HR = 4.035, 95% CI 1.475-11.035; LVEF < 30%, HR = 8.131, 95% CI 1.805-36.636; P < 0.05). CONCLUSIONS In LVNC patients, the types of arrhythmias are numerous and unrepresentative, and arrhythmia is not the prognostic factor. Arrhythmia combined with presence of LGE or LVEF < 30% is associated with poor prognosis in LVNC patients.
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Affiliation(s)
- Zi-Qi Zhou
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Wen-Chong He
- Research Management Office, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongcheng District, Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China
| | - Wei Bai
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Wei Huang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Rui-Lai Hou
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China
| | - Yi-Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongcheng District, Peking Union Medical College, No. 1 Shuaifuyuan, Beijing, 100730, China.
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China.
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Mid-wall striae fibrosis predicts heart failure admission, composite heart failure events, and life-threatening arrhythmias in dilated cardiomyopathy. Sci Rep 2022; 12:1739. [PMID: 35110630 PMCID: PMC8810767 DOI: 10.1038/s41598-022-05790-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/14/2022] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) admission is a dominant contributor to morbidity and healthcare costs in dilated cardiomyopathy (DCM). Mid-wall striae (MWS) fibrosis by late gadolinium enhancement (LGE) imaging has been associated with elevated arrhythmia risk. However, its capacity to predict HF-specific outcomes is poorly defined. We investigated its role to predict HF admission and relevant secondary outcomes in a large cohort of DCM patients. 719 patients referred for LGE MRI assessment of DCM were enrolled and followed for clinical events. Standardized image analyses and interpretations were conducted inclusive of coding the presence and patterns of fibrosis observed by LGE imaging. The primary clinical outcome was hospital admission for decompensated HF. Secondary heart failure and arrhythmic composite endpoints were also studied. Median age was 57 (IQR 47–65) years and median LVEF 40% (IQR 29–47%). Any fibrosis was observed in 228 patients (32%) with MWS fibrosis pattern present in 178 (25%). At a median follow up of 1044 days, 104 (15%) patients experienced the primary outcome, and 127 (18%) the secondary outcome. MWS was associated with a 2.14-fold risk of the primary outcome, 2.15-fold risk of the secondary HF outcome, and 2.23-fold risk of the secondary arrhythmic outcome. Multivariable analysis adjusting for all relevant covariates, inclusive of LVEF, showed patients with MWS fibrosis to experience a 1.65-fold increased risk (95% CI 1.11–2.47) of HF admission and 1-year event rate of 12% versus 7% without this phenotypic marker. Similar findings were observed for the secondary outcomes. Patients with LVEF > 35% plus MWS fibrosis experienced similar event rates to those with LVEF ≤ 35%. MWS fibrosis is a powerful and independent predictor of clinical outcomes in patients with DCM, identifying patients with LVEF > 35% who experience similar event rates to those with LVEF below this conventionally employed high-risk phenotype threshold.
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73
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Bauer BK, Meier C, Bietenbeck M, Lange PS, Eckardt L, Yilmaz A. Cardiovascular Magnetic Resonance-Guided Radiofrequency Ablation: Where Are We Now? JACC Clin Electrophysiol 2022; 8:261-274. [PMID: 35210090 DOI: 10.1016/j.jacep.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
The possibilities of cardiovascular magnetic resonance (CMR) imaging for myocardial tissue characterization and catheter ablation guidance are accompanied by some fictional concepts. In this review, we present the available facts about CMR-guided catheter ablation procedures as well as promising, however unproven, theoretical concepts. CMR promises to visualize the respective arrhythmogenic substrate and may thereby make it more localizable for electrophysiology (EP)-based ablation. Robust CMR imaging is challenged by motion of the heart resulting from cardiac and respiratory cycles. In contrast to conventional "passive" tracking of the catheter tip by real-time CMR, novel approaches based on "active" tracking are performed by integrating microcoils into the catheter tip that send a receiver signal. Several experimental and clinical studies were already performed based on real-time CMR for catheter ablation of atrial and ventricular arrhythmias. Importantly, successful ablation of the cavotricuspid isthmus was already performed in patients with typical atrial flutter. However, a complete EP procedure with real-time CMR-guided transseptal puncture and subsequent pulmonary vein isolation has not been shown so far in patients with atrial fibrillation. Moreover, real-time CMR-guided EP for ventricular tachycardia ablation was only performed in animal models using a transseptal, retrograde, or epicardial access-but not in humans. Essential improvements within the next few years regarding basic technical requirements, such as higher spatial and temporal resolution of real-time CMR imaging as well as clinically approved cardiac magnetic resonance-conditional defibrillators, are ultimately required-but can also be expected-and will move this field forward.
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Affiliation(s)
- Bastian Klemens Bauer
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany.
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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75
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Finocchiaro G, Magavern EF, Georgioupoulos G, Maurizi N, Sinagra G, Carr-White G, Pantazis A, Olivotto I. Sudden cardiac death in cardiomyopathies: acting upon "acceptable" risk in the personalized medicine era. Heart Fail Rev 2022; 27:1749-1759. [PMID: 35083629 DOI: 10.1007/s10741-021-10198-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Patients with cardiomyopathies are confronted with the risk of sudden cardiac death (SCD) throughout their lifetime. Despite the fact that SCD is relatively rare, prognostic stratification is an integral part of physician-patient discussion, with the goal of risk modification and prevention. The current approach is based on a concept of "acceptable risk." However, there are intrinsic problems with an algorithm-based approach to risk management, magnified by the absence of robust evidence underlying clinical decision support tools, which can make high- versus low-risk classifications arbitrary. Strategies aimed at risk reduction range from selecting patients for an implantable cardioverter defibrillator (ICD) to disqualification from competitive sports. These clinical options, especially when implying the use of finite financial resources, are often delivered from the physician's perspective citing decision-making algorithms. When the burden of intervention-related risks or financial costs is deemed higher than an "acceptable risk" of SCD, the patient's perspective may not be appropriately considered. Designating a numeric threshold of "acceptable risk" has ethical implications. One could reasonably ask "acceptable to whom?" In an era when individual choice and autonomy are pillars of the physician-patient relationship, the subjective aspects of perceived risk should be acknowledged and be part of shared decision-making. This is particularly true when the lack of a strong scientific evidence base makes a dichotomous algorithm-driven approach suboptimal for unmitigated translation to clinical practice.
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Affiliation(s)
- Gherardo Finocchiaro
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK. .,King's College London, London, UK. .,Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK. .,Cardiovascular Clinical Academic Group, St George's, University of London, London, UK.
| | - Emma F Magavern
- The London School of Medicine and Dentistry, William Harvey Research Institute, Barts, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | | | - Niccolo' Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gerald Carr-White
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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Chen Q, Zeng Y, Yang X, Wu Y, Zhang S, Huang S, Zhong Y, Chen M. Resveratrol ameliorates myocardial fibrosis by regulating Sirt1/Smad3 deacetylation pathway in rat model with dilated cardiomyopathy. BMC Cardiovasc Disord 2022; 22:17. [PMID: 35081907 PMCID: PMC8793224 DOI: 10.1186/s12872-021-02401-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the effects of Resveratrol (RSV) in rats with dilated cardiomyopathy (DCM). Methods Porcine cardiac myosin was used to set up rat model with DCM. RSV (10 mg/kg in RSV-L group and 50 mg/kg in RSV-H group) or vehicle was administered to rats with DCM once daily from the 28th day till the 90th day after the first immunization. Cardiac function of rats was evaluated by echocardiographic analysis. The deposition of fibrous tissues in the hearts was evaluated by Masson and picrosirius red staining. The mRNA levels of collagen type I (Col I), collagen type III (Col III) and silence information regulator 1 (Sirt1) were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The interaction of Sirt1 with Smad3 was revealed by coimmunoprecipitation. Results The heart weight, heart weight/body weight ratio, left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were significantly increased in rats with DCM, and attenuated by RSV. RSV also positively decreased fibrosis, and the expression of Col I and Col III in the myocardium. The Sirt1 mRNA was significantly decreased in myosin-immunized hearts and was positively increased by RSV. The Sirt1 combined with Smad3 directly. Acetylation of Smad3 (Ac-Smad3) was significantly increased in DCM and was markedly decreased by RSV. Conclusion RSV effectively ameliorated myocardial fibrosis and improved cardiac function by regulating Sirt1/Smad3 deacetylation pathway in rat model with DCM.
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Affiliation(s)
- Qingquan Chen
- Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350004, Fujian, China.
| | - Yu Zeng
- Xiamen Maternal and Pediatric Hospital, Women and Children's Hospital Affiliated To Xiamen University, Xiamen, 361003, China
| | - Xiulin Yang
- Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350004, Fujian, China
| | - Yue Wu
- Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350004, Fujian, China
| | - Shuyu Zhang
- Department of Laboratory Medicine, Fujian Obstetrics and Gynecology Hospital, Fuzhou, 350012, China
| | - Shirong Huang
- Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350004, Fujian, China
| | - Yameng Zhong
- Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350004, Fujian, China
| | - Min Chen
- Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, 88 Jiaotong Road, Fuzhou, 350004, Fujian, China. .,The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Fuzhou, 350122, China.
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77
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Casas G, Rodríguez-Palomares JF. Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis. J Clin Med 2022; 11:jcm11030578. [PMID: 35160031 PMCID: PMC8836975 DOI: 10.3390/jcm11030578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies.
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Affiliation(s)
- Guillem Casas
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Correspondence: (G.C.); (J.F.R.-P.)
| | - José F. Rodríguez-Palomares
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Correspondence: (G.C.); (J.F.R.-P.)
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78
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Seno A, Antiochos P, Lichtenfeld H, Rickers E, Qamar I, Ge Y, Blankstein R, Steigner M, Aghayev A, Jerosch-Herold M, Kwong RY. Prognostic Value of T1 Mapping and Feature Tracking by Cardiac Magnetic Resonance in Patients With Signs and Symptoms Suspecting Heart Failure and No Clinical Evidence of Coronary Artery Disease. J Am Heart Assoc 2022; 11:e020981. [PMID: 35023344 PMCID: PMC9238540 DOI: 10.1161/jaha.121.020981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The ability of left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) by cardiac magnetic resonance for risk stratification in suspected heart failure is limited. We aimed to evaluate the incremental prognostic value of cardiac magnetic resonance‐assessed extracellular volume fraction (ECV) and global longitudinal strain (GLS) in patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease. Methods and Results A total of 474 consecutive patients (57±21 years of age, 56% men) with heart failure‐related symptoms and absence of coronary artery disease underwent cardiac magnetic resonance. After median follow‐up of 18 months, 59 (12%) experienced the outcome of all‐cause death or heart failure hospitalization (DeathCHF). In univariate analysis, cardiac magnetic resonance‐assessed LVEF, LGE, GLS, and ECV were all significantly associated with DeathCHF. Adjusted for a multivariable baseline model including age, sex, LVEF and LGE, ECV, and GLS separately maintained a significant association with DeathCHF (ECV, hazard ratio [HR], 1.44 per 1 SD increase; 95% CI 1.13–1.84; P=0.003, and GLS, HR, 1.78 per 1 SD increase; 95% CI, 1.06–2.96; P=0.028 respectively). Adding both GLS and ECV to the baseline model significantly improved model discrimination (C statistic from 0.749 to 0.782, P=0.017) and risk reclassification (integrated discrimination improvement 0.046 [0.015–0.076], P=0.003; continuous net reclassification improvement 0.378 [0.065–0.752], P<0.001) for DeathCHF, beyond LVEF and LGE. Conclusions In patients with signs and symptoms suspecting heart failure and no clinical evidence of coronary artery disease, joint assessment of GLS and ECV provides incremental prognostic value for DeathCHF, independent of LVEF and LGE.
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Affiliation(s)
- Ayako Seno
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Panagiotis Antiochos
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Helena Lichtenfeld
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Eva Rickers
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Iqra Qamar
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Yin Ge
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Ron Blankstein
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA.,Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Michael Steigner
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Ayaz Aghayev
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Raymond Y Kwong
- Cardiovascular Imaging Section Cardiovascular Division of Department of Medicine and Department of Radiology Brigham and Women's Hospital Boston MA.,Cardiovascular Division Brigham and Women's Hospital Boston MA
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79
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Ryan M, Morgan H, Chiribiri A, Nagel E, Cleland J, Perera D. Myocardial viability testing: all STICHed up, or about to be REVIVED? Eur Heart J 2022; 43:118-126. [PMID: 34791132 PMCID: PMC8757581 DOI: 10.1093/eurheartj/ehab729] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023] Open
Abstract
Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the future.
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Affiliation(s)
- Matthew Ryan
- School of Cardiovascular Medicine and Sciences, King’s College London, Westminster Bridge Road, London SE1 7EH, UK
| | - Holly Morgan
- School of Cardiovascular Medicine and Sciences, King’s College London, Westminster Bridge Road, London SE1 7EH, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London SE1 7EH, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - John Cleland
- Robertson Centre for Biostatistics, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, King’s College London, Westminster Bridge Road, London SE1 7EH, UK
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80
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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81
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Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nat Rev Cardiol 2022; 19:100-116. [PMID: 34489589 PMCID: PMC8420965 DOI: 10.1038/s41569-021-00605-5] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 02/08/2023]
Abstract
Left ventricular ejection fraction (EF) remains the major parameter for diagnosis, phenotyping, prognosis and treatment decisions in heart failure. The 2016 ESC heart failure guidelines introduced a third EF category for an EF of 40-49%, defined as heart failure with mid-range EF (HFmrEF). This category has been largely unexplored compared with heart failure with reduced EF (HFrEF; defined as EF <40% in this Review) and heart failure with preserved EF (HFpEF; defined as EF ≥50%). The prevalence of HFmrEF within the overall population of patients with HF is 10-25%. HFmrEF seems to be an intermediate clinical entity between HFrEF and HFpEF in some respects, but more similar to HFrEF in others, in particular with regard to the high prevalence of ischaemic heart disease in these patients. HFmrEF is milder than HFrEF, and the risk of cardiovascular events is lower in patients with HFmrEF or HFpEF than in those with HFrEF. By contrast, the risk of non-cardiovascular adverse events is similar or greater in patients with HFmrEF or HFpEF than in those with HFrEF. Evidence from post hoc and subgroup analyses of randomized clinical trials and a trial of an SGLT1-SGLT2 inhibitor suggests that drugs that are effective in patients with HFrEF might also be effective in patients with HFmrEF. Although the EF is a continuous measure with considerable variability, in this comprehensive Review we suggest that HFmrEF is a useful categorization of patients with HF and shares the most important clinical features with HFrEF, which supports the renaming of HFmrEF to HF with mildly reduced EF.
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Affiliation(s)
- Gianluigi Savarese
- grid.4714.60000 0004 1937 0626Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Davide Stolfo
- grid.4714.60000 0004 1937 0626Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden ,Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy
| | - Lars H. Lund
- grid.4714.60000 0004 1937 0626Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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82
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Pour-Ghaz I, Heckle M, Ifedili I, Kayali S, Nance C, Kabra R, Jha SK, Jefferies JL, Levine YC. Beyond Ejection Fraction: Novel Clinical Approaches Towards Sudden Cardiac Death Risk Stratification in Patients with Dilated Cardiomyopathy. Curr Cardiol Rev 2022; 18:e040821195265. [PMID: 34348632 PMCID: PMC9413734 DOI: 10.2174/1573403x17666210804125939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/16/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022] Open
Abstract
Implantable Cardioverter-Defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death due to ventricular tachyarrhythmia. The most commonly used risk stratification algorithms use Left Ventricular Ejection Fraction (LVEF) to determine which patients qualify for ICD therapy, even though LVEF is a better marker of total mortality than ventricular tachyarrhythmias mortality. This review evaluates imaging tools and novel biomarkers proposed for better risk stratifying arrhythmic substrate, thereby identifying optimal ICD therapy candidates.
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Affiliation(s)
- Issa Pour-Ghaz
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mark Heckle
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ikechukwu Ifedili
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sharif Kayali
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christopher Nance
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rajesh Kabra
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Sunil K Jha
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - John L Jefferies
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Yehoshua C Levine
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Methodist Le Bonheur Healthcare, Memphis, TN, USA
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83
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Shu S, Wang C, Hong Z, Zhou X, Zhang T, Peng Q, Wang J, Zheng C. Prognostic Value of Late Enhanced Cardiac Magnetic Resonance Imaging Derived Texture Features in Dilated Cardiomyopathy Patients With Severely Reduced Ejection Fractions. Front Cardiovasc Med 2021; 8:766423. [PMID: 34977183 PMCID: PMC8718517 DOI: 10.3389/fcvm.2021.766423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Late enhanced cardiac magnetic resonance (CMR) images of the left ventricular myocardium contain an enormous amount of information that could provide prognostic value beyond that of late gadolinium enhancements (LGEs). With computational postprocessing and analysis, the heterogeneities and variations of myocardial signal intensities can be interpreted and measured as texture features. This study aimed to evaluate the value of texture features extracted from late enhanced CMR images of the myocardium to predict adverse outcomes in patients with dilated cardiomyopathy (DCM) and severe systolic dysfunction.Methods: This single-center study retrospectively enrolled patients with DCM with severely reduced left ventricular ejection fractions (LVEFs < 35%). Texture features were extracted from enhanced late scanning images, and the presence and extent of LGEs were also measured. Patients were followed-up for clinical endpoints composed of all-cause deaths and cardiac transplantation. Cox proportional hazard regression and Kaplan–Meier analyses were used to evaluate the prognostic value of texture features and conventional CMR parameters with event-free survival.Results: A total of 114 patients (37 women, median age 47.5 years old) with severely impaired systolic function (median LVEF, 14.0%) were followed-up for a median of 504.5 days. Twenty-nine patients experienced endpoint events, 12 died, and 17 underwent cardiac transplantations. Three texture features from a gray-level co-occurrence matrix (GLCM) (GLCM_contrast, GLCM_difference average, and GLCM_difference entropy) showed good prognostic value for adverse events when analyzed using univariable Cox hazard ratio regression (p = 0.007, p = 0.011, and p = 0.007, retrospectively). When each of the three features was analyzed using a multivariable Cox regression model that included the clinical parameter (systolic blood pressure) and LGE extent, they were found to be independently associated with adverse outcomes.Conclusion: Texture features related LGE heterogeneities and variations (GLCM_contrast, GLCM_difference average, and GLCM_difference entropy) are novel markers for risk stratification toward adverse events in DCM patients with severe systolic dysfunction.
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Affiliation(s)
- Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Cheng Wang
- Department of Cardiology, Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziming Hong
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers, Shanghai, China
| | | | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Jing Wang
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Chuansheng Zheng
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84
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Lota AS, Tsao A, Owen R, Halliday BP, Auger D, Vassiliou VS, Tayal U, Almogheer B, Vilches S, Al-Balah A, Patel A, Mouy F, Buchan R, Newsome S, Gregson J, Ware JS, Cook SA, Cleland JGF, Pennell DJ, Prasad SK. Prognostic Significance of Nonischemic Myocardial Fibrosis in Patients With Normal LV Volumes and Ejection-Fraction. JACC Cardiovasc Imaging 2021; 14:2353-2365. [PMID: 34274268 PMCID: PMC8648892 DOI: 10.1016/j.jcmg.2021.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/20/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aims to investigate the prognostic significance of late gadolinium enhancement (LGE) in patients without coronary artery disease and with normal range left ventricular (LV) volumes and ejection fraction. BACKGROUND Nonischemic patterns of LGE with normal LV volumes and ejection fraction are increasingly detected on cardiovascular magnetic resonance, but their prognostic significance, and consequently management, is uncertain. METHODS Patients with midwall/subepicardial LGE and normal LV volumes, wall thickness, and ejection fraction on cardiovascular magnetic resonance were enrolled and compared to a control group without LGE. The primary outcome was actual or aborted sudden cardiac death (SCD). RESULTS Of 748 patients enrolled, 401 had LGE and 347 did not. The median age was 50 years (interquartile range: 38-61 years), LV ejection fraction 66% (interquartile range: 62%-70%), and 287 (38%) were women. Scan indications included chest pain (40%), palpitation (33%) and breathlessness (13%). No patient experienced SCD and only 1 LGE+ patient (0.13%) had an aborted SCD in the 11th follow-up year. Over a median of 4.3 years, 30 patients (4.0%) died. All-cause mortality was similar for LGE+/- patients (3.7% vs 4.3%; P = 0.71) and was associated with age (HR: 2.04 per 10 years; 95% CI: 1.46-2.79; P < 0.001). Twenty-one LGE+ and 4 LGE- patients had an unplanned cardiovascular hospital admission (HR: 7.22; 95% CI: 4.26-21.17; P < 0.0001). CONCLUSIONS There was a low SCD risk during long-term follow-up in patients with LGE but otherwise normal LV volumes and ejection fraction. Mortality was driven by age and not LGE presence, location, or extent, although the latter was associated with greater cardiovascular hospitalization for suspected myocarditis and symptomatic ventricular tachycardia.
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Affiliation(s)
- Amrit S Lota
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Adam Tsao
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Imperial College London Medical School, London, United Kingdom
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brian P Halliday
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Dominique Auger
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vassilios S Vassiliou
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Upasana Tayal
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Batool Almogheer
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
| | - Silvia Vilches
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
| | - Amer Al-Balah
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Imperial College London Medical School, London, United Kingdom
| | - Akhil Patel
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Imperial College London Medical School, London, United Kingdom
| | - Florence Mouy
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Rachel Buchan
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Simon Newsome
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James S Ware
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; MRC London Institute of Medical Sciences, London, United Kingdom
| | - Stuart A Cook
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; National Heart Centre Singapore, Singapore
| | - John G F Cleland
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Dudley J Pennell
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom.
| | - Sanjay K Prasad
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
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85
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 783] [Impact Index Per Article: 261.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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86
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Li S, Zhou D, Sirajuddin A, He J, Xu J, Zhuang B, Huang J, Yin G, Fan X, Wu W, Sun X, Zhao S, Arai AE, Lu M. T1 Mapping and Extracellular Volume Fraction in Dilated Cardiomyopathy: A Prognosis Study. JACC Cardiovasc Imaging 2021; 15:578-590. [PMID: 34538631 DOI: 10.1016/j.jcmg.2021.07.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/12/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study is to examine the prognostic value of T1 mapping and the extracellular volume (ECV) fraction in patients with dilated cardiomyopathy (DCM). BACKGROUND Patients with DCM with functional left ventricular remodeling have poorer prognoses. Noninvasive assessment of myocardial fibrosis using T1 mapping and the ECV fraction may improve risk stratification of patients with DCM; however, this has not yet been systematically evaluated. METHODS A total of 659 consecutive patients with DCM (498 men; 45 ± 15 years) who underwent cardiac magnetic resonance with T1 mapping and late gadolinium enhancement (LGE) imaging with a 1.5-T magnetic resonance scanner were enrolled in this study. Primary endpoints were cardiac-related death and heart transplantation. Secondary endpoints were hospitalization for heart failure, ventricular arrhythmias, and implantable cardioverter-defibrillator or cardiac resynchronization therapy implantation. Survival estimates were calculated by Kaplan-Meier curves with the log-rank test. RESULTS During a mean follow-up of 66.3 ± 20.9 months, 122 and 205 patients with DCM reached the primary and secondary endpoints, respectively. The presence of LGE had an association with both of the primary and secondary endpoints observed in the patients with DCM (both P < 0.001). The maximum native T1 (HR: 1.04; 95% CI: 1.02-1.09) and maximum ECV fraction (HR: 1.14; 95% CI: 1.08-1.21) had associations with the primary endpoints in the patients with positive LGE (both P < 0.001), whereas the mean native T1 (HR: 1.13; 95% CI: 1.10-1.36) and mean ECV fraction (HR: 1.32; 95% CI: 1.12-1.53) had the best associations in the patients with negative LGE (all P < 0.001). CONCLUSIONS T1 mapping and the ECV fraction had prognostic value in patients with DCM and were particularly important in patients with DCM without LGE. Using a combination of T1 mapping, ECV fraction, and LGE provided optimal risk stratification for patients with DCM.
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Affiliation(s)
- Shuang Li
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Zhou
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jian He
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Xu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghan Huang
- Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Yin
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxin Sun
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China; Department of Nuclear Medicine, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andrew E Arai
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China.
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87
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Moura B, Aimo A, Al-Mohammad A, Flammer A, Barberis V, Bayes-Genis A, Brunner-La Rocca HP, Fontes-Carvalho R, Grapsa J, Hülsmann M, Ibrahim N, Knackstedt C, Januzzi JL, Lapinskas T, Sarrias A, Matskeplishvili S, Meijers WC, Messroghli D, Mueller C, Pavo N, Simonavičius J, Teske AJ, van Kimmenade R, Seferovic P, Coats AJS, Emdin M, Richards AM. Integration of imaging and circulating biomarkers in heart failure: a consensus document by the Biomarkers and Imaging Study Groups of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:1577-1596. [PMID: 34482622 DOI: 10.1002/ejhf.2339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/28/2021] [Accepted: 08/29/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating biomarkers and imaging techniques provide independent and complementary information to guide management of heart failure (HF). This consensus document by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) presents current evidence-based indications relevant to integration of imaging techniques and biomarkers in HF. The document first focuses on application of circulating biomarkers together with imaging findings, in the broad domains of screening, diagnosis, risk stratification, guidance of treatment and monitoring, and then discusses specific challenging settings. In each section we crystallize clinically relevant recommendations and identify directions for future research. The target readership of this document includes cardiologists, internal medicine specialists and other clinicians dealing with HF patients.
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Affiliation(s)
- Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - Abdallah Al-Mohammad
- Medical School, University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar de Vila Nova Gaia/Espinho, Espinho, Portugal
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, UK
| | - Martin Hülsmann
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nasrien Ibrahim
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tomas Lapinskas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Axel Sarrias
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Noemi Pavo
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Justas Simonavičius
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
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88
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Sanna GD, Canonico ME, Santoro C, Esposito R, Masia SL, Galderisi M, Parodi G, Nihoyannopoulos P. Echocardiographic Longitudinal Strain Analysis in Heart Failure: Real Usefulness for Clinical Management Beyond Diagnostic Value and Prognostic Correlations? A Comprehensive Review. Curr Heart Fail Rep 2021; 18:290-303. [PMID: 34398411 DOI: 10.1007/s11897-021-00530-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a highly prevalent clinical syndrome characterized by considerable phenotypic heterogeneity. The traditional classification based on left ventricular ejection fraction (LVEF) is widely accepted by the guidelines and represents the grounds for patient enrollment in clinical trials, even though it shows several limitations. Ejection fraction (EF) is affected by preload, afterload, and contractility, it being problematic to express LV function in several conditions, such as HF with preserved EF (HFpEF), valvular heart disease, and subclinical HF, and in athletes. Over the last two decades, developments in diagnostic techniques have provided useful tools to overcome EF limitations. Strain imaging analysis (particularly global longitudinal strain (GLS)) has emerged as a useful echocardiographic technique in patients with HF, as it is able to simultaneously supply information on both systolic and diastolic functions, depending on cardiac anatomy and physiology/pathophysiology. The use of GLS has proved helpful in terms of diagnostic performance and prognostic value in several HF studies. Universally accepted cutoff values and variability across vendors remain an area to be fully explored, hence limiting routine application of this technique in clinical practice. In the present review, the current role of GLS in the diagnosis and management of patients with HF will be discussed. We describe, by critical analysis of the pros and cons, various clinical settings in HF, and how the appropriate use and interpretation of GLS can provide important clues.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.
| | - Mario E Canonico
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Stefano L Masia
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Petros Nihoyannopoulos
- Imperial College London (National Heart and Lung Institute), Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
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89
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Casas G, Limeres J, Oristrell G, Gutierrez-Garcia L, Andreini D, Borregan M, Larrañaga-Moreira JM, Lopez-Sainz A, Codina-Solà M, Teixido-Tura G, Sorolla-Romero JA, Fernández-Álvarez P, González-Carrillo J, Guala A, La Mura L, Soler-Fernández R, Sao Avilés A, Santos-Mateo JJ, Marsal JR, Ribera A, de la Pompa JL, Villacorta E, Jiménez-Jáimez J, Ripoll-Vera T, Bayes-Genis A, Garcia-Pinilla JM, Palomino-Doza J, Tiron C, Pontone G, Bogaert J, Aquaro GD, Gimeno-Blanes JR, Zorio E, Garcia-Pavia P, Barriales-Villa R, Evangelista A, Masci PG, Ferreira-González I, Rodríguez-Palomares JF. Clinical Risk Prediction in Patients With Left Ventricular Myocardial Noncompaction. J Am Coll Cardiol 2021; 78:643-662. [PMID: 34384546 DOI: 10.1016/j.jacc.2021.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Left ventricular noncompaction (LVNC) is a heterogeneous entity with uncertain prognosis. OBJECTIVES This study sought to develop and validate a prediction model of major adverse cardiovascular events (MACE) and to identify LVNC cases without events during long-term follow-up. METHODS This is a retrospective longitudinal multicenter cohort study of consecutive patients fulfilling LVNC criteria by echocardiography or cardiovascular magnetic resonance. MACE were defined as heart failure (HF), ventricular arrhythmias (VAs), systemic embolisms, or all-cause mortality. RESULTS A total of 585 patients were included (45 ± 20 years of age, 57% male). LV ejection fraction (LVEF) was 48% ± 17%, and 18% presented late gadolinium enhancement (LGE). After a median follow-up of 5.1 years, MACE occurred in 223 (38%) patients: HF in 110 (19%), VAs in 87 (15%), systemic embolisms in 18 (3%), and 34 (6%) died. LVEF was the main variable independently associated with MACE (P < 0.05). LGE was associated with HF and VAs in patients with LVEF >35% (P < 0.05). A prediction model of MACE was developed using Cox regression, composed by age, sex, electrocardiography, cardiovascular risk factors, LVEF, and family aggregation. C-index was 0.72 (95% confidence interval: 0.67-0.75) in the derivation cohort and 0.72 (95% confidence interval: 0.71-0.73) in an external validation cohort. Patients with no electrocardiogram abnormalities, LVEF ≥50%, no LGE, and negative family screening presented no MACE at follow-up. CONCLUSIONS LVNC is associated with an increased risk of heart failure and ventricular arrhythmias. LVEF is the variable most strongly associated with MACE; however, LGE confers additional risk in patients without severe systolic dysfunction. A risk prediction model is developed and validated to guide management.
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Affiliation(s)
- Guillem Casas
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Javier Limeres
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gerard Oristrell
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Laura Gutierrez-Garcia
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mar Borregan
- Genetics and Molecular Medicine Department and Pediatric Institute of Rare Diseases, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jose M Larrañaga-Moreira
- Inherited Cardiovascular Diseases Unit, Cardiology Department, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, A Coruña, Spain
| | - Angela Lopez-Sainz
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARD-Heart), Madrid, Spain
| | - Marta Codina-Solà
- Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gisela Teixido-Tura
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Paula Fernández-Álvarez
- Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Andrea Guala
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Rafaela Soler-Fernández
- Radiology Department, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, A Coruña, Spain
| | - Augusto Sao Avilés
- Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain; Neurology/Neuroimmunology Department, Vall d'Hebron Hospital, Barcelona, Spain; Statistics and Bioinformatics Unit (UEB-VHIR), Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Josep Ramon Marsal
- Epidemiology Unit of the Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid, Spain
| | - Aida Ribera
- Epidemiology Unit of the Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid, Spain
| | - José Luis de la Pompa
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Intercellular Signalling in Cardiovascular Development and Disease Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Eduardo Villacorta
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Juan Jiménez-Jáimez
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Tomás Ripoll-Vera
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario Son Llatzer and Institut d'Investigaciò Sanitària Illes Balears, Mallorca, Spain
| | - Antoni Bayes-Genis
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Garcia-Pinilla
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Heart Failure and Familial Cardiomyopathies Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Julián Palomino-Doza
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Coloma Tiron
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitari Dr Josep Trueta, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | | | - Jan Bogaert
- Gasthuisberg University Hospital, Leuven, Belgium
| | | | - Juan Ramon Gimeno-Blanes
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Heart Diseases Unit, Cardiology Department, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain; CAFAMUSME Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pablo Garcia-Pavia
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARD-Heart), Madrid, Spain; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | - Roberto Barriales-Villa
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiovascular Diseases Unit, Cardiology Department, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, A Coruña, Spain
| | - Artur Evangelista
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ignacio Ferreira-González
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Epidemiology Unit of the Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid, Spain.
| | - José F Rodríguez-Palomares
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain; Inherited Cardiovascular Disease Unit and Cardiovascular Genetics. Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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90
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Zhu K, Ma T, Su Y, Pan X, Huang R, Zhang F, Yan C, Xu D. Heart Failure With Mid-range Ejection Fraction: Every Coin Has Two Sides. Front Cardiovasc Med 2021; 8:683418. [PMID: 34368245 PMCID: PMC8333279 DOI: 10.3389/fcvm.2021.683418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022] Open
Abstract
This review summarizes current knowledge regarding clinical epidemiology, pathophysiology, and prognosis for patients with HFmrEF in comparison to HFrEF and HFpEF. Although recommended treatments currently focus on aggressive management of comorbidities, we summarize potentially beneficial therapies that can delay the process of heart failure by blocking the pathophysiology mechanism. More studies are needed to further characterize HFmrEF and identify effective management strategies that can reduce cardiovascular morbidity and mortality of patients with HFmrEF.
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Affiliation(s)
- Kaiyuan Zhu
- Department of Cardiology, Qidong People's Hospital, Nantong, China
| | - Teng Ma
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Su
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Pan
- Department of Geriatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rongrong Huang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fenglei Zhang
- Department of Cardiology, Qidong People's Hospital, Nantong, China
| | - Chunxi Yan
- Department of Cardiology, Qidong People's Hospital, Nantong, China
| | - Dachun Xu
- Department of Cardiology, Qidong People's Hospital, Nantong, China.,Department of Geriatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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91
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Paddock S, Tsampasian V, Assadi H, Mota BC, Swift AJ, Chowdhary A, Swoboda P, Levelt E, Sammut E, Dastidar A, Broncano Cabrero J, Del Val JR, Malcolm P, Sun J, Ryding A, Sawh C, Greenwood R, Hewson D, Vassiliou V, Garg P. Clinical Translation of Three-Dimensional Scar, Diffusion Tensor Imaging, Four-Dimensional Flow, and Quantitative Perfusion in Cardiac MRI: A Comprehensive Review. Front Cardiovasc Med 2021; 8:682027. [PMID: 34307496 PMCID: PMC8292630 DOI: 10.3389/fcvm.2021.682027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is a versatile tool that has established itself as the reference method for functional assessment and tissue characterisation. CMR helps to diagnose, monitor disease course and sub-phenotype disease states. Several emerging CMR methods have the potential to offer a personalised medicine approach to treatment. CMR tissue characterisation is used to assess myocardial oedema, inflammation or thrombus in various disease conditions. CMR derived scar maps have the potential to inform ablation therapy—both in atrial and ventricular arrhythmias. Quantitative CMR is pushing boundaries with motion corrections in tissue characterisation and first-pass perfusion. Advanced tissue characterisation by imaging the myocardial fibre orientation using diffusion tensor imaging (DTI), has also demonstrated novel insights in patients with cardiomyopathies. Enhanced flow assessment using four-dimensional flow (4D flow) CMR, where time is the fourth dimension, allows quantification of transvalvular flow to a high degree of accuracy for all four-valves within the same cardiac cycle. This review discusses these emerging methods and others in detail and gives the reader a foresight of how CMR will evolve into a powerful clinical tool in offering a precision medicine approach to treatment, diagnosis, and detection of disease.
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Affiliation(s)
- Sophie Paddock
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasiliki Tsampasian
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hosamadin Assadi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Bruno Calife Mota
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eva Sammut
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Amardeep Dastidar
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Jordi Broncano Cabrero
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Javier Royuela Del Val
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Paul Malcolm
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Julia Sun
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Richard Greenwood
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - David Hewson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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92
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CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter-Defibrillator in Non-Ischemic Cardiomyopathy. Int J Mol Sci 2021; 22:ijms22137115. [PMID: 34281168 PMCID: PMC8268120 DOI: 10.3390/ijms22137115] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two subgroups in recommending ICD implantation. Hence, risk stratification is required to determine the subgroup of patients with NICM who will likely benefit from ICD therapy. Various predictors have been proposed, among others genetic mutations, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDD), and T-wave alternans (TWA). In addition to these parameters, cardiovascular magnetic resonance imaging (CMR) has the potential to further improve risk stratification. CMR allows the comprehensive analysis of cardiac function and myocardial tissue composition. A range of CMR parameters have been associated with SCD. Applicable examples include late gadolinium enhancement (LGE), T1 relaxation times, and myocardial strain. This review evaluates the epidemiological aspects of SCD in NICM, the role of CMR for risk stratification, and resulting indications for ICD implantation.
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93
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Francone M, Aquaro GD, Barison A, Castelletti S, de Cobelli F, de Lazzari M, Esposito A, Focardi M, di Renzi P, Indolfi C, Lanzillo C, Lovato L, Maestrini V, Mercuro G, Natale L, Mantini C, Polizzi G, Rabbat M, Secchi F, Secinaro A, di Cesare E, Pontone G. Appropriate use criteria for cardiovascular MRI: SIC - SIRM position paper Part 2 (myocarditis, pericardial disease, cardiomyopathies and valvular heart disease). J Cardiovasc Med (Hagerstown) 2021; 22:515-529. [PMID: 34076599 DOI: 10.2459/jcm.0000000000001170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiovascular magnetic resonance (CMR) has emerged as an accurate diagnostic technique for the evaluation of patients with cardiac disease in the majority of clinical settings, thanks to an established additional diagnostic and prognostic value. This document has been developed by a joined group of experts of the Italian Society of Cardiology (SIC) and Italian Society of Radiology (SIRM) to provide a summary about the current state of technology and clinical applications of CMR, to improve the clinical diagnostic pathways and to promote its inclusion in clinical practice. The writing committee consisted of members and experts of both societies in order to develop a more integrated approach in the field of cardiac imaging. This section 2 will cover myocarditis, pericardial disease, cardiomyopathies and valvular heart disease.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | | | | | - Silvia Castelletti
- Istituto Auxologico Italiano IRCCS, Center for the Cardiac Arrhythmias of Genetic Origin
| | - Francesco de Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan
| | - Manuel de Lazzari
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Italy
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan
| | - Marta Focardi
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena
| | - Paolo di Renzi
- U.O.C. Radiologia, Ospedale 'San Giovanni Calibita' Fatebenefratelli - Isola Tiberina - Rome
| | - Ciro Indolfi
- Division of Cardiology, University Magna Graecia, Italy and Mediterranea Cardiocentro, Naples
| | | | - Luigi Lovato
- Cardiovascular Radiology Unit, Department of Imaging S.Orsola-Malpighi University Hospital, Bologna
| | - Viviana Maestrini
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Luigi Natale
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology - Diagnostic Imaging Area
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Universita ' Cattolica del Sacro Cuore, Rome
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University, Chieti
| | - Gesualdo Polizzi
- Unit of Radiodiagnostics II, University Hospital 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Mark Rabbat
- Loyola University of Chicago, Chicago
- Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome
| | - Ernesto di Cesare
- Department of Life, Healt and Enviromental Sciences, University of L'Aquila, L'Aquila
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94
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Linhart M, Doltra A, Acosta J, Borràs R, Jáuregui B, Fernández-Armenta J, Anguera I, Bisbal F, Martí-Almor J, Tolosana JM, Penela D, Soto-Iglesias D, Villuendas R, Perea RJ, Ortiz JT, Bosch X, Auricchio A, Mont L, Berruezo A. Ventricular arrhythmia risk is associated with myocardial scar but not with response to cardiac resynchronization therapy. Europace 2021; 22:1391-1400. [PMID: 32898254 DOI: 10.1093/europace/euaa142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS Sudden cardiac death (SCD) risk estimation in patients referred for cardiac resynchronization therapy (CRT) remains a challenge. By CRT-mediated improvement of left ventricular ejection fraction (LVEF), many patients loose indication for primary prevention implantable cardioverter-defibrillator (ICD). Increasing evidence shows the importance of myocardial scar for risk prediction. The aim of this study was to investigate the prognostic impact of myocardial scar depending on the echocardiographic response in patients undergoing CRT. METHODS AND RESULTS Patients with indication for CRT were prospectively enrolled. Decision about ICD or pacemaker implantation was based on clinical criteria. All patients underwent delayed-enhancement cardiac magnetic resonance imaging. Median follow-up duration was 45 (24-75) months. Primary outcome was a composite of sustained ventricular arrhythmia, appropriate ICD therapy, or SCD. A total of 218 patients with LVEF 25.5 ± 6.6% were analysed [158 (73%) male, 64.9 ± 10.7 years]. Myocardial scar was observed in 73 patients with ischaemic cardiomyopathy (ICM) (95% of ICM patients); in 62 with non-ischaemic cardiomyopathy (45% of these patients); and in all but 1 of 36 (17%) patients who reached the primary outcome. Myocardial scar was the only significant predictor of primary outcome [odds ratio 27.7 (3.8-202.7)], independent of echocardiographic CRT response. A total of 55 (25%) patients died from any cause or received heart transplant. For overall survival, only a combination of the absence of myocardial scar with CRT response was associated with favourable outcome. CONCLUSION Malignant arrhythmic events and SCD depend on the presence of myocardial scar but not on CRT response. All-cause mortality improved only with the combined absence of myocardial scar and CRT response.
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Affiliation(s)
- Markus Linhart
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Adelina Doltra
- Non-Invasive Cardiac Imaging Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Juan Acosta
- Unidad de Cardiología y Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain.,CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain
| | - Roger Borràs
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain
| | - Beatriz Jáuregui
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.,Cardiology Department, Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Juan Fernández-Armenta
- CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain.,Arrhythmia Unit, Cardiology Department, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009 Cádiz, Spain
| | - Ignasi Anguera
- Cardiology Department, Heart Disease Institute, Bellvitge Biomedical Research Institute IDIBELL, Bellvitge Hospital, University of Barcelona, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Felipe Bisbal
- Heart Institute (iCor), University Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Julio Martí-Almor
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Jose M Tolosana
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Diego Penela
- Cardiology Department, Ospedale Guglielmo da Saliceto, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - David Soto-Iglesias
- Cardiology Department, Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
| | - Roger Villuendas
- CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain.,Heart Institute (iCor), University Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Rosario J Perea
- Radiology Department, Hospital Clinic, University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Jose T Ortiz
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Xavier Bosch
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48. CH-6900 Lugano, Switzerland
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), University of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain
| | - Antonio Berruezo
- CIBERCV, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11, Planta 0 28029, Madrid, Spain.,Cardiology Department, Heart Institute, Teknon Medical Center, C/Vilana, 12, 08022 Barcelona, Spain
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95
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Mikami Y, Cornhill A, Dykstra S, Satriano A, Hansen R, Flewitt J, Seib M, Rivest S, Sandonato R, Lydell CP, Howarth AG, Heydari B, Merchant N, Fine N, White JA. Right ventricular insertion site fibrosis in a dilated cardiomyopathy referral population: phenotypic associations and value for the prediction of heart failure admission or death. J Cardiovasc Magn Reson 2021; 23:79. [PMID: 34134712 PMCID: PMC8210339 DOI: 10.1186/s12968-021-00761-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is increasingly recognized as a heterogenous disease with distinct phenotypes on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging. While mid-wall striae (MWS) fibrosis is a widely recognized phenotypic risk marker, other fibrosis patterns are prevalent but poorly defined. Right ventricular (RV) insertion (RVI) site fibrosis is commonly seen, but without objective criteria has been considered a non-specific finding. In this study we developed objective criteria for RVI fibrosis and studied its clinical relevance in a large cohort of patients with DCM. METHODS We prospectively enrolled 645 DCM patients referred for LGE-CMR. All underwent standardized imaging protocols and baseline health evaluations. LGE images were blindly scored using objective criteria, inclusive of RVI site and MWS fibrosis. Associations between LGE patterns and CMR-based markers of adverse chamber remodeling were evaluated. Independent associations of LGE fibrosis patterns with the primary composite clinical outcome of heart failure admission or death were determined by multivariable analysis. RESULTS The mean age was 56 ± 14 (28% female) with a mean left ventricular (LV) ejection fraction (LVEF) of 37%. At a median of 1061 days, 129 patients (20%) experienced the primary outcome. Any abnormal LGE was present in 306 patients (47%), inclusive of 274 (42%) meeting criteria for RVI site fibrosis and 167 (26%) for MWS fibrosis. All with MWS fibrosis showed RVI site fibrosis. Solitary RVI site fibrosis was associated with higher bi-ventricular volumes [LV end-systolic volume index (78 ± 39 vs. 66 ± 33 ml/m2, p = 0.01), RV end-diastolic volume index (94 ± 28 vs. 84 ± 22 ml/m2 (p < 0.01), RV end-systolic volume index (56 ± 26 vs. 45 ± 17 ml/m2, p < 0.01)], lower bi-ventricular function [LVEF 35 ± 12 vs. 39 ± 10% (p < 0.01), RV ejection fraction (RVEF) 43 ± 12 vs. 48 ± 10% (p < 0.01)], and higher extracellular volume (ECV). Patient with solitary RVI site fibrosis experienced a non-significant 1.4-fold risk of the primary outcome, increasing to a significant 2.6-fold risk when accompanied by MWS fibrosis. CONCLUSIONS RVI site fibrosis in the absence of MWS fibrosis is associated with bi-ventricular remodelling and intermediate risk of heart failure admission or death. Our study findings suggest RVI site fibrosis to be pre-requisite for the incremental development of MWS fibrosis, a more advanced phenotype associated with greater LV remodeling and risk of clinical events.
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Affiliation(s)
- Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Aidan Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Reis Hansen
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Michelle Seib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, #0700, SSB, Foothills Medical Centre, 1403-29th St. NW, Calgary, AB, T2N2T9, Canada.
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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96
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Abstract
Despite constant breakthroughs in heart failure (HF) therapy, the population of HF patients resume to grow and is linked to increased mortality and morbidity. Ventricular arrhythmias (VA) are one of the leading causes of mortality in HF subjects. Implantable cardioverter-defibrillators (ICDs) are currently the gold standard in treatment, preventing arrhythmic sudden cardiac death (SCD) episodes. However, the death rates related to HF remain elevated, as not all HF subjects benefit equally. Cardiac resynchronization therapy (CRT) has emerged as a novel approach for HF patients. These devices have been thoroughly investigated in major randomized controlled studies but continue to be underutilized in various countries. This review discusses the use of ICD
in HF populations on top of treatments.
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97
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Di Marco A, Brown PF, Bradley J, Nucifora G, Claver E, de Frutos F, Dallaglio PD, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Improved Risk Stratification for Ventricular Arrhythmias and Sudden Death in Patients With Nonischemic Dilated Cardiomyopathy. J Am Coll Cardiol 2021; 77:2890-2905. [PMID: 34112317 DOI: 10.1016/j.jacc.2021.04.030] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Risk stratification for ventricular arrhythmias (VA) and sudden death in nonischemic dilated cardiomyopathy (DCM) remains suboptimal. OBJECTIVES The goal of this study was to provide an improved risk stratification algorithm for VA and sudden death in DCM. METHODS This was a retrospective cohort study of consecutive patients with DCM who underwent cardiac magnetic resonance with late gadolinium enhancement (LGE) at 2 tertiary referral centers. The combined arrhythmic endpoint included appropriate implantable cardioverter-defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, and sudden death. RESULTS In 1,165 patients with a median follow-up of 36 months, LGE was an independent and strong predictor of the arrhythmic endpoint (hazard ratio: 9.7; p < 0.001). This association was consistent across all strata of left ventricular ejection fraction (LVEF). Epicardial LGE, transmural LGE, and combined septal and free-wall LGE were all associated with heightened risk. A simple algorithm combining LGE and 3 LVEF strata (i.e., ≤20%, 21% to 35%, >35%) was significantly superior to LVEF with the 35% cutoff (Harrell's C statistic: 0.8 vs. 0.69; area under the curve: 0.82 vs. 0.7; p < 0.001) and reclassified the arrhythmic risk of 34% of patients with DCM. LGE-negative patients with LVEF 21% to 35% had low risk (annual event rate 0.7%), whereas those with high-risk LGE distributions and LVEF >35% had significantly higher risk (annual event rate 3%; p = 0.007). CONCLUSIONS In a large cohort of patients with DCM, LGE was found to be a significant, consistent, and strong predictor of VA or sudden death. Specific high-risk LGE distributions were identified. A new clinical algorithm integrating LGE and LVEF significantly improved the risk stratification for VA and sudden death, with relevant implications for implantable cardioverter-defibrillator allocation.
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MESH Headings
- Aged
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Female
- Follow-Up Studies
- Humans
- Incidence
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Retrospective Studies
- Risk Assessment/methods
- Risk Factors
- Spain/epidemiology
- Survival Rate/trends
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/mortality
- United Kingdom/epidemiology
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
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98
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Curtis AB, Khan HA. Refining the Approach to Risk Stratification in Patients With Dilated Cardiomyopathy. J Am Coll Cardiol 2021; 77:2906-2908. [PMID: 34112318 DOI: 10.1016/j.jacc.2021.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
| | - Hassan A Khan
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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99
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Risk stratification for sudden cardiac death in patients with heart failure : Emerging role of imaging parameters. Herz 2021; 46:550-557. [PMID: 33909114 DOI: 10.1007/s00059-021-05032-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 08/25/2020] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heart failure with reduced ejection fraction is a common condition that has a poor prognosis. Accurate selection of patients with ischemic heart disease and idiopathic dilated cardiomyopathy, who are at risk of sudden cardiac death (SCD), remains a challenge. In these cases, current indications for implantable cardioverter-defibrillators (ICD) rely almost entirely on left ventricular ejection fraction. However, this parameter is insufficient. Recently, noninvasive imaging has provided insight into the mechanism underlying SCD using myocardial deformation on echocardiography and magnetic resonance imaging. The aim of this review article was to underline the emerging role of these novel parameters in identifying high-risk patients. METHODS A literature search was carried out for reports published with the following terms: "sudden cardiac death," "heart failure," "noninvasive imaging," "echocardiography," "deformation," "magnetic resonance imaging," and "ventricular arrhythmia." The search was restricted to reports published in English. RESULTS The findings of this analysis suggest that cardiac magnetic resonance imaging and strain assessment by echocardiography, particularly longitudinal strain, can be promising techniques for cardiovascular risk stratification in patients with heart failure. CONCLUSION In future, risk stratification of arrhythmia and patient selection for ICD placement may rely on a multiparametric approach using combinations of imaging modalities in addition to left ventricular ejection fraction.
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Abstract
Heart failure affects 1-2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.
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Affiliation(s)
- Nishant Lahoti
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Richard J Jabbour
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Brian Xiangzhi Wang
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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