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Xiong Y, Zhang Q. Prognosis value of galectin-3 in patients with dilated cardiomyopathy: a meta-analysis. PeerJ 2024; 12:e17201. [PMID: 38680895 PMCID: PMC11048071 DOI: 10.7717/peerj.17201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/15/2024] [Indexed: 05/01/2024] Open
Abstract
Background Accurate prediction and assessment of myocardial fibrosis (MF) and adverse cardiovascular events (MACEs) are crucial in patients with dilated cardiomyopathy (DCM). Several studies indicate that galectin-3 (gal-3) as a promising prognostic predictor in patients with DCM. Methods A comprehensive search was conducted in PubMed, EMBASE, the Cochrane Library, and Web of Science for relevant studies up to August 2023. The hazard ratios (HRs) of gal-3 for MACEs in DCM patients, and for MACEs in LGE(+) versus LGE(-) groups, were evaluated. Statistical analysis was performed using STATA SE 14.0 software. Results Seven studies, encompassing 945 patients, met the eligibility criteria. In DCM patients, abnormally elevated gal-3 levels were indicative of an increased MACEs risk (HR = 1.10, 95% CI [1.00-1.21], I2 = 65.7%, p = 0.008). Compared with the LGE(-) group, the level of gal-3 in LGE(+) group was higher (HR = 1.12, 95% CI [1.05-1.19], I2 = 31.4%, p = 0.233), and the combination of gal-3 and LGE significantly improved the prediction of MACEs. Sensitivity analysis confirmed the robustness of all results. Conclusions This study's findings suggest that elevated gal-3 levels significantly correlate with increased MACE risk in DCM, highlighting its potential as a biomarker. However, significant heterogeneity among studies necessitates further research to ascertain gal-3's predictive and diagnostic value in DCM prognosis, particularly in conjunction with LGE. PROSPERO ID CRD42023471199.
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Affiliation(s)
- Yan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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2
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Omara S, Glashan CA, Tofig BJ, Leenknegt L, Dierckx H, Panfilov AV, Beukers HKC, van Waasbergen MH, Tao Q, Stevenson WG, Nielsen JC, Lukac P, Kristiansen SB, van der Geest RJ, Zeppenfeld K. Multisize Electrode Field-of-View: Validation by High Resolution Gadolinium-Enhanced Cardiac Magnetic Resonance. JACC Clin Electrophysiol 2024; 10:637-650. [PMID: 38276927 DOI: 10.1016/j.jacep.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Voltage mapping to detect ventricular scar is important for guiding catheter ablation, but the field-of-view of unipolar, bipolar, conventional, and microelectrodes as it relates to the extent of viable myocardium (VM) is not well defined. OBJECTIVES The purpose of this study was to evaluate electroanatomic voltage-mapping (EAVM) with different-size electrodes for identifying VM, validated against high-resolution ex-vivo cardiac magnetic resonance (HR-LGE-CMR). METHODS A total of 9 swine with early-reperfusion myocardial infarction were mapped with the QDOT microcatheter. HR-LGE-CMR (0.3-mm slices) were merged with EAVM. At each EAVM point, the underlying VM in multisize transmural cylinders and spheres was quantified from ex vivo CMR and related to unipolar and bipolar voltages recorded from conventional and microelectrodes. RESULTS In each swine, 220 mapping points (Q1, Q3: 216, 260 mapping points) were collected. Infarcts were heterogeneous and nontransmural. Unipolar and bipolar voltage increased with VM volumes from >175 mm3 up to >525 mm3 (equivalent to a 5-mm radius cylinder with height >6.69 mm). VM volumes in subendocardial cylinders with 1- or 3-mm depth correlated poorly with all voltages. Unipolar voltages recorded with conventional and microelectrodes were similar (difference 0.17 ± 2.66 mV) and correlated best to VM within a sphere of radius 10 and 8 mm, respectively. Distance-weighting did not improve the correlation. CONCLUSIONS Voltage increases with transmural volume of VM but correlates poorly with small amounts of VM, which limits EAVM in defining heterogeneous scar. Microelectrodes cannot distinguish thin from thick areas of subendocardial VM. The field-of-view for unipolar recordings for microelectrodes and conventional electrodes appears to be 8 to 10 mm, respectively, and unexpectedly similar.
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Affiliation(s)
- Sharif Omara
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Claire A Glashan
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bawer J Tofig
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lore Leenknegt
- Department of Mathematics, KU Leuven campus Kortrijk, Kortrijk, Belgium
| | - Hans Dierckx
- Department of Mathematics, KU Leuven campus Kortrijk, Kortrijk, Belgium
| | | | - Hans K C Beukers
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jens C Nielsen
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Lukac
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Steen B Kristiansen
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | - Katja Zeppenfeld
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Leiden, the Netherlands, and Aarhus, Denmark; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
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Ma HY, Xie GY, Tao J, Li ZZ, Liu P, Zheng XJ, Wang RP. Identification of patients with nonischemic dilated cardiomyopathy at risk of malignant ventricular arrhythmias: insights from cardiac magnetic resonance feature tracking. BMC Cardiovasc Disord 2024; 24:29. [PMID: 38172720 PMCID: PMC10765793 DOI: 10.1186/s12872-023-03655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with nonischemic dilated cardiomyopathy (NIDCM) are prone to arrhythmias, and the cause of mortality in these patients is either end-organ dysfunction due to pump failure or malignant arrhythmia-related death. However, the identification of patients with NIDCM at risk of malignant ventricular arrhythmias (VAs) is challenging in clinical practice. The aim of this study was to evaluate whether cardiovascular magnetic resonance feature tracking (CMR-FT) could help in the identification of patients with NIDCM at risk of malignant VAs. METHODS A total of 263 NIDCM patients who underwent CMR, 24-hour Holter electrocardiography (ECG) and inpatient ECG were retrospectively evaluated. The patients with NIDCM were allocated to two subgroups: NIDCM with VAs and NIDCM without VAs. From CMR-FT, the global peak radial strain (GPRS), global longitudinal strain (GPLS), and global peak circumferential strain (GPCS) were calculated from the left ventricle (LV) model. We investigated the possible predictors of NIDCM combined with VAs by univariate and multivariate logistic regression analyses. RESULTS The percent LGE (15.51 ± 3.30 vs. 9.62 ± 2.18, P < 0.001) was higher in NIDCM patients with VAs than in NIDCM patients without VAs. Furthermore, the NIDCM patients complicated with VAs had significantly lower GPCS than the NIDCM patients without VAs (- 5.38 (- 7.50, - 4.22) vs.-9.22 (- 10.73, - 8.19), P < 0.01). Subgroup analysis based on LGE negativity showed that NIDCM patients complicated with VAs had significantly lower GPRS, GPCS, and GPLS than NIDCM patients without VAs (P < 0.05 for all). Multivariate analysis showed that both GPCS and %LGE were independent predictors of NIDCM combined with VAs. CONCLUSIONS CMR global strain can be used to identify NIDCM patients complicated with VAs early, specifically when LGE is not present. GPCS < - 13.19% and %LGE > 10.37% are independent predictors of NIDCM combined with VAs.
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Affiliation(s)
- Hai-Yan Ma
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Guang-You Xie
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Jian Tao
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Zong-Zhuang Li
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Pan Liu
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Xing-Ju Zheng
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Rong-Pin Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
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Motamed M, Liblik K, Miranda-Arboleda AF, Wamboldt R, Wang CN, Cingolani O, Rebman AW, Novak CB, Aucott JN, Farina JM, Baranchuk A. Disseminated Lyme disease and dilated cardiomyopathy: A systematic review. Trends Cardiovasc Med 2023; 33:531-536. [PMID: 35667636 DOI: 10.1016/j.tcm.2022.05.010] [Citation(s) in RCA: 1] [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: 03/20/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Lyme carditis is a well-established manifestation of early disseminated Lyme infection, yet the relationship between late disseminated Lyme disease and the development of dilated cardiomyopathy (DCM) remains unclear. The present systematic review aims to summarize existing literature on the association between late disseminated Lyme disease and DCM. A systematic review was conducted in PubMed, Embase, CENTRAL, and MEDLINE databases, after which a total of 11 observational studies (n = 771) were ultimately included for final data extraction. Although most studies (7/11) identified evidence associating Borrelia-infection with DCM, further research is required to isolate late disseminated Borrelia infection as a causative agent of DCM.
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Affiliation(s)
- Mehras Motamed
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Andres F Miranda-Arboleda
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada; Cardiology Department, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - Rachel Wamboldt
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Chang Nancy Wang
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada
| | - Oscar Cingolani
- Division of Cardiology, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cheryl B Novak
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan M Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Centre, Queen's University, Kingston General Hospital K7L 2V7, Kingston, ON, Canada.
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Sur M, Rasquinha MT, Arumugam R, Massilamany C, Gangaplara A, Mone K, Lasrado N, Yalaka B, Doiphode A, Gurumurthy C, Steffen D, Reddy J. Transgenic Mice Expressing Functional TCRs Specific to Cardiac Myhc-α 334-352 on Both CD4 and CD8 T Cells Are Resistant to the Development of Myocarditis on C57BL/6 Genetic Background. Cells 2023; 12:2346. [PMID: 37830560 PMCID: PMC10571761 DOI: 10.3390/cells12192346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Myocarditis is a predominant cause of congestive heart failure and sudden death in children and young adolescents that can lead to dilated cardiomyopathy. Lymphocytic myocarditis mediated by T cells can result from the recognition of cardiac antigens that may involve CD4 or CD8 T cells or both. In this report, we describe the generation of T cell receptor (TCR) transgenic mice on a C57BL/6 genetic background specific to cardiac myosin heavy chain (Myhc)-α 334-352 and make the following observations: First, we verified that Myhc-α 334-352 was immunogenic in wild-type C57BL/6 mice and induced antigen-specific CD4 T cell responses despite being a poor binder of IAb; however, the immunized animals developed only mild myocarditis. Second, TCRs specific to Myhc-α 334-352 in transgenic mice were expressed in both CD4 and CD8 T cells, suggesting that the expression of epitope-specific TCR is common to both cell types. Third, although T cells from naïve transgenic mice did not respond to Myhc-α 334-352, both CD4 and CD8 T cells from animals immunized with Myhc-α 334-352 responded to the peptide, indicating that antigen priming is necessary to break tolerance. Fourth, although the transgenic T cells could produce significant amounts of interferon-γ and interleukin-17, the immunized animals developed only mild disease, indicating that other soluble factors might be necessary for developing severe myocarditis. Alternatively, the C57BL/6 genetic background might be a major contributing factor for resistance to the development of myocarditis. Taken together, our model permits the determination of the roles of both CD4 and CD8 T cells to understand the disease-resistance mechanisms of myocarditis in a single transgenic system antigen-specifically.
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Affiliation(s)
- Meghna Sur
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
| | - Mahima T. Rasquinha
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
| | - Rajkumar Arumugam
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
- Bristol Myers Squibb, Summit, NJ 07901, USA
| | - Chandirasegaran Massilamany
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
- CRISPR Therapeutics, Boston, MA 02127, USA
| | - Arunkumar Gangaplara
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
- Miltenyi Biotec, Gaithersburg, MD 20878, USA
| | - Kiruthiga Mone
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
| | - Ninaad Lasrado
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
- Center for Virology and Vaccine Research, Harvard Medical School, Boston, MA 02115, USA
| | - Bharathi Yalaka
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
- Bristol Myers Squibb, Summit, NJ 07901, USA
| | - Aakash Doiphode
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
- Department of Animal Genetics and Breeding, Krantisinh Nana Patil College of Veterinary Science, Shirwal 412801, Maharashtra, India
| | - Channabasavaiah Gurumurthy
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - David Steffen
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
| | - Jay Reddy
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.S.); (M.T.R.); (R.A.); (C.M.); (A.G.); (K.M.); (N.L.); (B.Y.); (A.D.); (D.S.)
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Bustin A, Witschey WRT, van Heeswijk RB, Cochet H, Stuber M. Magnetic resonance myocardial T1ρ mapping : Technical overview, challenges, emerging developments, and clinical applications. J Cardiovasc Magn Reson 2023; 25:34. [PMID: 37331930 DOI: 10.1186/s12968-023-00940-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
The potential of cardiac magnetic resonance to improve cardiovascular care and patient management is considerable. Myocardial T1-rho (T1ρ) mapping, in particular, has emerged as a promising biomarker for quantifying myocardial injuries without exogenous contrast agents. Its potential as a contrast-agent-free ("needle-free") and cost-effective diagnostic marker promises high impact both in terms of clinical outcomes and patient comfort. However, myocardial T1ρ mapping is still at a nascent stage of development and the evidence supporting its diagnostic performance and clinical effectiveness is scant, though likely to change with technological improvements. The present review aims at providing a primer on the essentials of myocardial T1ρ mapping, and to describe the current range of clinical applications of the technique to detect and quantify myocardial injuries. We also delineate the important limitations and challenges for clinical deployment, including the urgent need for standardization, the evaluation of bias, and the critical importance of clinical testing. We conclude by outlining technical developments to be expected in the future. If needle-free myocardial T1ρ mapping is shown to improve patient diagnosis and prognosis, and can be effectively integrated in cardiovascular practice, it will fulfill its potential as an essential component of a cardiac magnetic resonance examination.
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Affiliation(s)
- Aurelien Bustin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Avenue du Haut Lévêque, 33604, Pessac, France.
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France.
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | | | - Ruud B van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Avenue du Haut Lévêque, 33604, Pessac, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Avenue du Haut Lévêque, 33604, Pessac, France
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
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Zhang Y, Zhang X, Wang Y, Hu X, Wang B, Yang J, Zhao X, Zhang L. Relationship between diffuse fibrosis assessed by CMR and depressed myocardial strain in different stages of heart failure. Eur J Radiol 2023; 164:110848. [PMID: 37156180 DOI: 10.1016/j.ejrad.2023.110848] [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: 10/26/2022] [Revised: 03/22/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To investigate the extent of the left ventricular (LV) diffuse myocardial fibrosis and the association with the degree of impaired myocardial strain in different stages of heart failure. BACKGROUND The increased diffuse myocardial fibrosis impairs the LV systolic and diastolic function. Previous studies found that the global longitudinal strain (GLS) impacted survival in patients with heart failure with preserved ejection fraction (HFpEF). However, limited data are available regarding the association between the degree of diffuse myocardial fibrosis and the severity of impaired myocardial strain in HFpEF. METHODS Sixty-six consecutive participants with heart failure (HF), and 15 healthy controls underwent cardiac magnetic resonance (CMR) examination. T1 mapping to calculate extracellular volume fractions (ECV) were used to assess diffuse myocardial fibrosis. ECV and myocardial strains were compared among the 3 groups. Associations between these two factors were also explored. RESULTS The patients with HFpEF showed increased myocardial ECV fractions (32.9 % ± 3.7 % vs. 29.2 % ± 2.9 %, p < 0.001) compared with the control group. The patients with HFm + rEF also had increased myocardial ECV fractions (36.8 % ± 5.4 % vs. 32.9 % ± 3.7 %, p < 0.001) compared with HFpEF. The myocardial ECV was significantly correlated with the GLS (r = 0.422, p = 0.020), global circumferential strain (GCS) (r = 0.491, p = 0.006), and global radial strain (GRS) (r = -0.533, p = 0.002) in the HFpEF groups, but no significant correlation was found in the HFm + rEF group (GLS: r = -0.002, p = 0.990; GCS: r = 0.153, p = 0.372; GRS: r = 0.070, p = 0.685) CONCLUSIONS: In patients with HF, only patients with HFpEF exhibited a significant correlation between increased diffuse myocardial fibrosis and impaired myocardial strain. Diffuse myocardial fibrosis plays a unique role in affecting myocardial strain in patients with HFpEF.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Xunan Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Yalan Wang
- Department of Ultrasonography, The Third People's Hospital of Bengbu, 38 Shenglizhong Road, Bengshan District, Bengbu, China.
| | - Xinxing Hu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Bin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Jia Yang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
| | - Xiance Zhao
- Philips Healthcare, 718 Lingshi Road, Jingan District, Shanghai, China.
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 650 Xinsongjiang Road, Songjiang District, Shanghai, China.
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8
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Kaur N, Sharma RK, Singh Kushwah A, Singh N, Thakur S. A Comprehensive Review of Dilated Cardiomyopathy in Pre-clinical Animal Models in Addition to Herbal Treatment Options and Multi-modality Imaging Strategies. Cardiovasc Hematol Disord Drug Targets 2023; 22:207-225. [PMID: 36734898 DOI: 10.2174/1871529x23666230123122808] [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: 08/26/2022] [Revised: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 02/01/2023]
Abstract
Dilated cardiomyopathy (DCM) is distinguished by ventricular chamber expansion, systolic dysfunction, and normal left ventricular (LV) wall thickness, and is mainly caused due to genetic or environmental factors; however, its aetiology is undetermined in the majority of patients. The focus of this work is on pathogenesis, small animal models, as well as the herbal medicinal approach, and the most recent advances in imaging modalities for patients with dilated cardiomyopathy. Several small animal models have been proposed over the last few years to mimic various pathomechanisms that contribute to dilated cardiomyopathy. Surgical procedures, gene mutations, and drug therapies are all characteristic features of these models. The pros and cons, including heart failure stimulation of extensively established small animal models for dilated cardiomyopathy, are illustrated, as these models tend to procure key insights and contribute to the development of innovative treatment techniques for patients. Traditional medicinal plants used as treatment in these models are also discussed, along with contemporary developments in herbal therapies. In the last few decades, accurate diagnosis, proper recognition of the underlying disease, specific risk stratification, and forecasting of clinical outcome, have indeed improved the health of DCM patients. Cardiac magnetic resonance (CMR) is the bullion criterion for assessing ventricular volume and ejection fraction in a reliable and consistent direction. Other technologies, like strain analysis and 3D echocardiography, have enhanced this technique's predictive and therapeutic potential. Nuclear imaging potentially helps doctors pinpoint the causative factors of left ventricular dysfunction, as with cardiac sarcoidosis and amyloidosis.
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Affiliation(s)
- Navneet Kaur
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
| | - Rahul Kumar Sharma
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
| | - Ajay Singh Kushwah
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
| | - Nisha Singh
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
| | - Shilpa Thakur
- Department of Pharmacology, Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
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9
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Mitochondria and Doxorubicin-Induced Cardiomyopathy: A Complex Interplay. Cells 2022; 11:cells11132000. [PMID: 35805084 PMCID: PMC9266202 DOI: 10.3390/cells11132000] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Cardiotoxicity has emerged as a major side effect of doxorubicin (DOX) treatment, affecting nearly 30% of patients within 5 years after chemotherapy. Heart failure is the first non-cancer cause of death in DOX-treated patients. Although many different molecular mechanisms explaining the cardiac derangements induced by DOX were identified in past decades, the translation to clinical practice has remained elusive to date. This review examines the current understanding of DOX-induced cardiomyopathy (DCM) with a focus on mitochondria, which were increasingly proven to be crucial determinants of DOX-induced cytotoxicity. We discuss DCM pathophysiology and epidemiology and DOX-induced detrimental effects on mitochondrial function, dynamics, biogenesis, and autophagy. Lastly, we review the current perspectives to contrast the development of DCM, which is still a relatively diffused, invalidating, and life-threatening condition for cancer survivors.
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10
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Neves EGA, Koh CC, Souza-Silva TG, Passos LSA, Silva ACC, Velikkakam T, Villani F, Coelho JS, Brodskyn CI, Teixeira A, Gollob KJ, Nunes MDCP, Dutra WO. T-Cell Subpopulations Exhibit Distinct Recruitment Potential, Immunoregulatory Profile and Functional Characteristics in Chagas versus Idiopathic Dilated Cardiomyopathies. Front Cardiovasc Med 2022; 9:787423. [PMID: 35187122 PMCID: PMC8847602 DOI: 10.3389/fcvm.2022.787423] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic Chagas cardiomyopathy (CCC) is one of the deadliest cardiomyopathies known and the most severe manifestation of Chagas disease, which is caused by infection with the parasite Trypanosoma cruzi. Idiopathic dilated cardiomyopathies (IDC) are a diverse group of inflammatory heart diseases that affect the myocardium and are clinically similar to CCC, often causing heart failure and death. While T-cells are critical for mediating cardiac pathology in CCC and IDC, the mechanisms underlying T-cell function in these cardiomyopathies are not well-defined. In this study, we sought to investigate the phenotypic and functional characteristics of T-cell subpopulations in CCC and IDC, aiming to clarify whether the inflammatory response is similar or distinct in these cardiomyopathies. We evaluated the expression of systemic cytokines, determined the sources of the different cytokines, the expression of their receptors, of cytotoxic molecules, and of molecules associated with recruitment to the heart by circulating CD4+, CD8+, and CD4-CD8- T-cells from CCC and IDC patients, using multiparameter flow cytometry combined with conventional and unsupervised machine-learning strategies. We also used an in silico approach to identify the expression of genes that code for key molecules related to T-cell function in hearts of patient with CCC and IDC. Our data demonstrated that CCC patients displayed a more robust systemic inflammatory cytokine production as compared to IDC. While CD8+ T-cells were highly activated in CCC as compared to IDC, CD4+ T-cells were more activated in IDC. In addition to differential expression of functional molecules, these cells also displayed distinct expression of molecules associated with recruitment to the heart. In silico analysis of gene transcripts in the cardiac tissue demonstrated a significant correlation between CD8 and inflammatory, cytotoxic and cardiotropic molecules in CCC transcripts, while no correlation with CD4 was observed. A positive correlation was observed between CD4 and perforin transcripts in hearts from IDC but not CCC, as compared to normal tissue. These data show a clearly distinct systemic and local cellular response in CCC and IDC, despite their similar cardiac impairment, which may contribute to identifying specific immunotherapeutic targets in these diseases.
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Affiliation(s)
- Eula G. A. Neves
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carolina C. Koh
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thaiany G. Souza-Silva
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lívia Silva Araújo Passos
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Brigham and Womens Hospital, Harvard University, Boston, MA, United States
| | - Ana Carolina C. Silva
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Teresiama Velikkakam
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Villani
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Minas Gerais State University, Divinópolis, Brazil
| | - Janete Soares Coelho
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Ezequiel Dias Foundation, Belo Horizonte, Brazil
| | - Claudia Ida Brodskyn
- Gonçalo Moniz Research Center, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Andrea Teixeira
- Rene Rachou Institute, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brazil
| | - Kenneth J. Gollob
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, Brazil
| | - Maria do Carmo P. Nunes
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Walderez O. Dutra
- Department of Morphology, Cell-Cell Interactions Laboratory, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, Brazil
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Walderez O. Dutra
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11
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Bourque K, Hawey C, Jiang A, Mazarura GR, Hébert TE. Biosensor-based profiling to track cellular signalling in patient-derived models of dilated cardiomyopathy. Cell Signal 2022; 91:110239. [PMID: 34990783 DOI: 10.1016/j.cellsig.2021.110239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 12/18/2022]
Abstract
Dilated cardiomyopathies (DCM) represent a diverse group of cardiovascular diseases impacting the structure and function of the myocardium. To better treat these diseases, we need to understand the impact of such cardiomyopathies on critical signalling pathways that drive disease progression downstream of receptors we often target therapeutically. Our understanding of cellular signalling events has progressed substantially in the last few years, in large part due to the design, validation and use of biosensor-based approaches to studying such events in cells, tissues and in some cases, living animals. Another transformative development has been the use of human induced pluripotent stem cells (hiPSCs) to generate disease-relevant models from individual patients. We highlight the importance of going beyond monocellular cultures to incorporate the influence of paracrine signalling mediators. Finally, we discuss the recent coalition of these approaches in the context of DCM. We discuss recent work in generating patient-derived models of cardiomyopathies and the utility of using signalling biosensors to track disease progression and test potential therapeutic strategies that can be later used to inform treatment options in patients.
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Affiliation(s)
- Kyla Bourque
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada
| | - Cara Hawey
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada
| | - Alyson Jiang
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada
| | - Grace R Mazarura
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada
| | - Terence E Hébert
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec H3G 1Y6, Canada.
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12
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Žorž N, Poglajen G, Frljak S, Knezevič I, Vrtovec B. Transendocardial CD34 + Cell Therapy Improves Local Mechanical Dyssynchrony in Patients With Nonischemic Dilated Cardiomyopathy. Cell Transplant 2022; 31:9636897221080384. [PMID: 35320035 PMCID: PMC8949703 DOI: 10.1177/09636897221080384] [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] [Indexed: 11/16/2022] Open
Abstract
We investigated the effects of cell therapy on local mechanical dyssynchrony (LMD) in patients with nonischemic dilated cardiomyopathy (NICM). We analyzed electromechanical data of 30 NICM patients undergoing CD34+ cell transplantation. All patients underwent bone marrow stimulation; CD34+ cells were collected by apheresis and injected transendocardially. At baseline and at 6 months after therapy, we performed electromechanical mapping and measured unipolar voltage (UV) and LMD at cell injection sites. LMD was defined as a temporal difference between global and segmental peak systolic displacement normalized to the average duration of the RR interval. Favorable clinical response was defined as increase in the left ventricular ejection fraction (LVEF) ≥5% between baseline and 6 months. Using paired electromechanical point-by-point analysis, we were able to identify 233 sites of CD34+ cell injections in 30 patients. We found no overall differences in local UV between baseline and 6 months (10.7 ± 4.1 mV vs 10.0 ± 3.6 mV, P = 0.42). In contrast, LMD decreased significantly (17 ± 17% at baseline vs 13 ± 12% at 6 months, P = 0.00007). Favorable clinical response at 6 months was found in 19 (63%) patients (group A), and 11 (37%) patients did not respond to cell therapy (group B). At baseline, the two groups did not differ in age, gender, LVEF, or N terminal-pro brain natriuretic peptide (NT-proBNP) levels. Similarly, we found no differences in baseline UV (9.5 ± 2.9 mV in group A vs 8.6 ± 2.4 mV in group B, P = 0.41) or LMD at cell injection sites (17 ± 19% vs 16 ± 14%, P = 0.64). In contrast, at 6 months, we found higher UV in group A (10.0 ± 3.1 mV vs 7.4 ± 1.9 mV in group B, P = 0.04). Furthermore, when compared with group B, patients in group A displayed a significantly lower LMD (11 ± 12% vs 16 ± 10%, P = 0.002). Thus, it appears that favorable clinical effects of cell therapy in NICM patients may be associated with a decrease of LMD at cell injection sites.
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Affiliation(s)
- Neža Žorž
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sabina Frljak
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ivan Knezevič
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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13
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Sun W, Shen X, Wang J, Zhu S, Zhang Y, Wu C, Xie Y, Yang Y, Dong N, Wang G, Li Y, Lv Q, Liang B, Zhang L, Xie M. Association Between 2D- and 3D-Speckle-Tracking Longitudinal Strain and Cardiovascular Magnetic Resonance Evidence of Diffuse Myocardial Fibrosis in Heart Transplant Recipients. Front Cardiovasc Med 2021; 8:727745. [PMID: 34917656 PMCID: PMC8669344 DOI: 10.3389/fcvm.2021.727745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to: (1) evaluate the association between myocardial fibrosis (MF) quantified by extracellular volume fraction (ECV) and myocardial strain measured by two-dimensional (2D)- and three-dimensional speckle-tracking echocardiography (3D-STE) and (2) further investigate which strain parameter measured by 2D- and 3D-STE is the more robust predictor of MF in heart transplant (HT) recipients. Methods: A total of 40 patients with HT and 20 healthy controls were prospectively enrolled. Left ventricular (LV)-global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were measured by 2D- and 3D-STE. LV diffuse MF was defined by cardiovascular magnetic resonance (CMR)-ECV. Results: The HT recipients had a significantly higher native T1 and ECV than healthy controls (1043.8 ± 34.0 vs. 999.7 ± 19.7 ms, p < 0.001; 26.6 ± 2.7 vs. 24.3 ± 1.8%, p = 0.02). The 3D- and 2D-STE-LVGLS and LVGCS were lower (p < 0.005) in the HT recipients than in healthy controls. ECV showed a moderate correlation with 2D-LVGLS (r = 0.53, p = 0.002) and 3D-LVGLS (r = 0.60, p < 0.001), but it was not correlated with 2D or 3D-LVGCS, or LVGRS. Furthermore, 3D-LVGLS and 2D-LVGLS had a similar correlation with CMR-ECV (r = 0.60 vs. 0.53, p = 0.670). A separate stepwise multivariate linear analysis showed that both the 2D-LVGLS (β = 0.39, p = 0.019) and 3D-LVGLS (β = 0.54, p < 0.001) were independently associated with CMR-ECV. Conclusion: CMR marker of diffuse MF was present in asymptomatic patients with HT and appeared to be associated with decreased myocardial strain by echocardiography. Both the 2D- and 3D-LVGLS were independently correlated with diffuse LVMF, which may provide an alternative non-invasive tool for monitoring the development of adverse fibrotic remodeling during the follow-up of HT recipients.
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Affiliation(s)
- Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xuehua Shen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanting Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yun Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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14
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Singla N, Mehra S, Garga UC. Diagnostic Role of Cardiovascular Magnetic Resonance Imaging in Dilated Cardiomyopathy. Indian J Radiol Imaging 2021; 31:116-123. [PMID: 34316119 PMCID: PMC8299491 DOI: 10.1055/s-0041-1730133] [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] [Indexed: 10/28/2022] Open
Abstract
Aims The purpose of the study was to compare the accuracy of cardiac magnetic resonance (CMR) with echocardiography for the evaluation of ventricular dysfunction in patients of dilated cardiomyopathy (DCM). Further, we evaluated the potential of CMR for myocardial tissue characterization. Design Prospective observational. Materials and Methods A total of 30 patients with suspected DCM prospectively underwent cardiac magnetic resonance (MR) using a 1.5 Tesla MR scanner, with appropriate phased-array body coils. Dynamic sequences after injection of 0.1 mmol/kg of body weight of gadolinium-based intravenous contrast (Magnevist) were acquired for each patient, after which delayed images were obtained at an interval of 12 to 15 minutes. Myocardial tagging was performed in all patients for assessment of wall motion abnormalities. Each MR examination was interpreted with two radiologists for chamber dimensions and ventricular dysfunction as well as morphologic characteristics with disagreement resolved by consensus. All patients included in the study were taken up for MR evaluation after cardiological evaluation through echocardiography and the results for both the studies were compared. Data were analyzed through standard statistical methods. Conclusion CMR is a comprehensive diagnostic tool, which can estimate the ventricular function more precisely than echocardiography. CMR reliably differentiates between ischemic and nonischemic etiologies of DCM based on patterns of late gadolinium enhancement (LGE) and based on the presence or absence of LGE, which helps to estimate the degree of myocardial fibrosis. Thereby it can be a useful tool in establishing risk stratification, predicting prognosis, and thus instituting appropriate therapy in DCM patients.
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Affiliation(s)
- Nehal Singla
- Department of Radio-Diagnosis, PGIMER and RML Hospital, New Delhi, India
| | - Shibani Mehra
- Department of Radio-Diagnosis, PGIMER and RML Hospital, New Delhi, India
| | - Umesh C Garga
- Department of Radio-Diagnosis, PGIMER and RML Hospital, New Delhi, India
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15
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Yang EY, Shah DJ. Cardiac Magnetic Resonance in Nonischemic Cardiomyopathies. Methodist Debakey Cardiovasc J 2020; 16:97-105. [PMID: 32670469 DOI: 10.14797/mdcj-16-2-97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has emerged as a key modality to assess nonischemic cardiomyopathies. Its ability to detect cardiac morphology and function with fast cine imaging, myocardial edema with T2-based techniques, and fibrosis with late gadolinium enhancement techniques has enabled noninvasive characterization of cardiac tissue, thus helping clinicians assess cardiovascular risk and determine the most effective management strategy. Active investigations into parametric imaging techniques will further expand the potential clinical applications of CMR for cardiac tissue characterization. This review discusses the use of CMR techniques in characterizing the major morphofunctional phenotypes of nonischemic cardiomyopathies.
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Affiliation(s)
- Eric Y Yang
- HOUSTON METHODIST HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Dipan J Shah
- HOUSTON METHODIST HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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16
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Saito T, Asai K, Tachi M, Sato S, Mozawa K, Adachi A, Sasaki Y, Amano Y, Mizuno K, Kumita SI, Shimizu W. Long-term prognostic value of ultrastructural features in dilated cardiomyopathy: comparison with cardiac magnetic resonance. ESC Heart Fail 2020; 7:682-691. [PMID: 32150669 PMCID: PMC7160479 DOI: 10.1002/ehf2.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/14/2020] [Accepted: 02/06/2020] [Indexed: 01/18/2023] Open
Abstract
AIMS This study aims to determine the implications associated with long-term prognosis of heart failure (HF) in patients with dilated cardiomyopathy (DCM) presenting initially as decompensated HF. We stratified the phase of DCM patients without late gadolinium enhancement (LGE) based on ultrastructural changes in cardiomyocytes. METHODS AND RESULTS Left ventricular (LV) endomyocardial biopsy was performed in 55 consecutive DCM patients with initial decompensated HF. Ultrastructural changes in cardiomyocytes detected by electron microscopy were compared with data including LGE with cardiac magnetic resonance and HF recurrence. Of the 55 DCM patients, 24 (44%) showed LGE, and 26 (47%) showed recurrence decompensated HF, while 23 patients (42%) showed autophagic vacuoles in cardiomyocytes by electron microscopy. Multivariate analysis identified atrial fibrillation [hazard ratio (HR), 3.40; 95% confidence interval (CI), 1.45-7.98], haemoglobin level (HR, 0.82; 95% CI, 0.68-0.99), beta-blocker use (HR, 0.18; 95% CI, 0.05-0.74), and autophagic vacuoles (HR, 0.25; 95% CI, 0.09-0.65) as predictors of HF recurrence in the total patient population. In patients without LGE, only autophagic vacuoles were independent predictors of readmission because of HF (HR, 0.29; 95% CI, 0.09-0.90). In patients with LGE, atrial fibrillation (HR, 19.10; 95% CI, 2.97-123.09), and mid-linear LGE (HR, 12.96; 95% CI, 2.02-82.94) were independent predictors of readmission because of HF. CONCLUSIONS In DCM patients with LGE, characterised by progression of LV remodelling, the LGE pattern was a predictor of HF recurrence, whereas in patients without LGE, absence of autophagic vacuoles was a predictor of HF recurrence.
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Affiliation(s)
- Tsunenori Saito
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Masaki Tachi
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Shigeru Sato
- Tokyo Electron Microscopy Laboratory, Chiba, Japan
| | - Kosuke Mozawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Akiko Adachi
- Division of Morphological and Biomolecular Research, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiro Sasaki
- Division of Morphological and Biomolecular Research, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuo Amano
- Department of Radiology, Nihon University Hospital, Tokyo, Japan
| | - Kyoichi Mizuno
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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17
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Pospisil D, Novotny T, Jarkovsky J, Farkasova B, Kozak M, Krivan L, Vlasinova J, Kala P, Sepsi M. Differences in right-to-left vs left-to-right interventricular conduction times in patients indicated to cardiac resynchronization therapy. PLoS One 2020; 15:e0228731. [PMID: 32074118 PMCID: PMC7029862 DOI: 10.1371/journal.pone.0228731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Differences in conduction times from right ventricle to left ventricle and from left ventricle to right ventricle respectively were observed during biventricular devices implantation when changing pacing vector direction. In this article the phenomenon of interventricular conduction time differences is described and assessed in relationship to various clinical and electrophysiological parameters. METHODS In 62 consecutive patients (9 females) interventricular conduction times between right and left ventricle in both directions were measured during cardiac resynchronization therapy device implantation procedure. Complex pacing protocol was performed. RESULTS Investigated individuals was divided into 3 subgroups according to type of interventricular conduction pattern and statistically tested with various clinical data. Substantial differences in right-to-left vs left-to-right conduction times (> 5 ms, range 7-72 ms) were observed in 24 (39%) of all patients. They were more common in patients with dilated cardiomyopathy (20 of 38, 53%) compared to 4 (17%) of 24 patients with coronary artery disease (p = 0.011). The phenomenon occurred more often in hypertensive patients (p = 0.012). Other tested factors were nonsignificant. CONCLUSIONS There are almost no data on this topic. The occurrence of conduction difference phenomenon is quite common in dilated cardiomyopathy while it is rare in coronary artery disease. We assume the diffuse nature of the disease and the way of remodeling of myocardium play the main role. Knowledge of this phenomenon could be useful in personalized cardiac resynchronization therapy optimization.
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Affiliation(s)
- David Pospisil
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Novotny
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Barbora Farkasova
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milan Kozak
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lubomir Krivan
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jitka Vlasinova
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milan Sepsi
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- * E-mail:
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18
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Frljak S, Jaklic M, Zemljic G, Cerar A, Poglajen G, Vrtovec B. CD34 + Cell Transplantation Improves Right Ventricular Function in Patients with Nonischemic Dilated Cardiomyopathy. Stem Cells Transl Med 2019; 7:168-172. [PMID: 29380563 PMCID: PMC5788875 DOI: 10.1002/sctm.17-0197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/22/2017] [Indexed: 12/19/2022] Open
Abstract
We investigated the effects of CD34+ cell therapy on right ventricular (RV) function in patients with nonischemic dilated cardiomyopathy (DCM). We enrolled 60 patients with DCM who were randomized to CD34+ cell therapy (Stem Cells (SC) Group n = 30), or no cell therapy (Controls, n = 30). The SC Group received granulocyte‐colony stimulating factor, and CD34+ cells were collected by apheresis and injected transendocardially. Patients were followed for 6 months. At baseline, the groups did not differ in age, gender, left ventricular ejection fraction, N‐terminal probrain natriuretic peptide, or parameters of RV function. At 6 months, we found a significant improvement in RV function in the SC Group (tricuspid annular plane systolic excursion [TAPSE]: +0.44 ± 0.64 cm, p = .001; peak systolic tissue Doppler velocity of tricuspid annulus [St]: +1.5 ± 2.1 cm/s; p = .001; percent of fractional area change [FAC]: +8.6% ± 5%, p = .01), but not in Controls (TAPSE: −0.07 ± 0.32 cm, p = .40; St: −0.1 ± 1.2 cm/s; p = .44; FAC: −1.2% ± 3.2%, p = .50). On repeat electroanatomical mapping, we found an improvement in interventricular septum viability in 19 of 30 patients from the SC Group; this correlated with the improvements in RV function (13/19 in the improved septum group versus 3/11 in the remaining cohort, p = .029). These results suggest that patients with DCM, changes in RV function correlate with changes of viability of interventricular septum. CD34+ cell therapy appears to be associated with improved right ventricular function in this patient cohort. (Clinical Trial Registration Information: www.clinicaltrials.gov; NCT02248532). Stem Cells Translational Medicine2018;7:168–172
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Affiliation(s)
- Sabina Frljak
- Advanced Heart Failure and Transplantation Centre, UMC Ljubljana, Slovenia
| | - Martina Jaklic
- Advanced Heart Failure and Transplantation Centre, UMC Ljubljana, Slovenia
| | - Gregor Zemljic
- Advanced Heart Failure and Transplantation Centre, UMC Ljubljana, Slovenia
| | - Andraz Cerar
- Advanced Heart Failure and Transplantation Centre, UMC Ljubljana, Slovenia
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Centre, UMC Ljubljana, Slovenia
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Centre, UMC Ljubljana, Slovenia.,Stanford University School of Medicine, Stanford, California, USA
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19
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Histopathological and Morphometric Study of Fibrosis and Nuclear Pleomorphism in Dilated Cardiomyopathy. CURRENT HEALTH SCIENCES JOURNAL 2019; 45:73-78. [PMID: 31297266 PMCID: PMC6592661 DOI: 10.12865/chsj.45.01.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 01/21/2019] [Indexed: 11/23/2022]
Abstract
Histopathological changes associated with dilated cardiomyopathy (CMD) are frequently nonspecific and often only present in the terminal stage of the disease. The study followed the histopathological and morphometric quantification of fibrosis and nuclear pleomorphism in CMD. We analyzed left ventricle myocardial fragments harvested during autopsy, from 35 cases with clinical diagnosis of CMD and 5 cases of normal myocardium. Fibrosis was present in all CMD cases, with higher values compared with control cases. Nuclear pleomorphism was identified in 18 cases (45%), two of the analyzed parameters, respectively the ratio of nuclear diameters and roundness of nucleus, revealing significant differences in CMD compared to the control cases. Myocardial fibrosis present in all cases of CMD represents a major feature of the disease. The nuclear pleomorphism due to the nuclei change in diameters and size was more pronounced in the vicinity of fibrosis areas, possibly related to this alteration.
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20
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Gudenschwager EK, Abbott JA, LeRoith T. Dilated cardiomyopathy with endocardial fibroelastosis in a juvenile Pallas cat. J Vet Diagn Invest 2019; 31:289-293. [PMID: 30694111 DOI: 10.1177/1040638719827061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a myocardial disease characterized by ventricular chamber dilation associated with systolic myocardial dysfunction in the absence of other cardiac lesions. DCM occasionally develops in conjunction with proliferation of fibroelastic fibers in the endocardium, producing endocardial fibroelastosis (EFE). Although early reports describe EFE as a primary disease, evidence now suggests that EFE may develop as a response to myocardial dysfunction. Echocardiographic evaluation of a 4-wk-old Pallas cat ( Otocolobus manul) with respiratory distress revealed enlargement of both atria, enlarged end-systolic left ventricular dimension, and left ventricular dilation. DCM was diagnosed, and the cat was euthanized, given the poor prognosis. Postmortem examination revealed pericardial effusion and biventricular and biatrial enlargement. The interventricular septum and free walls of ventricles were thin. Histologically, the endocardium of the left and right ventricles was diffusely thickened; Verhoeff-Van Gieson staining of the left ventricular endocardium revealed a moderate amount of endocardial accumulation of elastin and collagen. These fibers were more prominent in papillary muscles and around coronary blood vessels. Based on these findings, we diagnosed DCM with EFE. Cardiac diseases are rarely diagnosed in wild felids.
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Affiliation(s)
- Erwin K Gudenschwager
- Departments of Biomedical Sciences and Pathobiology (Gudenschwager, LeRoith), Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA.,Small Animal Clinical Sciences (Abbott), Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Jonathan A Abbott
- Departments of Biomedical Sciences and Pathobiology (Gudenschwager, LeRoith), Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA.,Small Animal Clinical Sciences (Abbott), Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Tanya LeRoith
- Departments of Biomedical Sciences and Pathobiology (Gudenschwager, LeRoith), Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA.,Small Animal Clinical Sciences (Abbott), Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
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21
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Yi JE, Park J, Lee HJ, Shin DG, Kim Y, Kim M, Kwon K, Pyun WB, Kim YJ, Joung B. Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: A multicenter retrospective cohort study. PLoS One 2018; 13:e0208100. [PMID: 30485353 PMCID: PMC6261623 DOI: 10.1371/journal.pone.0208100] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction The presence of late gadolinium enhancement (LGE) at the right ventricular insertion point (RVIP) on cardiac magnetic resonance (CMR) is generally believed to be nonspecific, but the clinical implication of this unique LGE pattern in patients with non-ischemic dilated cardiomyopathy (NICM) has not been elucidated. Objectives We investigated the prognostic significance of RVIP-LGE in NICM patients. Methods A total of 360 consecutive NICM patients referred for CMR (102 with no LGE, 50 with RVIP-LGE, 121 with left ventricular [LV]-LGE, and 87 with both an LV and RVIP-LGE) were studied. The primary endpoint was a composite of the all-cause death, hospitalization due to worsening of heart failure, and major arrhythmic events. Results During a mean follow-up of 45.2 ± 36.5 months, 149 (41.4%) patients (22 [21.6%] no LGE vs. 16 [32.0%] RVIP-LGE vs. 62 [51.2%] LV-LGE vs. 49 [56.3%] both LV and RVIP-LGE, P < 0.0001) reached the primary endpoint. A Kaplan Meier curve demonstrated that RVIP-LGE patients had an intermediate trend of an event free survival rate for the composite endpoint (log-rank P < 0.0001). In a multivariable Cox regression model, LV-LGE (P = 0.008) and both LV and RVIP-LGE (P = 0.003) were significantly associated with a worse outcome, whereas RVIP-LGE was not (P = 0.101). In addition, RVIP-LGE patients (n = 32) had a more favorable outcome compared to LV-LGE patients (n = 32) even after matching the extent of the LGE (median 3.4% [interquartile range, 3.1–3.8], 8 [25.0%] RVIP-LGE vs. 20 [62.5%] LV-LGE, P = 0.002). Conclusions LGE confined to the RVIP among NICM patients did not significantly increase the risk of adverse cardiac events, and also showed a better outcome than the same extent of LGE located in the LV. Identification of this unique LGE distribution may help refine the current risk stratification.
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Affiliation(s)
- Jeong-Eun Yi
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Geum Shin
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Minsuk Kim
- Department of Pharmacology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kihwan Kwon
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Department of Cardiology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail: (BYJ); (YJK)
| | - Boyoung Joung
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail: (BYJ); (YJK)
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22
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Histopathological Aspects of the Myocardium in Dilated Cardiomyopathy. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:243-249. [PMID: 30647944 PMCID: PMC6311227 DOI: 10.12865/chsj.44.03.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022]
Abstract
Dilated cardiomyopathy is the most common form of cardiac muscle disease,
accounting for approximately 60% of all cardiomyopathies. We proposed to
identify histopathological changes of the myocardium in dilative cardiomyopathy.
This study comprised a total of 19 cases, represented by myocardial fragments
from deceased patients with diagnosis of dilated cardiomyopathy.
Histopathological analysis allowed changes to be observed for both myocytes
and myocardial interstitial components. We have found a combination of
hypertrophic, atrophic and normal myocardocytes, or associated with the
presence of hydropic changes. We rarely identified the aspect of myocytosis,
cytoplasmic accumulation of lipofuscin pigment or mucinous material, and
variable nuclear pleomorphism. At the interstitial level we noticed changes
in fibrosis, lipomatosis and rarely the presence of inflammatory infiltrate.
Histopathological characteristics of the myocardium in dilated cardiomyopathy
are numerous but nonspecific, similar to those in the terminal stages of other
cardiac diseases.
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23
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Zhang K, Wang W, Zhao S, Katz SD, Iervasi G, Gerdes AM, Tang YD. Long-term prognostic value of combined free triiodothyronine and late gadolinium enhancement in nonischemic dilated cardiomyopathy. Clin Cardiol 2018; 41:96-103. [PMID: 29360143 DOI: 10.1002/clc.22858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/26/2017] [Accepted: 11/21/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Thyroid dysfunction and myocardial fibrosis are both associated with cardiovascular events in patients with dilated cardiomyopathy (DCM). HYPOTHESIS The combination of thyroid hormone (TH) and myocardial fibrosis (detected by late gadolinium enhancement [LGE]) is an independent and incremental predictor of adverse events in DCM. METHODS We consecutively enrolled 220 idiopathic DCM patients with thyroid function and LGE assessment at Fuwai Hospital (China) from January 2010 to October 2011 and followed up through December 2015. Patients were divided into 4 groups according to the presence or absence of LGE and FT3 value (median level of 2.79 pg/mL): LGE-positive + FT3 < 2.79 pg/mL, LGE-positive + FT3 ≥ 2.79 pg/mL, LGE-negative + FT3 < 2.79 pg/mL, and LGE-negative + FT3 ≥ 2.79 pg/mL. RESULTS During a median follow-up of 61 months, 56 patients (25.5%) died, with 27/56 (48.2%), 8/45 (17.8%), 12/54 (22.2%), and 9/65 (13.8%) among 4 groups (P = 0.009), respectively. Multivariable Cox regression analysis identified LGE-positive and FT3 < 2.79 pg/mL as a significant independent predictor of all-cause mortality (hazard ratio: 2.893, 95% confidence interval: 1.323-6.326, P = 0.008). Combining the predictive value of FT3 and LGE status significantly improved risk reclassification for all-cause mortality, as indicated by the net reclassification improvement (0.28; P = 0.005) and integrated discrimination improvement (0.058; P = 0.001). CONCLUSIONS The findings suggest that the combination of FT3 and LGE yielded a more accurate predictive value for long-term prognosis in patients with DCM, which may improve patient selection for intensive interventions.
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Affiliation(s)
- Kuo Zhang
- Departments of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Departments of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Stuart D Katz
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Giorgio Iervasi
- Clinical Physiology Institute, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - A Martin Gerdes
- Department of Biomedical Sciences, New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York
| | - Yi-Da Tang
- Departments of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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24
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Nakano SJ, Siomos AK, Garcia AM, Nguyen H, SooHoo M, Galambos C, Nunley K, Stauffer BL, Sucharov CC, Miyamoto SD. Fibrosis-Related Gene Expression in Single Ventricle Heart Disease. J Pediatr 2017; 191:82-90.e2. [PMID: 29050751 PMCID: PMC5705574 DOI: 10.1016/j.jpeds.2017.08.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/11/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate fibrosis and fibrosis-related gene expression in the myocardium of pediatric subjects with single ventricle with right ventricular failure. STUDY DESIGN Real-time quantitative polymerase chain reaction was performed on explanted right ventricular myocardium of pediatric subjects with single ventricle disease and controls with nonfailing heart disease. Subjects were divided into 3 groups: single ventricle failing (right ventricular failure before or after stage I palliation), single ventricle nonfailing (infants listed for primary transplantation with normal right ventricular function), and stage III (Fontan or right ventricular failure after stage III). To evaluate subjects of similar age and right ventricular volume loading, single ventricle disease with failure was compared with single ventricle without failure and stage III was compared with nonfailing right ventricular disease. Histologic fibrosis was assessed in all hearts. Mann-Whitney tests were performed to identify differences in gene expression. RESULTS Collagen (Col1α, Col3) expression is decreased in single ventricle congenital heart disease with failure compared with nonfailing single ventricle congenital heart disease (P = .019 and P = .035, respectively), and is equivalent in stage III compared with nonfailing right ventricular heart disease. Tissue inhibitors of metalloproteinase (TIMP-1, TIMP-3, and TIMP-4) are downregulated in stage III compared with nonfailing right ventricular heart disease (P = .0047, P = .013 and P = .013, respectively). Matrix metalloproteinases (MMP-2, MMP-9) are similar between nonfailing single ventricular heart disease and failing single ventricular heart disease, and between stage III heart disease and nonfailing right ventricular heart disease. There is no difference in the prevalence of right ventricular fibrosis by histology in subjects with single ventricular failure heart disease with right ventricular failure (18%) compared with those with normal right ventricular function (38%). CONCLUSIONS Fibrosis is not a primary contributor to right ventricular failure in infants and young children with single ventricular heart disease. Additional studies are required to understand whether antifibrotic therapies are beneficial in this population.
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Affiliation(s)
- Stephanie J. Nakano
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Austine K. Siomos
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Anastacia M. Garcia
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Hieu Nguyen
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Megan SooHoo
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Csaba Galambos
- Department of Pediatrics, Division of Pathology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Karin Nunley
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
| | - Brian L. Stauffer
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Cardiology, Denver Health and Hospital Authority, Denver, CO
| | - Carmen C. Sucharov
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shelley D. Miyamoto
- Department of Pediatrics, Division of Cardiology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO
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25
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Xie Y, Liao J, Yu Y, Guo Q, Yang Y, Ge J, Chen H, Chen R. Endothelial‑to‑mesenchymal transition in human idiopathic dilated cardiomyopathy. Mol Med Rep 2017; 17:961-969. [PMID: 29115553 PMCID: PMC5780177 DOI: 10.3892/mmr.2017.8013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 10/09/2017] [Indexed: 01/19/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular dilation and cardiac fibrosis. Emerging evidence indicated that endothelial-to-mesenchymal transition (Endo-MT) is a crucial event during organ fibrosis. This study was performed to clarify whether Endo-MT contributed to the progression of cardiac fibrosis in DCM. Cardiac samples from patients with DCM and control were obtained. The presence of endothelial markers, cluster of differentiation (CD)31 and vascular endothelial (VE)-cadherin, and mesenchymal markers, α smooth muscle actin (SMA) and fibroblast-specific protein 1 (FSP1) was performed using immunohistochemistry. Co-localization of endothelial markers and mesenchymal markers were identified using confocal immunofluorescence staining. Serum procollagen type I carboxy-terminal propeptide (PICP) and procollagen type III amino-terminal propeptide (PIIINP) were measured by ELISA. Protein levels of Wnt, β-catenin and Snail were determined using western blot analysis. Immunohistochemistry and double-immunofluorescence staining demonstrated that the expression of CD31 and VE-cadherin were significantly decreased in DCM samples, whereas the FSP-1, and αSMA were significantly increased. CD31 and VE-cadherin labeling indexes were respectively negatively correlated with left ventricular end-diastolic diameter (LVEDD) (CD31 r=−0.82, P<0.01; VE-cadherin r=−0.73, P<0.01), while FSP-1 and αSMA were positively associated with LVEDD (αSMA r=0.65, P<0.01, FSP1 r=0.53, P<0.01) and left ventricular ejection fraction (αSMA r=−0.18, P<0.05; FSP1 r=−0.21, P<0.05). Furthermore, PICP and PIIINP levels were positively associated with the co-expression labeling indexes (CD31/SMA co-labeling index and PICP r=0.727, P<0.01; CD31/SMA co-labeling index and PIIINP r=0.741, P<0.01; VE-Cadherin/FSP-1 co-labeling index and PICP r=0.716, P<0.01; VE-cadherin/FSP-1 co-labeling index and PIIINP r=0.648, P<0.05). Western blot analysis indicated that proteins levels of Wnt signaling and snail were significantly increased in DCM samples. These results suggested that Endo-MT is potentially implicated in the pathogenesis of myocardial fibrosis and remodeling during the development of DCM, indicating a potential therapeutic target for DCM treatment.
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Affiliation(s)
- Yeqing Xie
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Jianquan Liao
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Yong Yu
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Qi Guo
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Yingzhen Yang
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Junbo Ge
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Haozhu Chen
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Ruizhen Chen
- Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
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26
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Goh VJ, Le TT, Bryant J, Wong JI, Su B, Lee CH, Pua CJ, Sim CPY, Ang B, Aw TC, Cook SA, Chin CWL. Novel Index of Maladaptive Myocardial Remodeling in Hypertension. Circ Cardiovasc Imaging 2017; 10:e006840. [PMID: 28847911 PMCID: PMC5617557 DOI: 10.1161/circimaging.117.006840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hypertensive left ventricular hypertrophy (HTN-LVH) is a leading cause of heart failure. Conventional patterns of cardiac geometry do not adequately risk-stratify patients with HTN-LVH. Using cardiovascular magnetic resonance, we developed a novel Remodeling Index (RI) that was designed to detect an exaggerated hypertrophic response to hypertension and tested its potential to risk-stratify hypertensive patients. METHODS AND RESULTS The RI was derived using LaPlace's Law (), and normal RI ranges were established in 180 healthy volunteers. The utility of the RI was examined in 256 asymptomatic hypertensive patients and 10 patients with heart failure with preserved ejection fraction. Hypertensive patients underwent multimodal cardiac assessment: contrast-enhanced cardiovascular magnetic resonance, echocardiograms, 24-hour blood pressure monitoring, and cardiac biomarkers (high-sensitivity cardiac troponins, NT-proBNP [N-terminal pro-B-type natriuretic peptide], and galectin-3). Blood pressure accounted for only 20% of the variance observed in LV mass. Although there was no association between blood pressure and myocardial fibrosis, LV mass was independently associated with fibrosis. Compared with hypertensive patients without LVH (n=191; 74.6%) and those with HTN-LVH and normal RI (n=50; 19.5%), patients with HTN-LVH and low RI (HTN-LVH/low RI; n=15, 5.9%) had an amplified myocardial response: elevated indexed LV masses (83±24 g/m2), more fibrosis (73%), and higher biomarkers of myocardial injury and dysfunction (P<0.05 for all). RI was similar in HTN-LVH/low RI and heart failure with preserved ejection fraction (4.1 [3.4-4.5] versus 3.7 [3.4-4.0], respectively; P=0.15). CONCLUSIONS We suggest that RI provides an approach for stratifying hypertensive patients and is suitable for testing in other disease cohorts to assess its clinical utility. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02670031.
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Affiliation(s)
- Vera J Goh
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Thu-Thao Le
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jennifer Bryant
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Jia Ing Wong
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Boyang Su
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chi-Hang Lee
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chee Jian Pua
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Chloe P Y Sim
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Briana Ang
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Tar Choon Aw
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Stuart A Cook
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.)
| | - Calvin W L Chin
- From the Department of Internal Medicine, Singapore General Hospital, Singapore (V.J.G.); Department of Cardiology, National Heart Centre Singapore (T.-T.L., J.B., J.I.W., B.S., C.J.P., C.P.Y.S., B.A., S.A.C., C.W.L.C.); National University Heart Centre Singapore (C.-H.L.); Duke-NUS Medical School, Singapore, Singapore (S.A.C., C.W.L.C.); and Depatrment of Laboratory Medicine, Changi General Hospital, Singapore (T.C.A.).
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Saito T, Asai K, Sato S, Hayashi M, Adachi A, Sasaki Y, Takano H, Mizuno K, Shimizu W. Autophagic vacuoles in cardiomyocytes of dilated cardiomyopathy with initially decompensated heart failure predict improved prognosis. Autophagy 2016; 12:579-87. [PMID: 26890610 DOI: 10.1080/15548627.2016.1145326] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Autophagy is a process of bulk protein degradation and organelle turnover, and is a current therapeutic target in several diseases. The present study aimed to clarify the significance of myocardial autophagy of patients with dilated cardiomyopathy (DCM). Left ventricular endomyocardial biopsy was performed in 250 consecutive patients with DCM (54.9±13.9 years; male, 79%), initially presenting with decompensated heart failure (HF). The association of these findings with HF mortality or recurrence was examined. Myofilament changes, which are apparent in the degenerated cardiomyocytes of DCM, were recognized in 164 patients (66%), and autophagic vacuoles in cardiomyocytes were identified in or near the area of myofilament changes in 86 patients (34%). Morphometrically, fibrosis (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93 to 0.99) and mitochondrial abnormality (OR, 2.24; 95% CI, 1.23 to 4.08) were independently related with autophagic vacuoles. During the follow-up period of 4.9±3.9 y, 24 patients (10%) died, including 10 (4%) who died of HF, and 67 (27%) were readmitted for HF recurrence. Multivariate analysis identified a family history of DCM (hazard ratio [HR], 2.117; 95% CI, 1.199 to 3.738), hemoglobin level (HR, 0.845; 95% CI, 0.749 to 0.953), myofilament changes (HR, 13.525; 95% CI, 5.340 to 34.255), and autophagic vacuoles (HR, 0.214; 95% CI, 0.114 to 0.400) as independent predictors of death or readmission due to HF recurrence. In conclusion, autophagic vacuoles in cardiomyocytes are associated with a better HF prognosis in patients with DCM, suggesting autophagy may play a role in the prevention of myocardial degeneration.
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Affiliation(s)
- Tsunenori Saito
- a Department of Cardiovascular Medicine , Nippon Medical School , Tokyo , Japan
| | - Kuniya Asai
- a Department of Cardiovascular Medicine , Nippon Medical School , Tokyo , Japan
| | - Shigeru Sato
- b Tokyo Electron Microscopy Laboratory , Chiba , Japan
| | - Meiso Hayashi
- a Department of Cardiovascular Medicine , Nippon Medical School , Tokyo , Japan
| | - Akiko Adachi
- c Division of Morphological and Biomolecular Research , Graduate School of Medicine, Nippon Medical School , Tokyo , Japan
| | - Yoshihiro Sasaki
- c Division of Morphological and Biomolecular Research , Graduate School of Medicine, Nippon Medical School , Tokyo , Japan
| | - Hitoshi Takano
- a Department of Cardiovascular Medicine , Nippon Medical School , Tokyo , Japan
| | - Kyoichi Mizuno
- a Department of Cardiovascular Medicine , Nippon Medical School , Tokyo , Japan
| | - Wataru Shimizu
- a Department of Cardiovascular Medicine , Nippon Medical School , Tokyo , Japan
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Free Triiodothyronine Level Correlates with Myocardial Injury and Prognosis in Idiopathic Dilated Cardiomyopathy: Evidence from Cardiac MRI and SPECT/PET Imaging. Sci Rep 2016; 6:39811. [PMID: 28004791 PMCID: PMC5177909 DOI: 10.1038/srep39811] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/25/2016] [Indexed: 01/15/2023] Open
Abstract
Thyroid dysfunction is associated with poor prognosis in heart failure, but theories of mechanisms are mainly based on animal experiments, not on human level. We aimed to explore the relation between thyroid function and myocardial injuries in idiopathic dilated cardiomyopathy (IDCM) using cardiac magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Myocardial fibrosis was detected by late gadolinium enhancement (LGE) MRI, and myocardial perfusion/metabolism was evaluated by 99mTc-MIBI SPECT /18F-FDG PET imaging. Across the quartiles of FT3, decreased percentage of segments with LGE and perfusion/metabolism abnormalities were found. As for FT4 and TSH levels, no significant distribution trend of myocardial injuries could be detected. In logistic analysis, FT3 was independently associated with the presence of LGE (OR: 0.140, 95% CI: 0.035-0.567), perfusion abnormalities (OR: 0.172, 95% CI: 0.040-0.738) and metabolism abnormalities (OR: 0.281, 95% CI: 0.081-0.971). After a median follow-up of 46 months, LGE-positive and FT3 < 2.77 pg/mL was identified as the strongest predictor of cardiac events (HR: 8.623, 95% CI: 3.626-16.438). Low FT3 level is associated with myocardial fibrosis and perfusion/metabolism abnormalities in patients with IDCM. The combination of FT3 level and LGE provides useful information for assessing the prognosis of IDCM.
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McElwee SK, Velasco A, Doppalapudi H. Mechanisms of sudden cardiac death. J Nucl Cardiol 2016; 23:1368-1379. [PMID: 27457531 DOI: 10.1007/s12350-016-0600-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death (SCD) continues to be a major public health problem and is thought to account for almost half of all cardiac deaths. Cardiac arrest and SCD are most commonly due to ventricular arrhythmias. Most patients who suffer cardiac arrest have underlying structural heart disease, with coronary artery disease (CAD) being the most common. In the setting of CAD, ventricular arrhythmias can result due to acute ischemia in the absence of preexisting myocardial scarring or in the presence of established scar from prior infarction without clinically significant ischemia. LV systolic dysfunction is an important predictor of risk for SCD in ischemic heart disease and in most nonischemic disorders, although other factors such as ventricular hypertrophy also play a role. Cardiac arrest and SCD can also occur due to primary electrical disorders in the absence of major structural abnormalities.
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Affiliation(s)
- Samuel K McElwee
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alejandro Velasco
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
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30
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Fibrosis and Fibrotic Gene Expression in Pediatric and Adult Patients With Idiopathic Dilated Cardiomyopathy. J Card Fail 2016; 23:314-324. [PMID: 27890770 DOI: 10.1016/j.cardfail.2016.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 11/11/2016] [Accepted: 11/23/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although fibrosis seems to be prognostic for adverse outcomes in adults with idiopathic dilated cardiomyopathy (IDC), little is known about the prevalence and development of fibrosis in pediatric IDC hearts. We hypothesized that there is less activation of fibrosis at a molecular level in pediatric IDC hearts than in failing adult hearts. METHODS AND RESULTS Pediatric hearts were analyzed histologically to determine the prevalence of fibrosis. Left ventricular tissue from adult and pediatric IDC hearts and adult and pediatric nonfailing (NF) hearts were subjected to quantitative reverse-transcription polymerase chain reaction to study the expression of important mRNAs that affect fibrosis. We found age-specific differences between IDC and NF hearts in the regulation of noncoding galectin-3, Corin, matrix metalloproteinase (MMP) 2, MMP-9, tissue inhibitor of metalloproteinase (TIMP) 2, and TIMP-3. We also found markers that were similarly altered in both adult and pediatric IDC hearts (interleukin-1 receptor-like 1 receptor, TIMP-1, and TIMP-4). Finally, microRNAs 29a-c were significantly decreased in the pediatric IDC patients. CONCLUSIONS Pediatric IDC patients demonstrate age-specific differences in the molecular pathways implicated in fibrosis in the adult heart. At the ultrastructural level the unique gene expression pattern appears to limit fibrosis in the failing pediatric heart.
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Liu T, Ma X, Liu W, Ling S, Zhao L, Xu L, Song D, Liu J, Sun Z, Fan Z, Luo T, Kang J, Liu X, Dong J. Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure. Front Physiol 2016; 7:484. [PMID: 27840608 PMCID: PMC5083842 DOI: 10.3389/fphys.2016.00484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods: Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results: LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration, and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD, and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005–1.071, p = 0.022; Model II 6SD HR 1.045, 95%CI 1.001–1.084, p = 0.022). Conclusion: LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohai Ma
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Wei Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Shukuan Ling
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center Beijing, China
| | - Lei Zhao
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Lei Xu
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Deli Song
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General Hospital Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, School of Science, Curtin University Perth, WA, Australia
| | - Zhanming Fan
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Taiyang Luo
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Junping Kang
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohui Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
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The evaluation of non-ischemic dilated cardiomyopathy with T1 mapping and ECV methods using 3T cardiac MRI. Radiol Med 2016; 122:106-112. [PMID: 27785679 DOI: 10.1007/s11547-016-0701-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/19/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of this study was to examine the correlation between ventricular function and the extracellular volume fraction (ECV) in patients with non-ischemic dilated cardiomyopathy (NIDCM) using 3.0 T magnetic resonance imaging (MRI). We also hypothesized that native T1 and ECV values would be increased in patients with NIDCM, independent of the left ventricular ejection fraction (LVEF). The findings of our study could lead to further studies of the follow-up protocols. MATERIALS AND METHODS In total, 53 consecutive dilated cardiomyopathy patients who had undergone cardiac MRI were functionally evaluated and underwent tissue characterization. RESULTS The mean native T1 value was 1235 ± 10 ms, and the mean ECV value was 35.4 ± 2.7% in the myocardia. The LVEF values ranged from 29 to 44%. No significant correlations were observed between functional analysis measurements and native T1 or ECV values. CONCLUSIONS Our results showed that myocardial fibrosis is unrelated to cardiac functional findings in NIDCM patients. Therefore, we propose that these patients should be evaluated using MRI and tissue characterization techniques, in addition to cardiac functional analysis.
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Cardiac magnetic resonance and galectin-3 level as predictors of prognostic outcomes for non-ischemic cardiomyopathy patients. Int J Cardiovasc Imaging 2016; 32:1725-1733. [PMID: 27566192 DOI: 10.1007/s10554-016-0958-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022]
Abstract
This study was aimed at determining whether late gadolinium enhancement (LGE) in conjunction with Galectin-3 (Gal-3) level offered more precise prognosis of non-ischemic cardiomyopathy (NICM) in comparison to LGE alone. Results of LGE and Gal-3 expression in 192 patients with NICM, including 85 subjects with dilated cardiomyopathy (DCM) and 107 with hypertrophic cardiomyopathy (HCM), were examined. As suggested by the characteristics of LGE and Gal-3 levels, patients were divided into four groups: LGE positive + low Gal-3 (n = 10 for DCM, n = 15 for HCM), LGE positive + high Gal-3 (n = 25 for DCM, n = 51 for HCM), LGE negative + low Gal-3 (n = 32 for DCM, n = 29 for HCM), LGE negative + high Gal-3 (n = 18 for DCM, n = 12 for HCM). Primary endpoints over the follow-up period included major adverse cardiac events (MACEs). Kaplan-Meier survival analysis and univariate Cox proportional hazard models were used to analyze the survival status of patients with NICM. The optimal cut-off value of Gal-3 level for two types of NICM was determined by receiver operating characteristic analysis (13.38 U/L for DCM and 14.40 U/L for HCM). The combination of LGE and Gal-3 levels offered a more significant prognostic value than using LGE alone for both DCM and HCM (DCM P = 0.001 < 0.012; HCM P = 0.037 < 0.040). Moreover, the Cox proportional hazard model suggested that both LGE status [Hazard ratio (HR) = 2.62, P = 0.017] and Gal-3 level (HR = 1.16, P = 0.013) were significant predictors of MACEs in DCM, while they did not appear to have significant prognostic values for HCM (P = 0.06 and 0.64). Furthermore, the multivariate analysis only confirmed LGE as an independent element in predicting prognosis of DCM (HR = 12.19, P = 0.026). In conclusion, LGE status was an independent indicator of DCM prognosis, yet the insignificant role of LGE in HCM prognosis could be limited by sample size.
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34
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Stephenson MK, Lenihan S, Covarrubias R, Huttinger RM, Gumina RJ, Sawyer DB, Galindo CL. Scanning Electron Microscopy of Macerated Tissue to Visualize the Extracellular Matrix. J Vis Exp 2016. [PMID: 27340841 DOI: 10.3791/54005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fibrosis is a component of all forms of heart disease regardless of etiology, and while much progress has been made in the field of cardiac matrix biology, there are still major gaps related to how the matrix is formed, how physiological and pathological remodeling differ, and most importantly how matrix dynamics might be manipulated to promote healing and inhibit fibrosis. There is currently no treatment option for controlling, preventing, or reversing cardiac fibrosis. Part of the reason is likely the sheer complexity of cardiac scar formation, such as occurs after myocardial infarction to immediately replace dead or dying cardiomyocytes. The extracellular matrix itself participates in remodeling by activating resident cells and also by helping to guide infiltrating cells to the defunct lesion. The matrix is also a storage locker of sorts for matricellular proteins that are crucial to normal matrix turnover, as well as fibrotic signaling. The matrix has additionally been demonstrated to play an electromechanical role in cardiac tissue. Most techniques for assessing fibrosis are not qualitative in nature, but rather provide quantitative results that are useful for comparing two groups but that do not provide information related to the underlying matrix structure. Highlighted here is a technique for visualizing cardiac matrix ultrastructure. Scanning electron microscopy of decellularized heart tissue reveals striking differences in structure that might otherwise be missed using traditional quantitative research methods.
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Affiliation(s)
- Matthew K Stephenson
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center
| | - Sean Lenihan
- Department of Medicine, Vanderbilt University Medical Center; Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Roman Covarrubias
- Department of Medicine, Vanderbilt University Medical Center; Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Ryan M Huttinger
- Department of Medicine, Vanderbilt University Medical Center; Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | - Richard J Gumina
- Department of Medicine, Vanderbilt University Medical Center; Division of Cardiovascular Medicine, Vanderbilt University Medical Center
| | | | - Cristi L Galindo
- Department of Medicine, Vanderbilt University Medical Center; Division of Cardiovascular Medicine, Vanderbilt University Medical Center;
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Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK. The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol 2016; 67:2996-3010. [DOI: 10.1016/j.jacc.2016.03.590] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 01/23/2023]
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MEMON SARFARAZ, GANGA HARSHAV, KLUGER JEFFREY. Late Gadolinium Enhancement in Patients with Nonischemic Dilated Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:731-47. [DOI: 10.1111/pace.12873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 01/23/2023]
Affiliation(s)
- SARFARAZ MEMON
- Division of Cardiology; Hartford Hospital; Hartford Connecticut
| | - HARSHA V. GANGA
- Division of Cardiology; Brown University; Providence Rhode Island
| | - JEFFREY KLUGER
- Division of Cardiology; Hartford Hospital; Hartford Connecticut
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Ikeda Y, Inomata T, Fujita T, Iida Y, Nabeta T, Ishii S, Maekawa E, Yanagisawa T, Mizutani T, Naruke T, Koitabashi T, Takeuchi I, Ako J. Cardiac fibrosis detected by magnetic resonance imaging on predicting time course diversity of left ventricular reverse remodeling in patients with idiopathic dilated cardiomyopathy. Heart Vessels 2016; 31:1817-1825. [DOI: 10.1007/s00380-016-0805-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/22/2016] [Indexed: 12/29/2022]
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38
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Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis. Clin Radiol 2015; 70:999-1008. [DOI: 10.1016/j.crad.2015.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/06/2015] [Accepted: 05/18/2015] [Indexed: 01/15/2023]
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39
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Santangeli P, Marchlinski FE. Ventricular Ectopy as a Modifiable Risk Factor for Heart Failure and Death. J Am Coll Cardiol 2015; 66:110-2. [DOI: 10.1016/j.jacc.2015.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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40
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Kachenoura N, Besson-Hajji L, Graves MJ, Reid S, Soulat G, Ashrafpoor G, De Cesare A, Hagege A, Redheuil A, Mousseaux E. Kinetic index combining native and postcontrast myocardial T1 in hypertrophic cardiomyopathy. J Magn Reson Imaging 2015; 42:1713-22. [DOI: 10.1002/jmri.24947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/28/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- Nadjia Kachenoura
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
| | - Laila Besson-Hajji
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
| | - Martin J Graves
- Radiology department; Cambridge University Hospitals NHS Foundation Trust; UK
| | | | - Gilles Soulat
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
| | - Golmehr Ashrafpoor
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
| | - Alain De Cesare
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d'Imagerie Biomédicale; F-75013 Paris France
| | - Albert Hagege
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology; Paris France
| | - Alban Redheuil
- Department of Cardiovascular Radiology; Institut de Cardiologie, Hôpital Pitié-Salpêtrière; Paris France
- Imaging Core Lab; ICAN; Paris France
| | - Elie Mousseaux
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges Pompidou; Paris France
- Paris-Centre de recherche Cardiovasculaire, HEGP, INSERM; Paris France
- Université Paris Descartes, Sorbonne Paris Cité Universités, Faculté de médecine; Paris France
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Abstract
Patients with dilated cardiomyopathies (DCM) face a significant burden of arrhythmias, including conduction defects such as atrioventricular block and interventricular delay in the form of left bundle branch block, resulting in altered electromechanical coupling that can exacerbate heart failure. Atrial fibrillation is common and carries an adverse prognosis. Ventricular arrhythmias and sudden cardiac death generally occur late in the disease course. Sustained monomorphic ventricular tachycardia accounts for most of the sustained ventricular arrhythmias in DCM. This article summarizes common forms of arrhythmias encountered in patients with DCM, and reviews the relevant electrophysiologic basis of these arrhythmias and their management.
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Affiliation(s)
- Saurabh Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - William G Stevenson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Roy M John
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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42
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Tateishi E, Noguchi T, Goto Y, Morita Y, Ishibashi-Ueda H, Yamada N, Kanzaki H, Nishimura K, Miyamoto Y, Anzai T, Ogawa H, Yasuda S. Prognostic impact of blood pressure response plus gadolinium enhancement in dilated cardiomyopathy. Heart 2015; 101:774-80. [PMID: 25761994 PMCID: PMC4431328 DOI: 10.1136/heartjnl-2014-307007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/11/2015] [Indexed: 02/03/2023] Open
Abstract
Objective Late gadolinium enhancement (LGE) is not necessarily ideal for detecting diffuse myocardial fibrosis in idiopathic dilated cardiomyopathy (DCM). Since systolic blood pressure response (SBPR) during exercise has been proposed to reflect cardiac pump reserve in patients with heart failure, we wished to determine whether LGE plus SBPR is a better prognostic factor in patients with DCM. Methods LGE and cardiopulmonary exercise testing results in consecutive 207 patients with DCM were examined. Patients were divided into four groups according to the presence or absence of LGE and the SBPR cut-off value of +40 mm Hg according to receiver operating characteristic curve analysis: LGE-positive+SBPR <40 mm Hg (n=65), LGE-positive+SBPR ≥40 mm Hg (n=40), LGE-negative+SBPR <40 mm Hg (n=33) and LGE-negative+SBPR ≥40 mm Hg (n=69). The composite end point was cardiac death, cardiac transplantation, LV assist device implantation, life-threatening arrhythmia or heart failure. Results Forty-two (20%) patients developed the composite end point, with rates of 35%, 20%, 21% and 6% in patients with LGE-positive+SBPR <40 mm Hg, LGE-positive+SBPR ≥40 mm Hg, LGE-negative+SBPR <40 mm Hg and LGE-negative+SBPR ≥40 mm Hg status, respectively. Multivariable Cox regression analysis identified LGE-positive and SBPR <40 mm Hg as a significant independent predictor of cardiac events (HR 2.08, 95% CI 1.06 to 4.11, p=0.034). Of note, there was no significant difference in the cardiac event-free survival rate between the LGE-positive+SBPR ≥40 mm Hg and LGE-negative+SBPR <40 mm Hg groups (p=0.736). Conclusions The combination of LGE and SBPR provides more clinically relevant information for assessing the risk of cardiac events in patients with DCM than LGE status alone.
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Affiliation(s)
- Emi Tateishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Naoaki Yamada
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Bänsch D. [Risk stratification of sudden cardiac death in dilated cardiomyopathy. Programmed ventricular stimulation]. Herzschrittmacherther Elektrophysiol 2015; 26:8-11. [PMID: 25693482 DOI: 10.1007/s00399-015-0350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
There is a strong correlation between clinical presentation and results of the electrophysiological study (EPS) in patients with dilated cardiomyopathy. Patients with spontaneous ventricular tachycardia (VT) or syncope often have inducible VT in contrast to patients who have no history of arrhythmias or syncope. Therefore, the EPS is rather not useful for risk stratification but for planning of an adjuvant antiarrhythmic or ablation therapy. This is also true for patients with frequent ventricular extrasystole or nonsustained VT in whom VT may aggravate heart failure. An EP study may still be useful to differentiate between syncope of bradycardic or tachycardic origin.
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Affiliation(s)
- Dietmar Bänsch
- Herzzentrum, Uniklinik Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland,
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44
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Song J, Xing Y, Chen X, Song Z, Teng X, Wang M, Zheng Z, Hu S. Processing of the explanted heart. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 6:613-7. [PMID: 25599048 PMCID: PMC4290049 DOI: 10.4103/1947-2714.147975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Analysis of the explanted hearts from heart transplant recipients provides valuable clinical samples, which can be used to study the anatomy and pathology of the heart. PubMed database was employed as the article source of this review. This article summarized the processing methods of the explanted heart, including dissection, histopathologic examination, cryopreservation, and genetic testing. A standard processing of explanted hearts ensures the quality and reliability of samples. Analysis of explanted hearts facilitates the diagnostic assessment and therapy strategy of heart diseases.
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Affiliation(s)
- Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yong Xing
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiao Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhizhao Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiao Teng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Mangyuan Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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T1 mapping: characterisation of myocardial interstitial space. Insights Imaging 2014; 6:189-202. [PMID: 25424598 PMCID: PMC4376813 DOI: 10.1007/s13244-014-0366-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 01/19/2023] Open
Abstract
Abstract Myocardial fibrosis is always present in end-stage heart failure and is a major independent predictor of adverse cardiac outcome. Cardiac magnetic resonance (CMR) is an imaging method that permits a non-invasive assessment of the heart and has been established as the “gold standard” for the evaluation of cardiac anatomy and function, as well as for quantifying focal myocardial fibrosis in both ischaemic and non-ischaemic heart disease. However, cardiac pathologies characterised by diffuse myocardial fibrosis cannot be evaluated by late gadolinium enhancement (LGE) imaging, as there are no reference regions of normal myocardium. Recent improvements in CMR imaging techniques have enabled parametric mapping of relaxation properties (T1, T2 and T2*) clinically feasible within a single breath-hold. T1 mapping techniques performed both with and without contrast enable the quantification of diffuse myocardial fibrosis and myocardial infiltration. This article reviews current imaging techniques, emerging applications and the future potential and limitations of CMR for T1 mapping. Teaching points • Myocardial fibrosis is a common endpoint in a variety of cardiac diseases. • Myocardial fibrosis results in myocardial stiffness, heart failure, arrhythmia and sudden death. • T1-mapping CMR techniques enable the quantification of diffuse myocardial fibrosis. • Native T1 reflects myocardial disease involving the myocyte and interstitium. • The use of gadolinium allows measurement of the extracellular volume fraction, reflecting interstitial space.
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Koopmann M, Hong KP, Kholmovski EG, Huang EC, Hu N, Ying J, Levenson R, Vijayakumar S, Dosdall DJ, Ranjan R, Kim D. Post-contrast myocardial T(1) and ECV disagree in a longitudinal canine study. NMR IN BIOMEDICINE 2014; 27:988-95. [PMID: 24865566 PMCID: PMC4227501 DOI: 10.1002/nbm.3135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 05/18/2023]
Abstract
Both post-contrast myocardial T1 and extracellular volume (ECV) measurements have been associated with diffuse interstitial fibrosis. The cardiovascular magnetic resonance (CMR) field is migrating towards ECV, because it is largely insensitive to confounders that affect post-contrast myocardial T1 . Despite the theoretical advantages of myocardial ECV over post-contrast myocardial T1 , systematic experimental studies comparing the two measurements are largely lacking. We sought to measure the temporal changes in post-contrast myocardial T1 and ECV in an established canine model with chronic atrial fibrillation. Seventeen mongrel dogs, implanted with a pacemaker to induce chronic atrial fibrillation via rapid atrial pacing, were scanned multiple times for a total of 46 CMR scans at 3T. These dogs with different disease durations (0-22 months) were part of a separate longitudinal study aimed at studying the relationship between AF and pathophysiology. In each animal, we measured native and post-contrast T1 values and hematocrit. Temporal changes in post-contrast myocardial T1 and ECV, as well as other CMR parameters, were modeled with linear mixed effect models to account for repeated measurements over disease duration. In 17 animals, post-contrast myocardial T1 decreased significantly from 872 to 698 ms (p < 0.001), which corresponds to a 24.9% relative reduction. In contrast, ECV increased from 21.0 to 22.0% (p = 0.38), which corresponds to only a 4.5% relative increase. To partially investigate this discrepancy, we quantified collagen volume fraction (CVF) in post-mortem heart tissues of six canines sacrificed at different disease durations (0-22 months). CVF quantified by histology increased from 0.9 to 1.9% (p = 0.56), which agrees better with ECV than with post-contrast myocardial T1 . This study shows that post-contrast myocardial T1 and ECV may disagree in a longitudinal canine study. A more comprehensive study, including histologic, cardiac, and renal functional analyses, is warranted to test rigorously which CMR parameter (ECV or post-contrast myocardial T1 ) agrees better with CVF.
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Affiliation(s)
- Matthias Koopmann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital of Münster, Münster, Germany
| | - Kyung Pyo Hong
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, 84108
| | | | - Eric C. Huang
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA, 95817
| | - Nan Hu
- Division of Epidemiology, Internal Medicine, University of Utah, Salt Lake City, UT, 84112
| | - Jian Ying
- Division of Epidemiology, Internal Medicine, University of Utah, Salt Lake City, UT, 84112
| | - Richard Levenson
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA, 95817
| | - Sathya Vijayakumar
- Surgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, 84111
| | - Derek J. Dosdall
- Division of Cardiology, Internal Medicine, University of Utah, Salt Lake City, UT, 84112
| | - Ravi Ranjan
- Division of Cardiology, Internal Medicine, University of Utah, Salt Lake City, UT, 84112
| | - Daniel Kim
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, 84108
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Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2014; 30:1559-67. [PMID: 25008088 DOI: 10.1007/s10554-014-0487-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/02/2014] [Indexed: 01/28/2023]
Abstract
Left ventricular (LV) remodeling and myocardial fibrosis have been linked to adverse heart failure outcomes. Mid wall late gadolinium enhancement (MW-LGE) on cardiac magnetic resonance (CMR) imaging is well-associated with non-ischemic cardiomyopathy (NICM), but prevalence in ischemic cardiomyopathy (ICM) and association with remodeling are unknown. The population comprised patients with systolic dysfunction [LV ejection fraction (LVEF ≤ 40 %)]. CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. 285 patients were studied. MW-LGE was present in 12 %, and was tenfold more common with NICM (32 %) versus ICM (3 %, p < 0.001). However, owing to higher prevalence of ICM, 15 % of patients with MW-LGE had ICM. LV wall stress was higher (p = 0.02) among patients with, versus those without, MW-LGE despite similar systolic blood pressure (p = 0.24). In multivariate analysis, MW-LGE was associated with CMR-quantified LV end-diastolic volume (p = 0.03) independent of LVEF and mass. Incorporation of clinical and imaging variables demonstrated MW-LGE to be associated with higher LV end-diastolic volume (OR 1.13, CI 1.004-1.27 per 10 ml/m(2), p = 0.04) after controlling for presence of NICM (OR 16.0, CI 5.8-44.1, p < 0.001). While more common in NICM, MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.
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48
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Variability in fibrosis in tissue samples obtained during diaphragmatic and apical LVAD implantation. Cardiovasc Pathol 2014; 23:121-5. [DOI: 10.1016/j.carpath.2013.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/30/2013] [Accepted: 12/20/2013] [Indexed: 01/17/2023] Open
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49
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Ohyama Y, Volpe GJ, Lima JAC. Subclinical Myocardial Disease in Heart Failure Detected by CMR. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014; 7:9269. [PMID: 25132911 DOI: 10.1007/s12410-014-9269-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Noninvasive cardiac imaging plays a central role in the assessment of patients with heart failure at all stages of disease. Moreover, this role can be even more important for individuals with asymptomatic cardiac functional or structural abnormalities-subclinical myocardial disease - because they could have benefits from early interventions before the onset of clinical heart failure. In this sense, cardiac magnetic resonance offers not only precise global cardiac function and cardiac structure, but also more detailed regional function and tissue characterization by recent developing methods. In this section, some of the main methods available for subclinical myocardial disease detection are reviewed in terms of what they can provide and how they can improve heart failure assessment.
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Affiliation(s)
- Yoshiaki Ohyama
- Division of cardiology, Johns Hopkins University, Baltimore, MD, USA, 600N. Wolf Street/Blalock 524, Baltimore, MD, 21287,
| | - Gustavo J Volpe
- Division of cardiology, Johns Hopkins University, Baltimore, MD, USA, 600N. Wolf Street/Blalock 524, Baltimore, MD, 21287,
| | - Joao A C Lima
- Division of cardiology, Johns Hopkins University, Baltimore, MD, USA, 600N. Wolf Street/Blalock 524, Baltimore, MD, 21287,
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50
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Machii M, Satoh H, Shiraki K, Saotome M, Urushida T, Katoh H, Takehara Y, Sakahara H, Ohtani H, Wakabayashi Y, Ukigai H, Tawarahara K, Hayashi H. Distribution of late gadolinium enhancement in end-stage hypertrophic cardiomyopathy and dilated cardiomyopathy: Differential diagnosis and prediction of cardiac outcome. Magn Reson Imaging 2014; 32:118-24. [DOI: 10.1016/j.mri.2013.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/11/2013] [Accepted: 10/11/2013] [Indexed: 01/01/2023]
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