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Starnes JR, Xu M, George-Durrett K, Crum K, Raucci FJ, Spurney CF, Hor KN, Cripe LH, Husain N, Buddhe S, Gambetta K, Tamaroff J, Slaughter JC, Markham LW, Soslow JH. Rate of Change in Cardiac Magnetic Resonance Imaging Measures Is Associated With Death in Duchenne Muscular Dystrophy. J Am Heart Assoc 2024; 13:e032960. [PMID: 38686878 DOI: 10.1161/jaha.123.032960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death among patients with Duchenne muscular dystrophy (DMD). Identifying patients at risk of early death could allow for increased monitoring and more intensive therapy. Measures that associate with death could serve as surrogate outcomes in clinical trials. METHODS AND RESULTS Duchenne muscular dystrophy subjects prospectively enrolled in observational studies were included. Models using generalized least squares were used to assess the difference of cardiac magnetic resonance measurements between deceased and alive subjects. A total of 63 participants underwent multiple cardiac magnetic resonance imaging and were included in the analyses. Twelve subjects (19.1%) died over a median follow-up of 5 years (interquartile range, 3.1-7.0). Rate of decline in left ventricular ejection fraction was faster in deceased than alive subjects (P<0.0001). Rate of increase in indexed left ventricular end-diastolic (P=0.0132) and systolic (P<0.0001) volumes were higher in deceased subjects. Faster worsening in midcircumferential strain was seen in deceased subjects (P=0.049) while no difference in global circumferential strain was seen. The rate of increase in late gadolinium enhancement, base T1, and mid T1 did not differ between groups. CONCLUSIONS Duchenne muscular dystrophy death is associated with the rate of change in left ventricular ejection fraction, midcircumferential strain, and ventricular volumes. Aggressive medical therapy to decrease the rate of progression may improve the mortality rate in this population. A decrease in the rate of progression may serve as a valid surrogate outcome for therapeutic trials.
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Affiliation(s)
- Joseph R Starnes
- Division of Cardiology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN USA
| | - Meng Xu
- Department of Biostatistics Vanderbilt University Nashville TN USA
| | - Kristen George-Durrett
- Division of Cardiology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN USA
| | - Kimberly Crum
- Division of Cardiology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN USA
| | - Frank J Raucci
- Division of Cardiology, Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond VA USA
| | | | - Kan N Hor
- Division of Cardiology, Department of Pediatrics Nationwide Children's Hospital, Ohio State University Columbus OH USA
| | - Linda H Cripe
- Division of Cardiology, Department of Pediatrics Nationwide Children's Hospital, Ohio State University Columbus OH USA
| | - Nazia Husain
- Division of Cardiology, Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Sujatha Buddhe
- Division of Cardiology, Department of Pediatrics Stanford University School of Medicine Stanford CA USA
| | - Katheryn Gambetta
- Division of Cardiology, Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Jaclyn Tamaroff
- Division of Endocrinology and Diabetes, Department of Pediatrics Vanderbilt University Medical Center Nashville TN USA
| | | | - Larry W Markham
- Division of Cardiology, Department of Pediatrics Riley Hospital for Children at Indiana University Health Indianapolis IN USA
| | - Jonathan H Soslow
- Division of Cardiology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN USA
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2
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Chandrasekar H, Kaufman BD, Beattie MJ, Ennis DB, Syed AB, Zucker EJ, Maskatia SA. Abbreviated cardiac magnetic resonance imaging versus echocardiography for interval assessment of systolic function in Duchenne muscular dystrophy: patient satisfaction, clinical utility, and image quality. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:157-165. [PMID: 37831292 DOI: 10.1007/s10554-023-02977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Poor acoustic windows make interval assessment of systolic function in patients with (Duchenne Muscular Dystrophy) DMD by echocardiography (echo) difficult. Cardiac magnetic resonance imaging (CMR) can be challenging in DMD patients due to study duration and patient discomfort. We developed an abbreviated CMR (aCMR) protocol and hypothesized that aCMR would compare favorably to echo in image quality and clinical utility without significant differences in exam duration, patient satisfaction, and functional measurements. METHODS DMD patients were recruited prospectively to undergo echo and aCMR. Modalities were compared with a global quality assessment score (GQAS), clinical utility score (CUS), and patient satisfaction score (PSS). Results were compared using Wilcoxon signed-rank tests, Spearman correlations, intraclass correlations, and Bland-Altman analyses. RESULTS Nineteen DMD patients were included. PSS scores and exam duration were equivalent between modalities, while CUS and GQAS scores favored aCMR. ACMR scored markedly higher than echo in RV visualization and assessment of atrial size. Older age was negatively correlated with echo GQAS and CUS scores, as well as aCMR PSS scores. Higher BMI was positively correlated with aCMR GQAS scores. Nighttime PPV requirement and non-ambulatory status were correlated with worse echo CUS scores. Poor image quality precluding quantification existed in five (26%) echo and zero (0%) aCMR studies. There was moderate correlation between aCMR and echo for global circumferential strain and left ventricular four chamber global longitudinal strain. CONCLUSION The aCMR protocol resulted in improved clinical relevance and quality scores relative to echo, without significant detriment to patient satisfaction or exam duration.
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Affiliation(s)
- Hamsika Chandrasekar
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Beth D Kaufman
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Meaghan J Beattie
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel B Ennis
- Department of Radiology, Division of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ali B Syed
- Department of Radiology, Division of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Evan J Zucker
- Department of Radiology, Division of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shiraz A Maskatia
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
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3
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Trussell TM, Brown T, Marcuccio E, Mullikin A, Zang H, Ollberding NJ, Villa C, Lang SM. Left Atrial Phasic Function via Cardiac Magnetic Resonance Imaging in Patients with Duchenne Muscular Dystrophy. Pediatr Cardiol 2023:10.1007/s00246-023-03327-2. [PMID: 37940677 DOI: 10.1007/s00246-023-03327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
Cardiac dysfunction is a leading cause of morbidity and mortality in Duchenne muscular dystrophy (DMD). Left atrial (LA) function is a poorly understood concept in this patient population, and research suggests underlying structural changes that could affect atrial function. Cardiac magnetic resonance (CMR) imaging may provide an important non-invasive approach to evaluating LA function. This study was a single center retrospective review of consecutive CMR studies over a 1 year period comparing LA phasic function within a cohort of DMD patients, and to those with structurally and functionally normal hearts. LA strain measurements including global reservoir, conduit, boost-pump strain, and LA volumes were obtained retrospectively. Spearman correlation analyses were performed on atrial strain measurements. 107 DMD and 79 normal CMR studies were included. The DMD cohort had worse systolic function (p < 0.001), smaller indexed max LA and left ventricular (LV) volumes (p < 0.001), and greater LA emptying fraction (p < 0.001). In the DMD cohort, emptying fraction decreased with advanced patient age (p < 0.001) and diminishing systolic function (p < 0.001). DMD patients with moderate or severe LV dysfunction demonstrated lower LA emptying fraction (p = 0.002), more impaired 2-chamber LA reservoir (p = 0.003), and LA pump (p = 0.006) and conduit strain (p = 0.018). DMD patients with preserved function have lower indexed LA volumes with higher LA emptying fractions than controls. Progression of disease and age is associated with decreased LA emptying fraction with early manifestations in reservoir and conduit strain. These findings suggest that strain markers of LA compliance and early left ventricular relaxation are associated with worsening cardiomyopathy in the DMD population.
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Affiliation(s)
- Taylor M Trussell
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
| | - Tyler Brown
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Elisa Marcuccio
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Anna Mullikin
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Chet Villa
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
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4
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Villa C, Auerbach SR, Bansal N, Birnbaum BF, Conway J, Esteso P, Gambetta K, Hall EK, Kaufman BD, Kirmani S, Lal AK, Martinez HR, Nandi D, O’Connor MJ, Parent JJ, Raucci FJ, Shih R, Shugh S, Soslow JH, Tunuguntla H, Wittlieb-Weber CA, Kinnett K, Cripe L. Current Practices in Treating Cardiomyopathy and Heart Failure in Duchenne Muscular Dystrophy (DMD): Understanding Care Practices in Order to Optimize DMD Heart Failure Through ACTION. Pediatr Cardiol 2022; 43:977-985. [PMID: 35024902 PMCID: PMC8756173 DOI: 10.1007/s00246-021-02807-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 02/06/2023]
Abstract
Cardiac disease has emerged as a leading cause of mortality in Duchenne muscular dystrophy in the current era. This survey sought to identify the diagnostic and therapeutic approach to DMD among pediatric cardiologists in Advanced Cardiac Therapies Improving Outcomes Network. Pediatric cardiology providers within ACTION (a multi-center pediatric heart failure learning network) were surveyed regarding their approaches to cardiac care in DMD. Thirty-one providers from 23 centers responded. Cardiac MRI and Holter monitoring are routinely obtained, but the frequency of use and indications for ordering these tests varied widely. Angiotensin converting enzyme inhibitor and aldosterone antagonist are generally initiated prior to onset of systolic dysfunction, while the indications for initiating beta-blocker therapy vary more widely. Seventeen (55%) providers report their center has placed an implantable cardioverter defibrillator in at least 1 DMD patient, while 11 providers (35%) would not place an ICD for primary prevention in a DMD patient. Twenty-three providers (74%) would consider placement of a ventricular assist device (VAD) as destination therapy (n = 23, 74%) and three providers (10%) would consider a VAD only as bridge to transplant. Five providers (16%) would not consider VAD at their institution. Cardiac diagnostic and therapeutic approaches vary among ACTION centers, with notable variation present regarding the use of advanced therapies (ICD and VAD). The network is currently working to harmonize medical practices and optimize clinical care in an era of rapidly evolving outcomes and cardiac/skeletal muscle therapies.
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Affiliation(s)
- Chet Villa
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
| | - Scott R. Auerbach
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, Division of Cardiology, University of Colorado, Denver Anschutz Medical Campus, Children’s Hospital Colorado Aurora, Aurora, CO USA
| | - Neha Bansal
- grid.251993.50000000121791997Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY USA
| | - Brian F. Birnbaum
- grid.239559.10000 0004 0415 5050Children’s Mercy Hospital and Clinics, Kansas City, MO USA
| | - Jennifer Conway
- grid.416656.60000 0004 0633 3703Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
| | - Paul Esteso
- grid.2515.30000 0004 0378 8438Boston Children’s Hospital, Boston, MA USA
| | - Katheryn Gambetta
- grid.413808.60000 0004 0388 2248Ann and Robert H Lurie Children’s Hospital, Chicago, IL USA
| | - E. Kevin Hall
- grid.417307.6Yale New Haven Children’s Hospital, Yale University School of Medicine, New Haven, CT USA
| | - Beth D. Kaufman
- grid.168010.e0000000419368956Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA USA
| | - Sonya Kirmani
- grid.414182.a0000 0004 0496 1167Duke Children’s Pediatric and Congenital Heart Center, Duke Children’s Hospital, Durham, NC USA
| | - Ashwin K. Lal
- grid.223827.e0000 0001 2193 0096Division of Pediatric Cardiology, Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA
| | - Hugo R. Martinez
- grid.267301.10000 0004 0386 9246The Heart Institute at Le Bonheur Children’s Hospital and The University of Tennessee Health Science Center, Memphis, TN USA
| | - Deipanjan Nandi
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
| | - Matthew J. O’Connor
- grid.25879.310000 0004 1936 8972Division of Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - John J. Parent
- grid.257413.60000 0001 2287 3919Riley Hospital for Children, Indiana University, Indianapolis, IN USA
| | - Frank J. Raucci
- grid.224260.00000 0004 0458 8737Children’s Hospital of Richmond, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Renata Shih
- grid.15276.370000 0004 1936 8091Congenital Heart Center, University of Florida, Gainesville, FL USA
| | - Svetlana Shugh
- grid.428608.00000 0004 0444 4338Heart Institute, Joe DiMaggio Children’s Hospital, Hollywood, FL USA
| | - Jonathan H. Soslow
- grid.416074.00000 0004 0433 6783Department of Pediatrics, Thomas P. Graham Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XDepartment of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Carol A. Wittlieb-Weber
- grid.25879.310000 0004 1936 8972Division of Cardiology, Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kathi Kinnett
- grid.437213.00000 0004 5907 1479Parent Project Muscular Dystrophy, Hackensack, NJ USA
| | - Linda Cripe
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
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5
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Rapid cardiac MRI protocol for cardiac assessment in paediatric and young adult patients undergoing haematopoietic stem cell transplant: a feasibility study. Cardiol Young 2021; 31:973-978. [PMID: 33504397 DOI: 10.1017/s1047951120004990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Haematopoietic stem cell transplantation is an important and effective treatment strategy for many malignancies, marrow failure syndromes, and immunodeficiencies in children, adolescents, and young adults. Despite advances in supportive care, patients undergoing transplant are at increased risk to develop cardiovascular co-morbidities. METHODS This study was performed as a feasibility study of a rapid cardiac MRI protocol to substitute for echocardiography in the assessment of left ventricular size and function, pericardial effusion, and right ventricular hypertension. RESULTS A total of 13 patients were enrolled for the study (age 17.5 ± 7.7 years, 77% male, 77% white). Mean study time was 13.2 ± 5.6 minutes for MRI and 18.8 ± 5.7 minutes for echocardiogram (p = 0.064). Correlation between left ventricular ejection fraction by MRI and echocardiogram was good (ICC 0.76; 95% CI 0.47, 0.92). None of the patients had documented right ventricular hypertension. Patients were given a survey regarding their experiences, with the majority both perceiving that the echocardiogram took longer (7/13) and indicating they would prefer the MRI if given a choice (10/13). CONCLUSION A rapid cardiac MRI protocol was shown feasible to substitute for echocardiogram in the assessment of key factors prior to or in follow-up after haematopoietic stem cell transplantation.
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6
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Raucci FJ, Xu M, George-Durrett K, Crum K, Slaughter JC, Parra DA, Markham LW, Soslow JH. Non-contrast cardiovascular magnetic resonance detection of myocardial fibrosis in Duchenne muscular dystrophy. J Cardiovasc Magn Reson 2021; 23:48. [PMID: 33910579 PMCID: PMC8082768 DOI: 10.1186/s12968-021-00736-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/11/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) leads to progressive cardiomyopathy. Detection of myocardial fibrosis with late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) is critical for clinical management. Due to concerns of brain deposition of gadolinium, non-contrast methods for detecting and monitoring myocardial fibrosis would be beneficial. OBJECTIVES We hypothesized that native T1 mapping and/or circumferential (εcc) and longitudinal (εls) strain can detect myocardial fibrosis. METHODS 156 CMRs with gadolinium were performed in 66 DMD boys and included: (1) left ventricular ejection fraction (LVEF), (2) LGE, (3) native T1 mapping and myocardial tagging (εcc-tag measured using harmonic phase analysis). LGE was graded as: (1) presence/absence by segment, slice, and globally; (2) global severity from 0 (no LGE) to 4 (severe); (3) percent LGE using full width half maximum (FWHM). εls and εcc measured using feature tracking. Regression models to predict LGE included native T1 and either εcc-tag or εls and εcc measured at each segment, slice, and globally. RESULTS Mean age and LVEF at first CMR were 14 years and 54%, respectively. Global εls and εcc strongly predicted presence or absence of LGE (OR 2.6 [1.1, 6.0], p = 0.029, and OR 2.3 [1.0, 5.1], p = 0.049, respectively) while global native T1 did not. Global εcc, εls, and native T1 predicted global severity score (OR 2.6 [1.4, 4.8], p = 0.002, OR 2.6 [1.4, 6.0], p = 0.002, and OR 1.8 [1.1, 3.1], p = 0.025, respectively). εls correlated with change in LGE by severity score (n = 33, 3.8 [1.0, 14.2], p = 0.048) and εcc-tag correlated with change in percent LGE by FWHM (n = 34, OR 0.2 [0.1, 0.9], p = 0.01). CONCLUSIONS Pre-contrast sequences predict presence and severity of LGE, with εls and εcc being more predictive in most models, but there was not an observable advantage over using LVEF as a predictor. Change in LGE was predicted by εls (global severity score) and εcc-tag (FWHM). While statistically significant, our results suggest these sequences are currently not a replacement for LGE and may only have utility in a very limited subset of DMD patients.
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Affiliation(s)
- Frank J Raucci
- Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University Medical Center, 1000 E. Broad St, Suite 5-344, Children's Pavilion, Richmond, VA, 23219, USA.
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristen George-Durrett
- Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Crum
- Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A Parra
- Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Larry W Markham
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Jonathan H Soslow
- Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Panovský R, Pešl M, Máchal J, Holeček T, Feitová V, Juříková L, Masárová L, Pešlová E, Opatřil L, Mojica-Pisciotti ML, Kincl V. Quantitative assessment of left ventricular longitudinal function and myocardial deformation in Duchenne muscular dystrophy patients. Orphanet J Rare Dis 2021; 16:57. [PMID: 33516230 PMCID: PMC7847593 DOI: 10.1186/s13023-021-01704-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/21/2021] [Indexed: 01/01/2023] Open
Abstract
Background Duchenne muscular dystrophy (DMD) manifests in males mainly by skeletal muscle impairment, but also by cardiac dysfunction. The assessment of the early phases of cardiac involvement using echocardiography is often very difficult to perform in these patients. The aim of the study was to use cardiac magnetic resonance (CMR) strain analysis and mitral annular plane systolic excursion (MAPSE) in the detection of early left ventricular (LV) dysfunction in DMD patients.
Methods and results In total, 51 male DMD patients and 18 matched controls were examined by CMR. MAPSE measurement and functional analysis using feature tracking (FT) were performed. Three groups of patients were evaluated: A/ patients with LGE and LV EF < 50% (n = 8), B/ patients with LGE and LVEF ≥ 50% (n = 13), and C/ patients without LGE and LVEF ≥ 50% (n = 30). MAPSE and global LV strains of the 3 DMD groups were compared to controls (n = 18).
Groups A and B had significantly reduced values of MAPSE, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) in comparison to controls (p < 0.05). The values of MAPSE (11.6 ± 1.9 v 13.7 ± 2.7 mm) and GCS (− 26.2 ± 4.2 v − 30.0 ± 5.1%) were significantly reduced in group C compared to the controls (p < 0.05). Conclusion DMD patients had decreased LV systolic function measured by MAPSE and global LV strain even in the case of normal LV EF and the absence of LGE. FT and MAPSE measurement provide sensitive assessment of early cardiac involvement in DMD patients.
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Affiliation(s)
- Roman Panovský
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic. .,1St Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.
| | - Martin Pešl
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,1St Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Máchal
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,Department of Pathophysiology, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Tomáš Holeček
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Brno, Czech Republic
| | - Věra Feitová
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Brno, Czech Republic
| | - Lenka Juříková
- Department of Pediatric Neurology, University Hospital Brno, Brno, Czech Republic
| | - Lucia Masárová
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,1St Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Eva Pešlová
- First Department of Neurology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Lukáš Opatřil
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,1St Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | | | - Vladimír Kincl
- International Clinical Research Center, St. Anne's Faculty Hospital, Brno, Czech Republic.,1St Department of Internal Medicine/Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
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8
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Maforo NG, Magrath P, Moulin K, Shao J, Kim GH, Prosper A, Renella P, Wu HH, Halnon N, Ennis DB. T 1-Mapping and extracellular volume estimates in pediatric subjects with Duchenne muscular dystrophy and healthy controls at 3T. J Cardiovasc Magn Reson 2020; 22:85. [PMID: 33302967 PMCID: PMC7731511 DOI: 10.1186/s12968-020-00687-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in patients with Duchenne muscular dystrophy (DMD)-a fatal X-linked genetic disorder. Late gadolinium enhancement (LGE) imaging is the current gold standard for detecting myocardial tissue remodeling, but it is often a late finding. Current research aims to investigate cardiovascular magnetic resonance (CMR) biomarkers, including native (pre-contrast) T1 and extracellular volume (ECV) to evaluate the early on-set of microstructural remodeling and to grade disease severity. To date, native T1 measurements in DMD have been reported predominantly at 1.5T. This study uses 3T CMR: (1) to characterize global and regional myocardial pre-contrast T1 differences between healthy controls and LGE + and LGE- boys with DMD; and (2) to report global and regional myocardial post-contrast T1 values and myocardial ECV estimates in boys with DMD, and (3) to identify left ventricular (LV) T1-mapping biomarkers capable of distinguishing between healthy controls and boys with DMD and detecting LGE status in DMD. METHODS Boys with DMD (N = 28, 13.2 ± 3.1 years) and healthy age-matched boys (N = 20, 13.4 ± 3.1 years) were prospectively enrolled and underwent a 3T CMR exam including standard functional imaging and T1 mapping using a modified Look-Locker inversion recovery (MOLLI) sequence. Pre-contrast T1 mapping was performed on all boys, but contrast was administered only to boys with DMD for post-contrast T1 and ECV mapping. Global and segmental myocardial regions of interest were contoured on mid LV T1 and ECV maps. ROI measurements were compared for pre-contrast myocardial T1 between boys with DMD and healthy controls, and for post-contrast myocardial T1 and ECV between LGE + and LGE- boys with DMD using a Wilcoxon rank-sum test. Results are reported as median and interquartile range (IQR). p-Values < 0.05 were considered significant. Receiver Operating Characteristic analysis was used to evaluate a binomial logistic classifier incorporating T1 mapping and LV function parameters in the tasks of distinguishing between healthy controls and boys with DMD, and detecting LGE status in DMD. The area under the curve is reported. RESULTS Boys with DMD had significantly increased global native T1 [1332 (60) ms vs. 1289 (56) ms; p = 0.004] and increased within-slice standard deviation (SD) [100 (57) ms vs. 74 (27) ms; p = 0.001] compared to healthy controls. LGE- boys with DMD also demonstrated significantly increased lateral wall native T1 [1322 (68) ms vs. 1277 (58) ms; p = 0.001] compared to healthy controls. LGE + boys with DMD had decreased global myocardial post-contrast T1 [565 (113) ms vs 635 (126) ms; p = 0.04] and increased global myocardial ECV [32 (8) % vs. 28 (4) %; p = 0.02] compared to LGE- boys. In all classification tasks, T1-mapping biomarkers outperformed a conventional biomarker, LV ejection fraction. ECV was the best performing biomarker in the task of predicting LGE status (AUC = 0.95). CONCLUSIONS Boys with DMD exhibit elevated native T1 compared to healthy, sex- and age-matched controls, even in the absence of LGE. Post-contrast T1 and ECV estimates from 3T CMR are also reported here for pediatric patients with DMD for the first time and can distinguish between LGE + from LGE- boys. In all classification tasks, T1-mapping biomarkers outperform a conventional biomarker, LVEF.
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Affiliation(s)
- Nyasha G Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Kévin Moulin
- Department of Radiology, Stanford University, 1201 Welch Road, Room P264, Stanford, CA, 94305-5488, USA
| | - Jiaxin Shao
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Grace Hyun Kim
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Ashley Prosper
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Nancy Halnon
- Department of Pediatrics (Cardiology), University of California, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, 1201 Welch Road, Room P264, Stanford, CA, 94305-5488, USA.
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Lang SM, Alsaied T, Khoury PR, Ryan TD, Taylor MD. Variations in native T1 values in patients with Duchenne muscular dystrophy with and without late gadolinium enhancement. Int J Cardiovasc Imaging 2020; 37:635-642. [PMID: 32951096 DOI: 10.1007/s10554-020-02031-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022]
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked genetic disorder leading to progressive skeletal and cardiac myopathy. Elevated myocardial T1 values correlate with fibrosis in most disease processes, but DMD skeletal and cardiac histopathology is defined by fibrofatty replacement that may result in a decrease in T1 values, due to the low T1 of fat. The study goal was to assess myocardial T1 values in DMD patients with and without late gadolinium enhancement (LGE). A retrospective analysis was performed on all patients with DMD referred for CMR at our institution from 7/5/2017 to 10/24/2018. T1 measurements were performed using breath-held modified Look Locker inversion recovery (MOLLI) sequences at the basal and mid-ventricular levels. The cohort was separated into patients without the presence of LGE (LGE-) and patients with current or previous LGE (LGE+). A total of 207 CMR studies were analyzed. The LGE- group comprised 88 patients while 119 patients were in the LGE+ group. The LGE+ group was older, had larger indexed LV end-diastolic volume and lower LV ejection fraction (LVEF) compared to the LGE- group. T1 values in the LGE+ group were lower compared to the LGE- group (mid T1 1012 ms vs. 1035 ms; p = 0.002), with 5 CMR studies demonstrating mid T1 values < 900 ms. There was no correlation between mid T1 and LVEF in the LGE- group. In the LGE+ cohort, lower T1 values correlated with worse LVEF (r = 0.34, p = 0.0002). The association between mid T1 values and LVEF remained statistically significant on multivariable analysis when accounting for number of LGE segments, LVEDVi, and age (p = 0.009). This is the largest study assessing native T1 values in patients with DMD. The results demonstrate that patients with LGE had lower T1 values than patients without LGE. In the LGE+ group, lower T1 values correlated with worse LV systolic function. These results are consistent with the evolving recognition of fibrofatty replacement in advanced stages of DMD myopathy. Furthermore, our study supports that there is not a simple linear relationship between increasing T1 values and advancing disease progression reported in most other cardiomyopathies.
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Affiliation(s)
- Sean M Lang
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
| | - Tarek Alsaied
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA.,Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Thomas D Ryan
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Michael D Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
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Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2020; 36:769-787. [PMID: 32281010 DOI: 10.1007/s10554-020-01845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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