1
|
Fadl SA, Revels JW, Rezai Gharai L, Hanneman K, Dana F, Proffitt EK, Grizzard JD. Cardiac MRI of Hereditary Cardiomyopathy. Radiographics 2022; 42:625-643. [PMID: 35275782 DOI: 10.1148/rg.210147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hereditary cardiomyopathy comprises a heterogeneous group of diseases of the cardiac muscle that are characterized by the presence of genetic mutations. Cardiac MRI is central to evaluation of patients with cardiomyopathy owing to its ability to allow evaluation of many different tissue properties in a single examination. For example, cine MRI is the standard of care for assessment of myocardial structure and function. It clearly shows regions of asymmetric wall thickening that are typical of hypertrophic cardiomyopathy and allows it to be differentiated from other hereditary disorders such as Fabry disease or transthyretin cardiac amyloidosis that produce concentric hypertrophy. Late gadolinium enhancement provides a different tissue property and allows these latter two causes of concentric hypertrophy to be distinguished on the basis of their enhancement appearances (Fabry disease shows midwall basal inferolateral enhancement, and amyloidosis shows global subendocardial enhancement). Native T1 mapping may similarly allow differentiation between Fabry disease and amyloidosis without the use of contrast material. T2*-weighted MRI is important in the detection and quantification of iron overload cardiomyopathy. Other hereditary entities for which comprehensive MRI has proven essential include Danon disease, familial dilated cardiomyopathy, hereditary muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy, and ventricular noncompaction. As a result of the diagnostic power of cardiac MRI, cardiac MRI examinations are being requested with increasing frequency, not only in academic centers but also in community practices. The genetic background, pathophysiologic characteristics, and clinical presentation of patients with hereditary cardiomyopathy are described; the characteristic cardiac MRI features of hereditary cardiomyopathy are discussed; and the role of MRI in risk stratification, treatment, and prognostication in patients with cardiomyopathy is reviewed. ©RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Shaimaa A Fadl
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Jonathan W Revels
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Leila Rezai Gharai
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Kate Hanneman
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Franklin Dana
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - Elizabeth Kate Proffitt
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| | - John D Grizzard
- From the Department of Radiology, Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA 23219 (S.A.F., L.R.G., F.D., E.K.P., J.D.G.); Department of Radiology, University of New Mexico, Albuquerque, NM (J.W.R.); and Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont, Canada (K.H.)
| |
Collapse
|
2
|
Gerull B, Brodehl A. Insights Into Genetics and Pathophysiology of Arrhythmogenic Cardiomyopathy. Curr Heart Fail Rep 2021; 18:378-390. [PMID: 34478111 PMCID: PMC8616880 DOI: 10.1007/s11897-021-00532-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
Purpose of Review Arrhythmogenic cardiomyopathy (ACM) is a genetic disease characterized by life-threatening ventricular arrhythmias and sudden cardiac death (SCD) in apparently healthy young adults. Mutations in genes encoding for cellular junctions can be found in about half of the patients. However, disease onset and severity, risk of arrhythmias, and outcome are highly variable and drug-targeted treatment is currently unavailable. Recent Findings This review focuses on advances in clinical risk stratification, genetic etiology, and pathophysiological concepts. The desmosome is the central part of the disease, but other intercalated disc and associated structural proteins not only broaden the genetic spectrum but also provide novel molecular and cellular insights into the pathogenesis of ACM. Signaling pathways and the role of inflammation will be discussed and targets for novel therapeutic approaches outlined. Summary Genetic discoveries and experimental-driven preclinical research contributed significantly to the understanding of ACM towards mutation- and pathway-specific personalized medicine.
Collapse
Affiliation(s)
- Brenda Gerull
- Comprehensive Heart Failure Center (CHFC), Department of Medicine I, University Clinic Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
| | - Andreas Brodehl
- Heart and Diabetes Center NRW, Erich and Hanna Klessmann Institute, University Hospital of the Ruhr-University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| |
Collapse
|
3
|
Emrich T, Bordonaro V, Schoepf UJ, Petrescu A, Young G, Halfmann M, Schoeler T, Decker J, Abidoye I, Emrich AL, Kreitner KF, Schmidt KH, Varga-Szemes A, Secinaro A. Right/Left Ventricular Blood Pool T2 Ratio as an Innovative Cardiac MRI Screening Tool for the Identification of Left-to-Right Shunts in Patients With Right Ventricular Disease. J Magn Reson Imaging 2021; 55:1452-1458. [PMID: 34374157 DOI: 10.1002/jmri.27881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Left-to-right (L-R) shunts are characterized by a pathological connection between high- and low-pressure systems, leading to a mixing of oxygen-rich blood with low oxygenated blood. They are typically diagnosed by phase-contrast cardiac magnetic resonance imaging (MRI) which requires extensive planning. T2 is sensitive to blood oxygenation and may be able to detect oxygenation differences between the left (LV) and right ventricles (RV) caused by L-R shunts. PURPOSE To test the feasibility of routine T2 mapping to detect L-R shunts. STUDY TYPE Retrospective. POPULATION Patients with known L-R shunts (N = 27), patients with RV disease without L-R shunts (N = 21), and healthy volunteers (HV; N = 52). FIELD STRENGTH/SEQUENCE 1.5 and 3 T/balanced steady-state free-precession (bSSFP) sequence (cine imaging), T2-prepared bSSFP sequence (T2 mapping), and velocity sensitized gradient echo sequence (phase-contrast MRI). ASSESSMENT Aortic (Qs) and pulmonary (Qp) flow was measured by phase-contrast imaging, and the Qp/Qs ratio was calculated as a measure of shunt severity. T2 maps were used to measure T2 in the RV and LV and the RV/LV T2 ratio was calculated. Cine imaging was used to calculate RV end-diastolic volume index (RV-EDVi). STATISTICAL TESTS Wilcoxon test, paired t-tests, Spearmen correlation coefficient, receiver operating curve (ROC) analysis. Significance level P < 0.05. RESULTS The Qp/Qs and T2 ratios in L-R shunt patients (1.84 ± 0.84 and 0.89 ± 0.07) were significantly higher compared to those in patients with RV disease (1.01 ± 0.03 and 0.72 ± 0.10) and in HV (1.04 ± 0.04 and 0.71 ± 0.09). A T2 ratio of >0.78 showed a sensitivity, specificity, and negative predictive value of 100%, 73.9%, and 100%, respectively, for the detection of L-R shunts. The T2 ratio was strongly correlated with the severity of the shunt (r = 0.83). DATA CONCLUSION RV/LV T2 ratio is an imaging biomarker that may be able to detect or rule-out L-R shunts. Such a diagnostic tool may prevent unnecessary phase-contrast acquisitions in cases with RV dilatation of unknown etiology. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.,Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Veronica Bordonaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Aniela Petrescu
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Gabrielle Young
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Moritz Halfmann
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Theresia Schoeler
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Josua Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.,Department of Diagnostic and Interventional Radiology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Ibukun Abidoye
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Radiology, Afe Babalola University Multisystem Hospital, Ado-Ekiti, Nigeria
| | - Anna Lena Emrich
- Department of Cardiothoracic and Vascular Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Karl-Friedrich Kreitner
- Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kai Helge Schmidt
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|