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Rubiś P, Banyś P, Krupiński M, Mielnik M, Wiśniowska-Śmiałek S, Dziewięcka E, Urbańczyk-Zawadzka M. Temporal progression of replacement and interstitial fibrosis in optimally managed dilated cardiomyopathy patients: A prospective study. Int J Cardiol 2024; 407:131988. [PMID: 38547964 DOI: 10.1016/j.ijcard.2024.131988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/25/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND To prospectively examine the dynamic evolution of fibrotic processes within a one-year in patients with dilated cardiomyopathy (DCM). METHODS Between May 2019 and September 2020, 102 DCM patients (mean age 45.2 ± 11.8 years, EF 29.9 ± 11.6%) underwent cardiac magnetic resonance (CMR-1). After 13.9 ± 2.9 months, 92 of these patients underwent a follow-up CMR (CMR-2). Replacement fibrosis was assessed via late gadolinium enhancement (LGE), quantified in terms of LGE mass and extent. Interstitial fibrosis was evaluated via T1-mapping and expressed as extracellular volume fraction (ECV). This data, along with left ventricular (LV) mass, facilitated the calculation of LV matrix and cellular volumes. RESULTS At CMR-1, LGE was present in 45 patients (48.9%), whereas at CMR-2 LGE was detected in 46 (50%) (p = 0.88). Although LGE mass remained stable, LGE extent increased from 2.18 ± 4.1% to 2.7 ± 4.6% (p < 0.01). Conversely, ECV remained unchanged [27.7% (25.5-31.3) vs. 26.7% (24.5-29.9); p = 0.19]; however, LV matrix and cell volumes exhibited a noteworthy regression. During a subsequent follow-up of 19.2 ± 9 months (spanning from CMR-2 to April 30th, 2023), the composite primary outcome (all-cause mortality, HTX, LVAD or heart failure worsening) was evident in 18 patients. Only the LV matrix volume index at follow-up was an independent predictor of outcome (OR 1.094; 95%CI 1.004-1.192; p < 0.05). CONCLUSIONS In optimally managed DCM patients, both replacement and interstitial fibrosis remained stable over the course of one year. In contrast, LV matrix and cell volumes displayed significant regression. LV matrix volume index at 12-month follow-up was found to be an independent predictor of outcome in DCM.
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Affiliation(s)
- Pawel Rubiś
- Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Institute of Cardiology, Krakow Specialist Hospital named after St. John Paul II, Poland.
| | - Paweł Banyś
- Department of Radiology, Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland
| | - Maciej Krupiński
- Department of Radiology, Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland
| | - Małgorzata Mielnik
- Department of Radiology, Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland
| | - Sylwia Wiśniowska-Śmiałek
- Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Institute of Cardiology, Krakow Specialist Hospital named after St. John Paul II, Poland
| | - Ewa Dziewięcka
- Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Institute of Cardiology, Krakow Specialist Hospital named after St. John Paul II, Poland
| | - Małgorzata Urbańczyk-Zawadzka
- Department of Radiology, Krakow Specialist Hospital named after St. John Paul II, Pradnicka street 80, 31-202 Krakow, Poland
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Li N, Xue Y, Zhu C, Chen N, Qi M, Fang M, Huang S. The zinc-finger transcription factor KLF6 regulates cardiac fibrosis. Life Sci 2024:122805. [PMID: 38851422 DOI: 10.1016/j.lfs.2024.122805] [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: 03/23/2024] [Revised: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
AIMS Heart failure (HF) is one of the most devastating consequences of cardiovascular diseases. Regardless of etiology, cardiac fibrosis is present and promotes the loss of heart function in HF patients. Cardiac resident fibroblasts, in response to a host of pro-fibrogenic stimuli, trans-differentiate into myofibroblasts to mediate cardiac fibrosis, the underlying mechanism of which remains incompletely understood. METHODS Fibroblast-myofibroblast transition was induced in vitro by exposure to transforming growth factor (TGF-β). Cardiac fibrosis was induced in mice by either transverse aortic constriction (TAC) or by chronic infusion with angiotensin II (Ang II). RESULTS Through bioinformatic screening, we identified Kruppel-like factor 6 (KLF6) as a transcription factor preferentially up-regulated in cardiac fibroblasts from individuals with non-ischemic cardiomyopathy (NICM) compared to the healthy donors. Further analysis showed that nuclear factor kappa B (NF-κB) bound to the KLF6 promoter and mediated KLF6 trans-activation by pro-fibrogenic stimuli. KLF6 knockdown attenuated whereas KLF6 over-expression enhanced TGF-β induced fibroblast-myofibroblast transition in vitro. More importantly, myofibroblast-specific KLF6 depletion ameliorated cardiac fibrosis and rescued heart function in mice subjected to the TAC procedure or chronic Ang II infusion. SIGNIFICANCE In conclusion, our data support a role for KLF6 in cardiac fibrosis.
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Affiliation(s)
- Nan Li
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Human Anatomy, Nanjing Medical University, Nanjing, China
| | - Yujia Xue
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Human Anatomy, Nanjing Medical University, Nanjing, China
| | - Chenghao Zhu
- State Key Laboratory of Natural Medicines, Department of Pharmacology, China Pharmaceutical University, Nanjing, China
| | - Naxia Chen
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research, Department of Cardiology, the First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Mengwen Qi
- Center for Experimental Medicine, Jiangsu Health Vocational College, Nanjing, China
| | - Mingming Fang
- Center for Experimental Medicine, Jiangsu Health Vocational College, Nanjing, China.
| | - Shang Huang
- Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Key Laboratory of Emergency and Trauma of Ministry of Education, Institute of Cardiovascular Research, Department of Cardiology, the First Affiliated Hospital, Hainan Medical University, Haikou, China.
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3
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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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Angeli E, Jordan M, Otto M, Stojanović SD, Karsdal M, Bauersachs J, Thum T, Fiedler J, Genovese F. The role of fibrosis in cardiomyopathies: An opportunity to develop novel biomarkers of disease activity. Matrix Biol 2024; 128:65-78. [PMID: 38423395 DOI: 10.1016/j.matbio.2024.02.008] [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: 10/16/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
Cardiomyopathies encompass a spectrum of heart disorders with diverse causes and presentations. Fibrosis stands out as a shared hallmark among various cardiomyopathies, reflecting a common thread in their pathogenesis. This prevalent fibrotic response is intricately linked to the consequences of dysregulated extracellular matrix (ECM) remodeling, emphasizing its significance in the development and progression the disease. This review explores the ECM involvement in various cardiomyopathies and its impact on myocardial stiffness and fibrosis. Additionally, we discuss the potential of ECM fragments as early diagnosis, prognosis, and risk stratification. Biomarkers deriving from turnover of collagens and other ECM proteins hold promise in clinical applications. We outline current clinical management, future directions, and the potential for personalized ECM-targeted therapies with specific focus on microRNAs. In summary, this review examines the role of the fibrosis in cardiomyopathies, highlighting the potential of ECM-derived biomarkers in improving disease management with implications for precision medicine.
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Affiliation(s)
- Elisavet Angeli
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Nordic Bioscience A/S, Herlev, Denmark.
| | - Maria Jordan
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hanover, Federal Republic of Germany; Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), Hanover, Federal Republic of Germany
| | - Mandy Otto
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hanover, Federal Republic of Germany; Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), Hanover, Federal Republic of Germany
| | - Stevan D Stojanović
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Federal Republic of Germany; Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Federal Republic of Germany
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Federal Republic of Germany
| | - Thomas Thum
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hanover, Federal Republic of Germany; Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), Hanover, Federal Republic of Germany; Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Federal Republic of Germany
| | - Jan Fiedler
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hanover, Federal Republic of Germany; Fraunhofer Cluster of Excellence for Immune Mediated Diseases (CIMD), Hanover, Federal Republic of Germany
| | - Federica Genovese
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Amemiya K, Matsuyama TA, Ishibashi-Ueda H, Morita Y, Matsumoto M, Ohta-Ogo K, Ikeda Y, Tsukamoto Y, Fukushima N, Fukushima S, Fujita T, Hatakeyama K. Can right ventricular endomyocardial biopsy predict left ventricular fibrosis beforehand in dilated cardiomyopathy? ESC Heart Fail 2024; 11:1001-1008. [PMID: 38234242 DOI: 10.1002/ehf2.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/18/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
AIMS Myocardial fibrosis of the left ventricle (LV) is a prognostic factor in dilated cardiomyopathy (DCM). This study aims to evaluate whether fibrosis of right ventricular (RV) endomyocardial biopsy (EMB) can predict the degree of LV fibrosis beforehand in DCM. METHODS AND RESULTS Fibrosis extent in 70 RV-EMB specimens of DCM diagnosis was compared with that in the whole cross-sectional LV of excised hearts in the same patients (52 explanted hearts for transplant and 18 autopsied hearts). The median interval between biopsy and excision was 4.1 (0.13-19.3) years. The fibrosis area ratio of the EMBs and excised hearts were evaluated via image analysis. The distribution of cardiovascular magnetic resonance-late gadolinium enhancement (LGE) in the intraventricular septum was classified into four quartile categories. The fibrosis area ratio in RV-EMB correlated significantly with that in the short-axis cut of the LV of excised hearts (r = 0.82, P < 0.0001) and with a diffuse pattern of LGE (r = 0.71, P = 0.003). In a multivariate model, after adjusting for the interval between biopsy performance and heart excision, the fibrosis area ratio in RV-EMB was associated with that in LV-excised heart (regression coefficient, 0.82; 95% confidence interval, 0.68-0.95; P < 0.0001). CONCLUSIONS The fibrosis observed in RV-EMB positively correlated with the extent of fibrosis in the LV of excised hearts in patients with DCM. The study findings may help predict LV fibrosis, considered a prognostic factor of DCM through relatively accessible biopsy techniques.
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Affiliation(s)
- Kisaki Amemiya
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Legal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Taka-Aki Matsuyama
- Department of Legal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
- Division of Pathology, Hokusetsu General Hospital, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Manabu Matsumoto
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasumasa Tsukamoto
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Senri Kinran University, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Pimpalwar N, Celik S, Karbalaei Sadegh M, Czuba T, Gidlöf O, Smith JG. Analysis of genetic variant associated with heart failure mortality implicates thymic stromal lymphopoietin as mediator of strain-induced myocardial fibroblast-mast cell crosstalk and fibrosis. FASEB J 2024; 38:e23510. [PMID: 38407489 DOI: 10.1096/fj.202302000rr] [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: 09/30/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
Heart failure (HF) is a leading cause of death and disability globally. Heritable factors and the extent and pattern of myocardial fibrosis are important determinants of outcomes in patients with HF. In a genome-wide association study of mortality in HF, we recently identified a genetic polymorphism on chromosome 5q22 associated with HF mortality. Here, we sought to study the mechanisms by which this variant may influence myocardial disease processes. We find that the risk allele is located in an enhancer motif upstream of the TSLP gene (encoding thymic stromal lymphopoietin), conferring increased binding of the transcription factor nescient helix-loop helix 1 (NHLH1) and increased TSLP expression in human heart. Further, we find that increased strain of primary human myocardial fibroblasts results in increased TSLP expression and that the TSLP receptor is expressed in myocardial mast cells in human single nuclei RNA sequence data. Finally, we show that TSLP overexpression induces increased transforming growth factor β expression in myocardial mast cells and tissue fibrosis. Collectively, our findings based on follow-up of a human genetic finding implicate a novel pathway in myocardial tissue homeostasis and remodeling.
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Affiliation(s)
- Neha Pimpalwar
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Selvi Celik
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Mardjaneh Karbalaei Sadegh
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Tomasz Czuba
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Gidlöf
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
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7
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Xu Y, Li Y, Wang S, Wan K, Tan Y, Li W, Wang J, Guo J, Ghaithan S, Cheng W, Sun J, Zhang Q, Han Y, Chen Y. Prognostic value of mid-term cardiovascular magnetic resonance follow-up in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study. J Cardiovasc Magn Reson 2024; 26:101002. [PMID: 38237899 PMCID: PMC10926272 DOI: 10.1016/j.jocmr.2024.101002] [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: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The prognostic value of follow-up cardiovascular magnetic resonance (CMR) in dilated cardiomyopathy (DCM) patients is unclear. We aimed to investigate the prognostic value of cardiac function, structure, and tissue characteristics at mid-term CMR follow-up. METHODS The study population was a prospectively enrolled cohort of DCM patients who underwent guideline-directed medical therapy with baseline and follow-up CMR, which included measurement of biventricular volume and ejection fraction, late gadolinium enhancement, native T1, native T2, and extracellular volume. During follow-up, major adverse cardiac events (MACE) were defined as a composite endpoint of cardiovascular death, heart transplantation, and heart-failure readmission. RESULTS Among 235 DCM patients (median CMR interval: 15.3 months; interquartile range: 12.5-19.2 months), 54 (23.0%) experienced MACE during follow-up (median: 31.2 months; interquartile range: 20.8-50.0 months). In multivariable Cox regression, follow-up CMR models showed significantly superior predictive value than baseline CMR models. Stepwise multivariate Cox regression showed that follow-up left ventricular ejection fraction (LVEF; hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.91-0.96; p < 0.001) and native T1 (HR, 1.01; 95% CI, 1.00-1.01; p = 0.030) were independent predictors of MACE. Follow-up LVEF ≥ 40% or stable LVEF < 40% with T1 ≤ 1273 ms indicated low risk (annual event rate < 4%), while stable LVEF < 40% and T1 > 1273 ms or LVEF < 40% with deterioration indicated high risk (annual event rate > 15%). CONCLUSIONS Follow-up CMR provided better risk stratification than baseline CMR. Improvements in the LVEF and T1 mapping are associated with a lower risk of MACE.
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Affiliation(s)
- Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yangjie Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shiqian Wang
- West China Clinical Medical College of Sichuan University, Chengdu, Sichuan Province, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yinxi Tan
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiajun Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Saeed Ghaithan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuchi Han
- Cardiac Imaging Cardiovascular Medicine, Wexner Medical Center, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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8
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Javed W, Malhotra A, Swoboda P. Cardiac magnetic resonance assessment of athletic myocardial fibrosis; Benign bystander or malignant marker? Int J Cardiol 2024; 394:131382. [PMID: 37741350 DOI: 10.1016/j.ijcard.2023.131382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
The benefits of exercise are irrefutable with a well-established dose-dependent relationship between exercise intensity and reduction in cardiovascular disease. Differentiating the physiological adaptation to exercise, termed the "athlete's heart" from cardiomyopathies, has been advanced by the advent of more sophisticated imaging modalities such as cardiac magnetic resonance imaging (CMR). Myocardial fibrosis on CMR is a mutual finding amongst seemingly healthy endurance athletes and individuals with cardiomyopathy. As a substrate for arrhythmias, fibrosis is traditionally associated with increased cardiovascular risk. In this article, we discuss the aetiologies, distribution and potential implications of myocardial fibrosis in athletes.
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Affiliation(s)
- Wasim Javed
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Peter Swoboda
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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9
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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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10
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Hammersley DJ, Jones RE, Owen R, Mach L, Lota AS, Khalique Z, De Marvao A, Androulakis E, Hatipoglu S, Gulati A, Reddy RK, Yoon WY, Talukder S, Shah R, Baruah R, Guha K, Pantazis A, Baksi AJ, Gregson J, Cleland JG, Tayal U, Pennell DJ, Ware JS, Halliday BP, Prasad SK. Phenotype, outcomes and natural history of early-stage non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:2050-2059. [PMID: 37728026 PMCID: PMC10946699 DOI: 10.1002/ejhf.3037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS To characterize the phenotype, clinical outcomes and rate of disease progression in patients with early-stage non-ischaemic cardiomyopathy (early-NICM). METHODS AND RESULTS We conducted a prospective observational cohort study of patients with early-NICM assessed by late gadolinium enhancement cardiovascular magnetic resonance (CMR). Cases were classified into the following subgroups: isolated left ventricular dilatation (early-NICM H-/D+), non-dilated left ventricular cardiomyopathy (early-NICM H+/D-), or early dilated cardiomyopathy (early-NICM H+/D+). Clinical follow-up for major adverse cardiovascular events (MACE) included non-fatal life-threatening arrhythmia, unplanned cardiovascular hospitalization or cardiovascular death. A subset of patients (n = 119) underwent a second CMR to assess changes in cardiac structure and function. Of 254 patients with early-NICM (median age 46 years [interquartile range 36-58], 94 [37%] women, median left ventricular ejection fraction [LVEF] 55% [52-59]), myocardial fibrosis was present in 65 (26%). There was no difference in the prevalence of fibrosis between subgroups (p = 0.90), however fibrosis mass was lowest in early-NICM H-/D+, higher in early-NICM H+/D- and highest in early-NICM H+/D+ (p = 0.03). Over a median follow-up of 7.9 (5.5-10.0) years, 28 patients (11%) experienced MACE. Non-sustained ventricular tachycardia (hazard ratio [HR] 5.1, 95% confidence interval [CI] 2.36-11.00, p < 0.001), myocardial fibrosis (HR 3.77, 95% CI 1.73-8.20, p < 0.001) and diabetes mellitus (HR 5.12, 95% CI 1.73-15.18, p = 0.003) were associated with MACE in a multivariable model. Only 8% of patients progressed from early-NICM to dilated cardiomyopathy with LVEF <50% over a median of 16 (11-34) months. CONCLUSION Early-NICM is not benign. Fibrosis develops early in the phenotypic course. In-depth characterization enhances risk stratification and might aid clinical management.
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Affiliation(s)
- Daniel J. Hammersley
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Richard E. Jones
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Anglia Ruskin Medical School, UKCambridgeUK
- Essex Cardiothoracic CentreBasildonUK
| | - Ruth Owen
- London School of Hygiene and Tropical MedicineLondonUK
| | - Lukas Mach
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Amrit S. Lota
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Zohya Khalique
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Antonio De Marvao
- Department of Women and Children's HealthKing's College LondonLondonUK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Emmanuel Androulakis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suzan Hatipoglu
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Rohin K. Reddy
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Won Young Yoon
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Suprateeka Talukder
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Riya Shah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Resham Baruah
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Antonis Pantazis
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - A. John Baksi
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - John Gregson
- London School of Hygiene and Tropical MedicineLondonUK
| | - John G.F. Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| | - Upasana Tayal
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Dudley J. Pennell
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - James S. Ware
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- MRC London Institute of Medical SciencesImperial College LondonLondonUK
| | - Brian P. Halliday
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sanjay K. Prasad
- National Heart and Lung InstituteImperial College LondonLondonUK
- Royal Brompton & Harefield HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
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11
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Dandel M. Cardiological Challenges Related to Long-Term Mechanical Circulatory Support for Advanced Heart Failure in Patients with Chronic Non-Ischemic Cardiomyopathy. J Clin Med 2023; 12:6451. [PMID: 37892589 PMCID: PMC10607800 DOI: 10.3390/jcm12206451] [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: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Long-term mechanical circulatory support by a left ventricular assist device (LVAD), with or without an additional temporary or long-term right ventricular (RV) support, is a life-saving therapy for advanced heart failure (HF) refractory to pharmacological treatment, as well as for both device and surgical optimization therapies. In patients with chronic non-ischemic cardiomyopathy (NICM), timely prediction of HF's transition into its end stage, necessitating life-saving heart transplantation or long-term VAD support (as a bridge-to-transplantation or destination therapy), remains particularly challenging, given the wide range of possible etiologies, pathophysiological features, and clinical presentations of NICM. Decision-making between the necessity of an LVAD or a biventricular assist device (BVAD) is crucial because both unnecessary use of a BVAD and irreversible right ventricular (RV) failure after LVAD implantation can seriously impair patient outcomes. The pre-operative or, at the latest, intraoperative prediction of RV function after LVAD implantation is reliably possible, but necessitates integrative evaluations of many different echocardiographic, hemodynamic, clinical, and laboratory parameters. VADs create favorable conditions for the reversal of structural and functional cardiac alterations not only in acute forms of HF, but also in chronic HF. Although full cardiac recovery is rather unusual in VAD recipients with pre-implant chronic HF, the search for myocardial reverse remodelling and functional improvement is worthwhile because, for sufficiently recovered patients, weaning from VADs has proved to be feasible and capable of providing survival benefits and better quality of life even if recovery remains incomplete. This review article aimed to provide an updated theoretical and practical background for those engaged in this highly demanding and still current topic due to the continuous technical progress in the optimization of long-term VADs, as well as due to the new challenges which have emerged in conjunction with the proof of a possible myocardial recovery during long-term ventricular support up to levels which allow successful device explantation.
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Affiliation(s)
- Michael Dandel
- German Centre for Heart and Circulatory Research (DZHK), 10785 Berlin, Germany
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12
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Theerasuwipakorn N, Chokesuwattanaskul R, Phannajit J, Marsukjai A, Thapanasuta M, Klem I, Chattranukulchai P. Impact of late gadolinium-enhanced cardiac MRI on arrhythmic and mortality outcomes in nonischemic dilated cardiomyopathy: updated systematic review and meta-analysis. Sci Rep 2023; 13:13775. [PMID: 37612359 PMCID: PMC10447440 DOI: 10.1038/s41598-023-41087-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/22/2023] [Indexed: 08/25/2023] Open
Abstract
Risk stratification based mainly on the impairment of left ventricular ejection fraction has limited performance in patients with nonischemic dilated cardiomyopathy (NIDCM). Evidence is rapidly growing for the impact of myocardial scar identified by late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) on cardiovascular events. We aim to assess the prognostic value of LGE on long-term arrhythmic and mortality outcomes in patients with NIDCM. PubMed, Scopus, and Cochrane databases were searched from inception to January 21, 2022. Studies that included disease-specific subpopulations of NIDCM were excluded. Data were independently extracted and combined via random-effects meta-analysis using a generic inverse-variance strategy. Data from 60 studies comprising 15,217 patients were analyzed with a 3-year median follow-up. The presence of LGE was associated with major ventricular arrhythmic events (pooled OR: 3.99; 95% CI 3.08, 5.16), all-cause mortality (pooled OR: 2.14; 95% CI 1.81, 2.52), cardiovascular mortality (pooled OR 2.83; 95% CI 2.23, 3.60), and heart failure hospitalization (pooled OR: 2.53; 95% CI 1.78, 3.59). Real-world evidence suggests that the presence of LGE on CMR was a strong predictor of adverse long-term outcomes in patients with NIDCM. Scar assessment should be incorporated as a primary determinant in the patient selection criteria for primary prophylactic implantable cardioverter-defibrillator placement.
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Affiliation(s)
- Nonthikorn Theerasuwipakorn
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Jeerath Phannajit
- Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Apichai Marsukjai
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Mananchaya Thapanasuta
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Pairoj Chattranukulchai
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
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13
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Wang TKM, Kocyigit D, Choi H, Anthony CM, Chan N, Bullen J, Popović ZB, Kapadia SR, Krishnaswamy A, Griffin BP, Flamm SD, Tang WHW, Kwon DH. Prognostic Power of Quantitative Assessment of Functional Mitral Regurgitation and Myocardial Scar Quantification by Cardiac Magnetic Resonance. Circ Cardiovasc Imaging 2023; 16:e015134. [PMID: 37503633 DOI: 10.1161/circimaging.122.015134] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The severity classification of functional mitral regurgitation (FMR) remains controversial despite adverse prognosis and rapidly evolving interventions. Furthermore, it is unclear if quantitative assessment with cardiac magnetic resonance can provide incremental risk stratification for patients with ischemic cardiomyopathy (ICM) or non-ICM (NICM) in terms of FMR and late gadolinium enhancement (LGE). We evaluated the impact of quantitative cardiac magnetic resonance parameters on event-free survival separately for ICM and NICM, to assess prognostic FMR thresholds and interactions with LGE quantification. METHODS Patients (n=1414) undergoing cardiac magnetic resonance for cardiomyopathy (ejection fraction<50%) assessment from April 1, 2001 to December 31, 2017 were evaluated. The primary end point was all-cause death, heart transplant, or left ventricular assist device implantation during follow-up. Multivariable Cox analyses were conducted to determine the impact of FMR, LGE, and their interactions with event-free survival. RESULTS There were 510 primary end points, 395/782 (50.5%) in ICM and 114/632 (18.0%) in NICM. Mitral regurgitation-fraction per 5% increase was independently associated with the primary end point, hazards ratios (95% CIs) of 1.04 (1.01-1.07; P=0.034) in ICM and 1.09 (1.02-1.16; P=0.011) in NICM. Optimal mitral regurgitation-fraction threshold for moderate and severe FMR were ≥20% and ≥35%, respectively, in both ICM and NICM, based on the prediction of the primary outcome. Similarly, optimal LGE thresholds were ≥5% in ICM and ≥2% in NICM. Mitral regurgitation-fraction×LGE emerged as a significant interaction for the primary end point in ICM (P=0.006), but not in NICM (P=0.971). CONCLUSIONS Mitral regurgitation-fraction and LGE are key quantitative cardiac magnetic resonance biomarkers with differential associations with adverse outcomes in ICM and NICM. Optimal prognostic thresholds may provide important clinical risk prognostication and may further facilitate the ability to derive selection criteria to guide therapeutic decision-making.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
- Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Harry Choi
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Chris M Anthony
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Jennifer Bullen
- Department of Quantitative Health Sciences (J.B.), Cleveland Clinic, Cleveland, OH
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
- Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Samir R Kapadia
- Section of Invasive and Interventional Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (S.R.K., A.K.), Cleveland Clinic, Cleveland, OH
| | - Amar Krishnaswamy
- Section of Invasive and Interventional Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (S.R.K., A.K.), Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - Scott D Flamm
- Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH
| | - W H Wilson Tang
- Section of Heart Failure and Transplantation Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH
| | - Deborah H Kwon
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH
- Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH
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14
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Ijichi T, Sundararaman N, Martin TG, Pandey R, Koronyo E, Kirk JA, Marbán E, Van Eyk JE, Fert-Bober J. Peptidyl arginine deiminase inhibition alleviates angiotensin II-induced fibrosis. Am J Transl Res 2023; 15:4558-4572. [PMID: 37560217 PMCID: PMC10408542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES The conversion of protein arginine residues to citrulline by calcium-dependent peptidyl arginine deiminases (PADs) has been implicated in the pathogenesis of several diseases, indicating that PADs are therapeutic targets. A recent study indicated that PAD4 regulates age-related organ fibrosis and dysfunction; however, the specific role of this PAD and its citrullination substrate remains unclear. We investigated whether pharmacological inhibition of PAD activity could affect the progression of fibrosis and restore heart function. METHODS Cardiac hypertrophy was induced by chronic infusion of angiotensin (Ang) II. After 2 weeks of AngII infusion, a PAD inhibitor (Cl-amidine hydrochloride) or vehicle (saline) was injected every other day for the next 14 days together with the continued administration of AngII for a total of up to 28 days. Cardiac fibrosis and remodeling were evaluated by quantitative heart tissue histology, echocardiography, and mass spectrometry. RESULTS A reverse AngII-induced effect was observed in PAD inhibitor-treated mice (n=6) compared with AngII vehicle-treated mice, as indicated by a significant reduction in the heart/body ratio (AngII: 6.51±0.8 mg/g vs. Cl-amidine: 5.27±0.6 mg/g), a reduction in fibrosis (AngII: 2.1-fold increased vs. Cl-amidine: 1.8-fold increased), and a reduction in left ventricular posterior wall diastole (LWVPd) (AngII: 1.1±0.04 vs. Cl-amidine: 0.78±0.02 mm). Label-free quantitative proteomics analysis of heart tissue indicated that proteins involved in fibrosis (e.g., periostin), cytoskeleton organization (e.g., transgelin), and remodeling (e.g., myosin light chain, carbonic anhydrase) were normalized by Cl-amidine treatment. CONCLUSION Our findings demonstrate that pharmacological inhibition of PAD may be an effective strategy to attenuate cardiac fibrosis.
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Affiliation(s)
- Takeshi Ijichi
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
- Department of Cardiology, School of Medicine, Tokai UniversityIsehara, Kanagawa 259-1193, Japan
| | - Niveda Sundararaman
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
- Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
| | - Thomas G Martin
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of MedicineMaywood, IL 60153, The United States
| | - Rakhi Pandey
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
- Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
| | - Etai Koronyo
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
- Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
| | - Jonathan A Kirk
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of MedicineMaywood, IL 60153, The United States
| | - Eduardo Marbán
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
| | - Jennifer E Van Eyk
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
- Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
| | - Justyna Fert-Bober
- Smidt Heart Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
- Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical CenterLos Angeles, CA 90048, The United States
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15
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Hawson J, Joshi S, Al-Kaisey A, Das SK, Anderson RD, Morton J, Kumar S, Kistler P, Kalman J, Lee G. Utility of cardiac imaging in patients with ventricular tachycardia. Indian Pacing Electrophysiol J 2023; 23:63-76. [PMID: 36958589 PMCID: PMC10160788 DOI: 10.1016/j.ipej.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
Ventricular tachycardia (VT) is a life-threatening arrhythmia that may be idiopathic or result from structural heart disease. Cardiac imaging is critical in the diagnostic workup and risk stratification of patients with VT. Data gained from cardiac imaging provides information on likely mechanisms and sites of origin, as well as risk of intervention. Pre-procedural imaging can be used to plan access route(s) and identify patients where post-procedural intensive care may be required. Integration of cardiac imaging into electroanatomical mapping systems during catheter ablation procedures can facilitate the optimal approach, reduce radiation dose, and may improve clinical outcomes. Intraprocedural imaging helps guide catheter position, target substrate, and identify complications early. This review summarises the contemporary imaging modalities used in patients with VT, and their uses both pre-procedurally and intra-procedurally.
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Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Subodh Joshi
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Souvik K Das
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia; Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Kistler
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
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16
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Weis A, Krueck S, Dombrowsky G, Schänzer A, Jux C, Uebing A, Voges I, Hitz MP, Rupp S. Genetic Screening Reveals Heterogeneous Clinical Phenotypes in Patients with Dilated Cardiomyopathy and Troponin T2 Variants. J Pers Med 2023; 13:jpm13040611. [PMID: 37108997 PMCID: PMC10145473 DOI: 10.3390/jpm13040611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Cardiomyopathies (CMs) are a heterogeneous and severe group of diseases that shows a highly variable cardiac phenotype and an incidence of app. 1/100.000. Genetic screening of family members is not yet performed routinely. Patients and methods: Three families with dilated cardiomyopathy (DCM) and pathogenic variants in the troponin T2, Cardiac Type (TNNT2) gene were included. Pedigrees and clinical data of the patients were collected. The reported variants in the TNNT2 gene showed a high penetrance and a poor outcome, with 8 of 16 patients dying or receiving heart transplantation. The age of onset varied from the neonatal period to the age of 52. Acute heart failure and severe decompensation developed within a short period in some patients. Conclusion: Family screening of patients with DCM improves risk assessment, especially for individuals who are currently asymptomatic. Screening contributes to improved treatment by enabling practitioners to set appropriate control intervals and quickly begin interventional measures, such as heart failure medication or, in selected cases, pulmonary artery banding.
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17
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Kositanurit W, Theerasuwipakorn N, Vorasettakarnkij Y, Ponkanist K, Lerdkhonsan C, Tumkosit M, Wendell DC, Chattranukulchai P. Reference values of myocardial native T1 and extracellular volume in patients without structural heart disease and had negative 3T cardiac magnetic resonance adenosine stress test. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2023; 45:101181. [PMID: 36793331 PMCID: PMC9923153 DOI: 10.1016/j.ijcha.2023.101181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
Background To establish the reference values of native T1 and extracellular volume (ECV) in patients without structural heart disease and had a negative adenosine stress 3T cardiac magnetic resonance. Methods Short-axis T1 mapping images were acquired using a modified Look-Locker inversion recovery technique before and after administration of 0.15 mmol/kg gadobutrol to calculate both native T1 and ECV. To compare the agreement between measurement strategies, regions of interest (ROI) were drawn in all 16 segments then averaged to represent mean global native T1. Additionally, an ROI was drawn in the mid-ventricular septum on the same image to represent the mid-ventricular septal native T1. Results Fifty-one patients (mean 65 years, 65 % women) were included. Mean global native T1 averaged from all 16 segments and a mid-ventricular septal native T1 were not significantly different (1221.2 ± 35.2 vs 1228.4 ± 43.7 ms, p = 0.21). Men had lower mean global native T1 (1195 ± 29.8 vs 1235.5 ± 29.4 ms, p < 0.001) than women. Both mean global and mid-ventricular septal native T1 were not correlated with age (r = 0.21, p = 0.13 and r = 0.18, p = 0.19, respectively). The calculated ECV was 26.6 ± 2.7 %, which was not influenced by either gender or age. Conclusions We report the first study to validate the native T1 and ECV reference ranges, factors influencing T1, and the validation across measurement methods in older Asian patients without structural heart disease and had a negative adenosine stress test. These references allow for better detection of abnormal myocardial tissue characteristics in clinical practice.
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Affiliation(s)
- Weerapat Kositanurit
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Nonthikorn Theerasuwipakorn
- Division of Cardiovascular Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Yongkasem Vorasettakarnkij
- Division of Hospital and Ambulatory Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Kanokvalee Ponkanist
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Chonthicha Lerdkhonsan
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Monravee Tumkosit
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - David C. Wendell
- Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University Medical Center, Durham, NC 27708, USA
| | - Pairoj Chattranukulchai
- Division of Cardiovascular Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Corresponding author at: Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand.
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18
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Bretherton RC, Reichardt IM, Zabrecky KA, Goldstein AJ, Bailey LR, Bugg D, McMillen TS, Kooiker KB, Flint GV, Martinson A, Gunaje J, Koser F, Plaster E, Linke WA, Regnier M, Moussavi-Harami F, Sniadecki NJ, DeForest CA, Davis J. Correcting dilated cardiomyopathy with fibroblast-targeted p38 deficiency. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.23.523684. [PMID: 36747691 PMCID: PMC9900749 DOI: 10.1101/2023.01.23.523684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Inherited mutations in contractile and structural genes, which decrease cardiomyocyte tension generation, are principal drivers of dilated cardiomyopathy (DCM)- the leading cause of heart failure 1,2 . Progress towards developing precision therapeutics for and defining the underlying determinants of DCM has been cardiomyocyte centric with negligible attention directed towards fibroblasts despite their role in regulating the best predictor of DCM severity, cardiac fibrosis 3,4 . Given that failure to reverse fibrosis is a major limitation of both standard of care and first in class precision therapeutics for DCM, this study examined whether cardiac fibroblast-mediated regulation of the heart's material properties is essential for the DCM phenotype. Here we report in a mouse model of inherited DCM that prior to the onset of fibrosis and dilated myocardial remodeling both the myocardium and extracellular matrix (ECM) stiffen from switches in titin isoform expression, enhanced collagen fiber alignment, and expansion of the cardiac fibroblast population, which we blocked by genetically suppressing p38α in cardiac fibroblasts. This fibroblast-targeted intervention unexpectedly improved the primary cardiomyocyte defect in contractile function and reversed ECM and dilated myocardial remodeling. Together these findings challenge the long-standing paradigm that ECM remodeling is a secondary complication to inherited defects in cardiomyocyte contractile function and instead demonstrate cardiac fibroblasts are essential contributors to the DCM phenotype, thus suggesting DCM-specific therapeutics will require fibroblast-specific strategies.
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19
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Fu X, Mishra R, Chen L, Arfat MY, Sharma S, Kingsbury T, Gunasekaran M, Saha P, Hong C, Yang P, Li D, Kaushal S. Exosomes mediated fibrogenesis in dilated cardiomyopathy through a MicroRNA pathway. iScience 2023; 26:105963. [PMID: 36818289 PMCID: PMC9932122 DOI: 10.1016/j.isci.2023.105963] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/02/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Cardiac fibrosis is a hallmark in late-stage familial dilated cardiomyopathy (DCM) patients, although the underlying mechanism remains elusive. Cardiac exosomes (Exos) have been reported relating to fibrosis in ischemic cardiomyopathy. Thus, we investigated whether Exos secreted from the familial DCM cardiomyocytes could promote fibrogenesis. Using human iPSCs differentiated cardiomyocytes we isolated Exos of angiotensin II stimulation conditioned media from either DCM or control (CTL) cardiomyocytes. Of interest, cultured cardiac fibroblasts had increased fibrogenesis following exposure to DCM-Exos rather than CTL-Exos. Meanwhile, injecting DCM-Exos into mouse hearts enhanced cardiac fibrosis and impaired cardiac function. Mechanistically, we identified the upregulation of miRNA-218-5p in the DCM-Exos as a critical contributor to fibrogenesis. MiRNA-218-5p activated TGF-β signaling via suppression of TNFAIP3, a master inflammation inhibitor. In conclusion, our results illustrate a profibrotic effect of cardiomyocytes-derived Exos that highlights an additional pathogenesis pathway for cardiac fibrosis in DCM.
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Affiliation(s)
- Xuebin Fu
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Rachana Mishra
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Ling Chen
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Mir Yasir Arfat
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Sudhish Sharma
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Tami Kingsbury
- Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Muthukumar Gunasekaran
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Progyaparamita Saha
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Charles Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peixin Yang
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deqiang Li
- Department of Surgery, Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author
| | - Sunjay Kaushal
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA,Corresponding author
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20
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Zou S, Khoo BL. Subtyping based on immune cell fractions reveal heterogeneity of cardiac fibrosis in end-stage heart failure. Front Immunol 2023; 14:1053793. [PMID: 36875078 PMCID: PMC9975711 DOI: 10.3389/fimmu.2023.1053793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Background A central issue hindering the development of effective anti-fibrosis drugs for heart failure is the unclear interrelationship between fibrosis and the immune cells. This study aims at providing precise subtyping of heart failure based on immune cell fractions, elaborating their differences in fibrotic mechanisms, and proposing a biomarker panel for evaluating intrinsic features of patients' physiological statuses through subtype classification, thereby promoting the precision medicine for cardiac fibrosis. Methods We inferred immune cell type abundance of the ventricular samples by a computational method (CIBERSORTx) based on ventricular tissue samples from 103 patients with heart failure, and applied K-means clustering to divide patients into two subtypes based on their immune cell type abundance. We also designed a novel analytic strategy: Large-Scale Functional Score and Association Analysis (LAFSAA), to study fibrotic mechanisms in the two subtypes. Results Two subtypes of immune cell fractions: pro-inflammatory and pro-remodeling subtypes, were identified. LAFSAA identified 11 subtype-specific pro-fibrotic functional gene sets as the basis for personalised targeted treatments. Based on feature selection, a 30-gene biomarker panel (ImmunCard30) established for diagnosing patient subtypes achieved high classification performance, with the area under the receiver operator characteristic curve corresponding to 0.954 and 0.803 for the discovery and validation sets, respectively. Conclusion Patients with the two subtypes of cardiac immune cell fractions were likely having different fibrotic mechanisms. Patients' subtypes can be predicted based on the ImmunCard30 biomarker panel. We envision that our unique stratification strategy revealed in this study will unravel advance diagnostic techniques for personalised anti-fibrotic therapy.
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Affiliation(s)
- Shangjie Zou
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Center for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, Hong Kong SAR, China
| | - Bee Luan Khoo
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Hong Kong Center for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, Hong Kong SAR, China.,Department of Precision Diagnostic and Therapeutic Technology, City University of Hong Kong-Shenzhen Futian Research Institute, Shenzhen, China
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21
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Nagalingam RS, Chattopadhyaya S, Al-Hattab DS, Cheung DYC, Schwartz LY, Jana S, Aroutiounova N, Ledingham DA, Moffatt TL, Landry NM, Bagchi RA, Dixon IMC, Wigle JT, Oudit GY, Kassiri Z, Jassal DS, Czubryt MP. Scleraxis and fibrosis in the pressure-overloaded heart. Eur Heart J 2022; 43:4739-4750. [PMID: 36200607 DOI: 10.1093/eurheartj/ehac362] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/02/2022] [Accepted: 06/23/2022] [Indexed: 01/05/2023] Open
Abstract
AIMS In response to pro-fibrotic signals, scleraxis regulates cardiac fibroblast activation in vitro via transcriptional control of key fibrosis genes such as collagen and fibronectin; however, its role in vivo is unknown. The present study assessed the impact of scleraxis loss on fibroblast activation, cardiac fibrosis, and dysfunction in pressure overload-induced heart failure. METHODS AND RESULTS Scleraxis expression was upregulated in the hearts of non-ischemic dilated cardiomyopathy patients, and in mice subjected to pressure overload by transverse aortic constriction (TAC). Tamoxifen-inducible fibroblast-specific scleraxis knockout (Scx-fKO) completely attenuated cardiac fibrosis, and significantly improved cardiac systolic function and ventricular remodelling, following TAC compared to Scx+/+ TAC mice, concomitant with attenuation of fibroblast activation. Scleraxis deletion, after the establishment of cardiac fibrosis, attenuated the further functional decline observed in Scx+/+ mice, with a reduction in cardiac myofibroblasts. Notably, scleraxis knockout reduced pressure overload-induced mortality from 33% to zero, without affecting the degree of cardiac hypertrophy. Scleraxis directly regulated transcription of the myofibroblast marker periostin, and cardiac fibroblasts lacking scleraxis failed to upregulate periostin synthesis and secretion in response to pro-fibrotic transforming growth factor β. CONCLUSION Scleraxis governs fibroblast activation in pressure overload-induced heart failure, and scleraxis knockout attenuated fibrosis and improved cardiac function and survival. These findings identify scleraxis as a viable target for the development of novel anti-fibrotic treatments.
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Affiliation(s)
- Raghu S Nagalingam
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Sikta Chattopadhyaya
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Danah S Al-Hattab
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - David Y C Cheung
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Leah Y Schwartz
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Sayantan Jana
- Department of Physiology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Nina Aroutiounova
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - D Allison Ledingham
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Teri L Moffatt
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Natalie M Landry
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Rushita A Bagchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Ian M C Dixon
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
| | - Jeffrey T Wigle
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada.,Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gavin Y Oudit
- Department of Physiology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Zamaneh Kassiri
- Department of Physiology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Davinder S Jassal
- Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada.,Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael P Czubryt
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Institute of Cardiovascular Sciences, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, Canada
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22
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Qiao J, Zhao P, Lu J, Huang L, Ma X, Zhou X, Xia L. Cardiac involvement in patients 1 year after recovery from moderate and severe COVID-19 infections. Front Cardiovasc Med 2022; 9:1009637. [PMID: 36386376 PMCID: PMC9646443 DOI: 10.3389/fcvm.2022.1009637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background Some patients suffered persistent cardiac symptoms after hospital discharge following COVID-19 infection, including chest tightness, chest pain, and palpitation. However, the cardiac involvement in these patients remains unknown. The purpose of this study was to investigate the effect of COVID-19 infection on the cardiovascular system after 1 year of recovery in patients hospitalized with persistent cardiac symptoms. Materials and methods In this prospective observational study, a total of 32 patients who had COVID-19 (11 diagnosed as severe COVID-19 and 21 as moderate) with persistent cardiac symptoms after hospital discharge were enrolled. Contrast-enhanced cardiovascular magnetic resonance (CMR) imaging was performed on all patients. Comparisons were made with age- and sex-matched healthy controls (n = 13), and age-, sex- and risk factor-matched controls (n = 21). Further analysis was made between the severe and moderate COVID-19 cohorts. Results The mean time interval between acute COVID-19 infection and CMR was 462 ± 18 days. Patients recovered from COVID-19 had reduced left ventricular ejection fraction (LVEF) (p = 0.003) and increased extracellular volumes (ECVs) (p = 0.023) compared with healthy controls. Focal late gadolinium enhancement (LGE) was found in 22 (68.8%) patients, mainly distributed linearly in the septal mid-wall or patchily in RV insertion point. The LGE extent in patients with severe COVID-19 was higher than that in patients with moderate COVID-19 (p = 0.009). Conclusion This 1-year follow-up study revealed that patients with persistent cardiac symptoms, after recovering from COVID-19, had decreased cardiac function and increased ECV compared with healthy controls. Patients with COVID-19 predominately had a LGE pattern of septal mid-wall or RV insertion point. Patients with severe COVID-19 had greater LGE extent than patients with moderate COVID-19.
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Affiliation(s)
- Jinhan Qiao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peijun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianyao Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoling Ma
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Liming Xia,
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23
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Tao Y, Gao C, Qian D, Cao D, Han L, Yang L. Regulatory mechanism of fibrosis-related genes in patients with heart failure. Front Genet 2022; 13:1032572. [DOI: 10.3389/fgene.2022.1032572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Heart failure (HF) is a complex clinical syndrome characterized by the inability to match cardiac output with metabolic needs. Research on regulatory mechanism of fibrosis-related genes in patients with HF is very limited. In order to understand the mechanism of fibrosis in the development and progression of HF, fibrosis -related hub genes in HF are screened and verified.Methods: RNA sequencing data was obtained from the Gene Expression Omnibus (GEO) cohorts to identify differentially expressed genes (DEGs). Thereafter, fibrosis-related genes were obtained from the GSEA database and that associated with HF were screened out. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways analysis was carried out to analyze the biological function of fibrosis-related DEGs. The protein-protein interaction (PPI) network of hub genes was constructed via the STRING database. Moreover, the diagnostic value of hub genes for HF was confirmed using ROC curves and expression analysis. Finally, quantitative real time PCR was used to detect the expression levels of mRNAs.Results: A total of 3, 469 DEGs were identified closely related to HF, and 1, 187 fibrosis-related DEGs were obtained and analyzed for GO and KEGG enrichment. The enrichment results of fibrosis-related DEGs were consistent with that of DEGs. A total of 10 hub genes (PPARG, KRAS, JUN, IL10, TLR4, STAT3, CXCL8, CCL2, IL6, IL1β) were selected via the PPI network. Receiver operating characteristic curve analysis was estimated in the test cohort, and 6 genes (PPARG, KRAS, JUN, IL10, TLR4, STAT3) with AUC more than 0.7 were identified as diagnosis genes. Moreover, miRNA-mRNA and TF-mRNA regulatory networks were constructed. Finally, quantitative real time PCR revealed these 6 genes may be used as the potential diagnostic biomarkers of HF.Conclusion: In this study, 10 fibrosis-related hub genes in the HF were identified and 6 of them were demonstrated as potential diagnostic biomarkers for HF.
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24
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Shen MT, Li Y, Guo YK, Gao Y, Jiang L, Shi R, Yang ZG. The Impact of Hypertension on Left Ventricular Function and Remodeling in Non-Ischemic Dilated Cardiomyopathy Patients: A 3.0 T MRI Study. J Magn Reson Imaging 2022. [PMID: 36226793 DOI: 10.1002/jmri.28475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) is highly prevalent in non-ischemic dilated cardiomyopathy (NIDCM) patients, but little is known about its impact on left ventricular (LV) function and remodeling. PURPOSE To evaluate the effect of hypertension on LV function and remodeling in NIDCM patients. STUDY TYPE Retrospective. POPULATION Two-hundred and twelve NIDCM (HTN-) patients, 91 NIDCM (HTN+) patients, and 74 normal controls. FIELD STRENGTH/SEQUENCE 3.0 T/bSSFP and phase-sensitive inversion recovery sequence. ASSESSMENT The LV geometry, myocardial strain, remodeling index (calculated as LVM/LVEDV), and LGE were measured and compared between groups. Determinants of LV strain and remodeling in NIDCM were investigated. STATISTICAL TESTS Student's t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis test, univariable and multivariable linear regression. A P value <0.05 was considered statistically significant. RESULTS Compared with normal controls, NIDCM patients had significantly higher LVEDV and significantly impaired LV strains, including LV global peak strain (PS) and peak systolic and diastolic strain rates in the radial, circumferential, and longitudinal directions. The NIDCM (HTN+) group had significantly decreased LV global longitudinal PS and peak diastolic strain rate (PDSR), and significantly increased LV mass index and remodeling index compared to the NIDCM (HTN-) group, despite there being no significant difference in ejection fraction (P = 0.241). The prevalence of LV LGE was significantly higher in the NIDCM (HTN+) group than in the NIDCM (HTN-) group. In multivariable regression models adjusted for potential confounders, hypertension was independently associated with LV global longitudinal PS and PDSR. Male sex, resting heart rate, and log(NT-proBNP) level were independent determinants of LV strains. Moreover, male sex, systolic and diastolic blood pressure, and presence of LGE were independent determinants of LV remodeling index. DATA CONCLUSION These findings suggest that coexistence of hypertension may further exacerbate the reduction in LV global strain and the aggravation of LV remodeling in NIDCM patients. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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25
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Lyu Z, Han W, Zhao H, Jiao Y, Xu P, Wang Y, Shen Q, Yang S, Zhao C, Tian L, Fu P. A clinical study on relationship between visualization of cardiac fibroblast activation protein activity by Al18F-NOTA-FAPI-04 positron emission tomography and cardiovascular disease. Front Cardiovasc Med 2022; 9:921724. [PMID: 36072860 PMCID: PMC9441604 DOI: 10.3389/fcvm.2022.921724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective FAP plays a vital role in myocardial injury and fibrosis. Although initially used to study imaging of primary and metastatic tumors, the use of FAPI tracers has recently been studied in cardiac remodeling after myocardial infarction. The study aimed to investigate the application of FAPI PET/CT imaging in human myocardial fibrosis and its relationship with clinical factors. Materials and methods Retrospective analysis of FAPI PET/CT scans of twenty-one oncological patients from 05/2021 to 03/2022 with visual uptake of FAPI in the myocardium were applying the American Heart Association 17-segment model of the left ventricle. The patients’ general data, echocardiography, and laboratory examination results were collected, and the correlation between PET imaging data and the above data was analyzed. Linear regression models, Kendall’s TaU-B test, the Spearman test, and the Mann–Whitney U test were used for the statistical analysis. Results 21 patients (60.1 ± 9.4 years; 17 men) were evaluated with an overall mean LVEF of 59.3 ± 5.4%. The calcific plaque burden of LAD, LCX, and RCA are 14 (66.7%), 12 (57.1%), and 9 (42.9%). High left ventricular SUVmax correlated with BMI (P < 0.05) and blood glucose level (P < 0.05), and TBR correlated with age (P < 0.05). A strong correlation was demonstrated between SUVmean and CTnImax (r = 0.711, P < 0.01). Negative correlation of SUVmean and LVEF (r = −0.61, P < 0.01), SUVmax and LVEF (r = −0.65, P < 0.01) were found. ROC curve for predicting calcified plaques by myocardial FAPI uptake (SUVmean) in LAD, LCX, and RCA territory showed AUCs were 0.786, 0.759, and 0.769. Conclusion FAPI PET/CT scans might be used as a new potential method to evaluate cardiac fibrosis to help patients’ management further. FAPI PET imaging can reflect the process of myocardial fibrosis. High FAPI uptakes correlate with cardiovascular risk factors and the distribution of coronary plaques.
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Affiliation(s)
- Zhehao Lyu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongyue Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuying Jiao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yangyang Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiuyi Shen
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuai Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Changjiu Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Tian
- Department of Pathology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Lin Tian,
| | - Peng Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Peng Fu,
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Xie E, Sung E, Saad E, Trayanova N, Wu KC, Chrispin J. Advanced imaging for risk stratification for ventricular arrhythmias and sudden cardiac death. Front Cardiovasc Med 2022; 9:884767. [PMID: 36072882 PMCID: PMC9441865 DOI: 10.3389/fcvm.2022.884767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of mortality, comprising approximately half of all deaths from cardiovascular disease. In the US, the majority of SCD (85%) occurs in patients with ischemic cardiomyopathy (ICM) and a subset in patients with non-ischemic cardiomyopathy (NICM), who tend to be younger and whose risk of mortality is less clearly delineated than in ischemic cardiomyopathies. The conventional means of SCD risk stratification has been the determination of the ejection fraction (EF), typically via echocardiography, which is currently a means of determining candidacy for primary prevention in the form of implantable cardiac defibrillators (ICDs). Advanced cardiac imaging methods such as cardiac magnetic resonance imaging (CMR), single-photon emission computerized tomography (SPECT) and positron emission tomography (PET), and computed tomography (CT) have emerged as promising and non-invasive means of risk stratification for sudden death through their characterization of the underlying myocardial substrate that predisposes to SCD. Late gadolinium enhancement (LGE) on CMR detects myocardial scar, which can inform ICD decision-making. Overall scar burden, region-specific scar burden, and scar heterogeneity have all been studied in risk stratification. PET and SPECT are nuclear methods that determine myocardial viability and innervation, as well as inflammation. CT can be used for assessment of myocardial fat and its association with reentrant circuits. Emerging methodologies include the development of "virtual hearts" using complex electrophysiologic modeling derived from CMR to attempt to predict arrhythmic susceptibility. Recent developments have paired novel machine learning (ML) algorithms with established imaging techniques to improve predictive performance. The use of advanced imaging to augment risk stratification for sudden death is increasingly well-established and may soon have an expanded role in clinical decision-making. ML could help shift this paradigm further by advancing variable discovery and data analysis.
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Affiliation(s)
- Eric Xie
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric Sung
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Elie Saad
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Natalia Trayanova
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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27
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Li K, Jiang Y, Huang Z, Zhou Y. Double Gain: The Radio Frequency Catheter Ablation of Ventricular Aneurysm Related Recurrent Ventricular Tachycardia on a Tremendous Cardiac Outpouching. Diagnostics (Basel) 2022; 12:diagnostics12081955. [PMID: 36010305 PMCID: PMC9406680 DOI: 10.3390/diagnostics12081955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a classic type of non-ischemic cardiomyopathy. Of these, idiopathic cardiomyopathy (IDCM) is a rare type of non-genetic dilated cardiomyopathy. More specifically, the patient had suspected IDCM combined with sustained polymorphic ventricular tachycardia (PMVT) of left ventricular basal segmental origin, cardiac systolic dysfunction and an ejection fraction (EF) of 29%. He had an abnormally large ventricular aneurysm (VA) in the posterior wall of the left ventricle with left ventricular end diastolic dimension (LVDd) of 90 mm. We performed an endocardial radiofrequency catheter ablation (RFCA) of the patient’s recurrent ventricular tachycardia (VT) on the basis of an implantable cardioverter (ICD). Although minimally invasive RFCA also carries a high risk, it is currently a two-pronged option to improve the patient’s quality of life and to prevent the recurrence of VT. Postoperatively, the patient was routinely given optimal anti-arrhythmic and heart failure (HF) treatments to improve cardiac function as well as being followed up for 9 months. The patient’s EF ascended to 36% without any recurrence of VT. In summary, RFCA of suspected IDCM combined with VA and VT of basal area origin would be an effective treatment.
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Affiliation(s)
- Kexin Li
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
- Institution for Hypertension of Soochow University, Suzhou 215000, China
| | - Yufeng Jiang
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
- Institution for Hypertension of Soochow University, Suzhou 215000, China
| | - Ziyin Huang
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
- Institution for Hypertension of Soochow University, Suzhou 215000, China
| | - Yafeng Zhou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, China
- Institution for Hypertension of Soochow University, Suzhou 215000, China
- Correspondence: ; Tel.: +86-512-65223637
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28
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Del Torto A, Guaricci AI, Pomarico F, Guglielmo M, Fusini L, Monitillo F, Santoro D, Vannini M, Rossi A, Muscogiuri G, Baggiano A, Pontone G. Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:758975. [PMID: 35355965 PMCID: PMC8959466 DOI: 10.3389/fcvm.2022.758975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome defined by the presence of heart failure symptoms and increased levels of circulating natriuretic peptide (NP) in patients with preserved left ventricular ejection fraction and various degrees of diastolic dysfunction (DD). HFpEF is a complex condition that encompasses a wide range of different etiologies. Cardiovascular imaging plays a pivotal role in diagnosing HFpEF, in identifying specific underlying etiologies, in prognostic stratification, and in therapeutic individualization. Echocardiography is the first line imaging modality with its wide availability; it has high spatial and temporal resolution and can reliably assess systolic and diastolic function. Cardiovascular magnetic resonance (CMR) is the gold standard for cardiac morphology and function assessment, and has superior contrast resolution to look in depth into tissue changes and help to identify specific HFpEF etiologies. Differently, the most important role of nuclear imaging [i.e., planar scintigraphy and/or single photon emission CT (SPECT)] consists in the screening and diagnosis of cardiac transthyretin amyloidosis (ATTR) in patients with HFpEF. Cardiac CT can accurately evaluate coronary artery disease both from an anatomical and functional point of view, but tissue characterization methods have also been developed. The aim of this review is to critically summarize the current uses and future perspectives of echocardiography, nuclear imaging, CT, and CMR in patients with HFpEF.
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Affiliation(s)
- Alberico Del Torto
- Department of Emergency and Acute Cardiac Care, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Daniela Santoro
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Monica Vannini
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- University Milano Bicocca, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- *Correspondence: Gianluca Pontone
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29
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Casas G, Rodríguez-Palomares JF. Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis. J Clin Med 2022; 11:jcm11030578. [PMID: 35160031 PMCID: PMC8836975 DOI: 10.3390/jcm11030578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies.
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Affiliation(s)
- Guillem Casas
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Correspondence: (G.C.); (J.F.R.-P.)
| | - José F. Rodríguez-Palomares
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Correspondence: (G.C.); (J.F.R.-P.)
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30
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Lim Y, Jeong A, Kwon DH, Lee YU, Kim YK, Ahn Y, Kook T, Park WJ, Kook H. P300/CBP-Associated Factor Activates Cardiac Fibroblasts by SMAD2 Acetylation. Int J Mol Sci 2021; 22:9944. [PMID: 34576109 PMCID: PMC8472677 DOI: 10.3390/ijms22189944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 01/07/2023] Open
Abstract
Various heart diseases cause cardiac remodeling, which in turn leads to ineffective contraction. Although it is an adaptive response to injury, cardiac fibrosis contributes to this remodeling, for which the reactivation of quiescent myofibroblasts is a key feature. In the present study, we investigated the role of the p300/CBP-associated factor (PCAF), a histone acetyltransferase, in the activation of cardiac fibroblasts. An intraperitoneal (i.p.) injection of a high dose (160 mg/kg) of isoproterenol (ISP) induced cardiac fibrosis and reduced the amount of the PCAF in cardiac fibroblasts in the mouse heart. However, the PCAF activity was significantly increased in cardiac fibroblasts, but not in cardiomyocytes, obtained from ISP-administered mice. An in vitro study using human cardiac fibroblast cells recapitulated the in vivo results; an treatment with transforming growth factor-β1 (TGF-β1) reduced the PCAF, whereas it activated the PCAF in the fibroblasts. PCAF siRNA attenuated the TGF-β1-induced increase in and translocation of fibrosis marker proteins. PCAF siRNA blocked TGF-β1-mediated gel contraction and cell migration. The PCAF directly interacted with and acetylated mothers against decapentaplegic homolog 2 (SMAD2). PCAF siRNA prevented TGF-β1-induced phosphorylation and the nuclear localization of SMAD2. These results suggest that the increase in PCAF activity during cardiac fibrosis may participate in SMAD2 acetylation and thereby in its activation.
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Affiliation(s)
- Yongwoon Lim
- Department of Pharmacology, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.L.); (A.J.); (D.-H.K.); (Y.-U.L.); (T.K.)
- Basic Research Laboratory for Vascular Remodeling, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.-K.K.); (Y.A.)
- BK21 Plus Center for Creative Biomedical Scientists, Chonnam National University, Gwangju 61469, Korea
- BioMedical Sciences Graduate Program (BMSGP), Chonnam National University, Hwasun 58128, Korea
| | - Anna Jeong
- Department of Pharmacology, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.L.); (A.J.); (D.-H.K.); (Y.-U.L.); (T.K.)
- Basic Research Laboratory for Vascular Remodeling, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.-K.K.); (Y.A.)
- BK21 Plus Center for Creative Biomedical Scientists, Chonnam National University, Gwangju 61469, Korea
- BioMedical Sciences Graduate Program (BMSGP), Chonnam National University, Hwasun 58128, Korea
| | - Duk-Hwa Kwon
- Department of Pharmacology, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.L.); (A.J.); (D.-H.K.); (Y.-U.L.); (T.K.)
- Basic Research Laboratory for Vascular Remodeling, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.-K.K.); (Y.A.)
- BK21 Plus Center for Creative Biomedical Scientists, Chonnam National University, Gwangju 61469, Korea
| | - Yeong-Un Lee
- Department of Pharmacology, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.L.); (A.J.); (D.-H.K.); (Y.-U.L.); (T.K.)
- Health and Environment Research Institute of Gwangju, 584, Mujin-daero, Seo-gu, Gwangju 61954, Korea
| | - Young-Kook Kim
- Basic Research Laboratory for Vascular Remodeling, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.-K.K.); (Y.A.)
- BK21 Plus Center for Creative Biomedical Scientists, Chonnam National University, Gwangju 61469, Korea
- Department of Biochemistry, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea
| | - Youngkeun Ahn
- Basic Research Laboratory for Vascular Remodeling, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.-K.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea
| | - Taewon Kook
- Department of Pharmacology, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.L.); (A.J.); (D.-H.K.); (Y.-U.L.); (T.K.)
- College of Life Sciences, Gwangju Institute of Science and Technology, Gwangju 61005, Korea;
| | - Woo-Jin Park
- College of Life Sciences, Gwangju Institute of Science and Technology, Gwangju 61005, Korea;
| | - Hyun Kook
- Department of Pharmacology, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.L.); (A.J.); (D.-H.K.); (Y.-U.L.); (T.K.)
- Basic Research Laboratory for Vascular Remodeling, Chonnam National University Medical School, Hwasun 58128, Jeollanamdo, Korea; (Y.-K.K.); (Y.A.)
- BK21 Plus Center for Creative Biomedical Scientists, Chonnam National University, Gwangju 61469, Korea
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31
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Cui C, Li Y, Liu Y, Huang D, Hu Y, Wang Y, Ma L, Liu L. Association Between Echocardiographic Non-invasive Myocardial Work Indices and Myocardial Fibrosis in Patients With Dilated Cardiomyopathy. Front Cardiovasc Med 2021; 8:704251. [PMID: 34485405 PMCID: PMC8415625 DOI: 10.3389/fcvm.2021.704251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives: To analyze the association between global myocardial work indices evaluated by non-invasive left ventricular (LV) pressure-strain loop (PSL) and LV myocardial fibrosis in patients with dilated cardiomyopathy (DCM). Methods: A total of 57 patients with DCM were included in this prospective study. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global longitudinal strain (GLS) were measured using LVPSL. LV volumes and LV ejection fraction (LVEF) were evaluated using cardiac magnetic resonance imaging (CMRI), LV myocardial fibrosis was estimated at CMRI by qualitative assessment of late gadolinium enhancement (LGE). According to the CMRI, the studied population was divided into two groups, namely: patients without LGE (LGE-) and patients with LGE (LGE+). Results: The LGE+ group presented with increased age, LV end systolic volume (LVESV) index and reduced GWI, GCW, GWE, GLS, CMRI-derived LVEF (LVEFCMRI), the differences between the two groups were statistically significant (P < 0.05). After correcting for age and LVESV index, LVEFCMRI, GLS, GWI, GCW, and GWE retained independent associations with LV myocardial fibrosis. According to receiver operating characteristics (ROC) analysis, LVEFCMRI, and GCW showed larger AUC and higher accuracy, sensitivity, and specificity than GLS, the accuracy of predicting LV myocardial fibrosis ranged from high to low as: LVEFCMRI, GCW, GWE, GWI, and GLS. Conclusions: LVEFCMRI, GWI, GCW, GWE, and GLS remained significant predictors of LV myocardial fibrosis. LVEFCMRI, and GCW appeared to better predict LV myocardial fibrosis compared with GLS.
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Affiliation(s)
- Cunying Cui
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yanan Li
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Danqing Huang
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Ying Wang
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Lijia Ma
- Department of Radiology, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasound, The People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
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32
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Prasad SK, Halliday BP. Myocardial Fibrosis in Dilated Cardiomyopathy: Moving From Stratifying Risk to Improving Outcomes. JACC Cardiovasc Imaging 2021; 14:1351-1353. [PMID: 34023259 DOI: 10.1016/j.jcmg.2021.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sanjay K Prasad
- National Heart Lung Institute, Imperial College & Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.
| | - Brian P Halliday
- National Heart Lung Institute, Imperial College & Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
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