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Lo Monaco M, Stankowski K, Figliozzi S, Nicoli F, Scialò V, Gad A, Lisi C, Marchini F, Dellino CM, Mollace R, Catapano F, Stefanini GG, Monti L, Condorelli G, Bertella E, Francone M. Multiparametric Mapping via Cardiovascular Magnetic Resonance in the Risk Stratification of Ventricular Arrhythmias and Sudden Cardiac Death. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:691. [PMID: 38792874 PMCID: PMC11122968 DOI: 10.3390/medicina60050691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
Risk stratification for malignant ventricular arrhythmias and sudden cardiac death is a daunting task for physicians in daily practice. Multiparametric mapping sequences obtained via cardiovascular magnetic resonance imaging can improve the risk stratification for malignant ventricular arrhythmias by unveiling the presence of pathophysiological pro-arrhythmogenic processes. However, their employment in clinical practice is still restricted. The present review explores the current evidence supporting the association between mapping abnormalities and the risk of ventricular arrhythmias in several cardiovascular diseases. The key message is that further clinical studies are needed to test the additional value of mapping techniques beyond conventional cardiovascular magnetic resonance imaging for selecting patients eligible for an implantable cardioverter defibrillator.
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Affiliation(s)
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Vincenzo Scialò
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
| | - Federico Marchini
- Humanitas Gavazzeni, 24125 Bergamo, Italy
- Centro Cardiologico Universitario, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy
| | - Carlo Maria Dellino
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | | | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
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Scharinger B, Boxhammer E, Rezar R, Hecht S, Wernly S, Widhalm T, Lichtenauer M, Hoppe UC, Hergan K, Wernly B, Strohmer B, Kaufmann R. Cardiac MRI after Sudden Cardiac Arrest: A Systematic Review. Radiol Cardiothorac Imaging 2024; 6:e230216. [PMID: 38634744 PMCID: PMC11056749 DOI: 10.1148/ryct.230216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
Purpose To perform a systematic review to assess the diagnostic and prognostic value of cardiac MRI after sudden cardiac arrest (SCA). Materials and Methods PubMed and Cochrane Library databases were systematically searched for studies investigating cardiac MRI after SCA in adult patients (≥18 years of age). The time frame of the encompassed studies spans from January 2012 to January 2023. The study protocol was preregistered in OSF Registries (www.osf.io/nxaev), and the systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa quality assessment scale. Results Fourteen studies involving 1367 individuals, 1257 (91.9%) of whom underwent cardiac MRI, were included. Inconsistent findings were reported on the diagnostic value of cardiac MRI-specific findings. The included studies demonstrated the following main findings: (a) cardiac MRI led to a new or alternative diagnosis in patients with SCA; (b) cardiac MRI identified pathologic or arrhythmogenic substrates; (c) cardiac MRI helped detect myocardial edema (potentially reversible); (d) cardiac MRI provided evidence for the occurrence of adverse events; and (e) functional markers or ventricular dimensions were considered prognostically relevant in a few studies. Relevant challenges in this systematic review were the lack of comparators and reference standards relative to cardiac MRI as the index test and patient selection bias. Conclusion Cardiac MRI following SCA can contribute to the diagnostic process and offer supplementary information essential for treatment planning. Limitations of the review include studies with insufficient comparators and potential bias in patient selection. Systematic review registration link: osf.io/nxaev Keywords: Cardiac MRI, Cardiovascular Disease, Cardiomyopathy, Ischemia, Myocardial Edema, Sudden Cardiac Arrest © RSNA, 2024.
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Affiliation(s)
| | | | - Richard Rezar
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Stefan Hecht
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Sarah Wernly
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Tobias Widhalm
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Michael Lichtenauer
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Uta C. Hoppe
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Klaus Hergan
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Bernhard Wernly
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Bernhard Strohmer
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
| | - Reinhard Kaufmann
- From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.),
Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W.,
M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research
(B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria;
and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf,
Austria (S.W., B.W.)
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Desmond A, Nguyen K, Watterson CT, Sklansky M, Satou GM, Prosper AE, Garg M, Van Arsdell GS, Finn JP, Afshar Y. Integration of Prenatal Cardiovascular Magnetic Resonance Imaging in Congenital Heart Disease. J Am Heart Assoc 2023; 12:e030640. [PMID: 37982254 PMCID: PMC10727279 DOI: 10.1161/jaha.123.030640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Standard of care echocardiography can have limited diagnostic accuracy in certain cases of fetal congenital heart disease. Prenatal cardiovascular magnetic resonance (CMR) imaging has potential to provide additional anatomic imaging information, including excellent soft tissue images in multiple planes, improving prenatal diagnostics and in utero hemodynamic assessment. We conducted a literature review of fetal CMR, including its development and implementation into clinical practice, and compiled and analyzed the results. Our findings included the fact that technological and innovative approaches are required to overcome some of the challenges in fetal CMR, in part due to the dynamic nature of the fetal heart. A number of reconstruction algorithms and cardiac gating strategies have been developed over time to improve fetal CMR image quality, allowing unique investigations into fetal hemodynamics, oxygenation, and growth. Studies demonstrate that incorporating CMR in the prenatal arena influences postnatal clinical management. With further refinement and experience, fetal CMR in congenital heart disease continues to evolve and demonstrate ongoing potential as a complementary imaging modality to fetal echocardiography in the care of these patients.
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Affiliation(s)
- Angela Desmond
- Division of Neonatology, Department of PediatricsUCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Kim‐Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Division of CardiologyDavid Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | | | - Mark Sklansky
- Division of Pediatric Cardiology, Department of PediatricsDavid Geffen School of Medicine, UCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Gary M. Satou
- Division of Pediatric Cardiology, Department of PediatricsDavid Geffen School of Medicine, UCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Ashley E. Prosper
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | - Meena Garg
- Division of Neonatology, Department of PediatricsUCLA Mattel Children’s HospitalLos AngelesCAUSA
| | - Glen S. Van Arsdell
- Division of Cardiac Surgery, Department of SurgeryDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | - J. Paul Finn
- Diagnostic Cardiovascular Imaging Laboratory, Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Division of CardiologyDavid Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Department of Radiological SciencesDavid Geffen School of Medicine, UCLALos AngelesCAUSA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyDavid Geffen School of Medicine, UCLALos AngelesCAUSA
- Molecular Biology InstituteUniversity of CaliforniaLos AngelesCAUSA
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4
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Bivona DJ, Oomen PJA, Wang Y, Morales FL, Abdi M, Gao X, Malhotra R, Darby A, Mehta N, Monfredi OJ, Mangrum JM, Mason PK, Levy WC, Mazimba S, Patel AR, Epstein FH, Bilchick KC. Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades. J Cardiovasc Dev Dis 2023; 10:409. [PMID: 37887856 PMCID: PMC10607260 DOI: 10.3390/jcdd10100409] [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: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
As the mechanism for worse prognosis after cardiac resynchronization therapy (CRT) upgrades in heart failure patients with RVP dependence (RVP-HF) has clinical implications for patient selection and CRT implementation approaches, this study's objective was to evaluate prognostic implications of cardiac magnetic resonance (CMR) findings and clinical factors in 102 HF patients (23.5% female, median age 66.5 years old, median follow-up 4.8 years) with and without RVP dependence undergoing upgrade and de novo CRT implants. Compared with other CRT groups, RVP-HF patients had decreased survival (p = 0.02), more anterior late-activated LV pacing sites (p = 0.002) by CMR, more atrial fibrillation (p = 0.0006), and higher creatinine (0.002). CMR activation timing at the LV pacing site predicted post-CRT LV functional improvement (p < 0.05), and mechanical activation onset < 34 ms by CMR at the LVP site was associated with decreased post-CRT survival in a model with higher pre-CRT creatinine and B-type natriuretic peptide (AUC 0.89; p < 0.0001); however, only the higher pre-CRT creatinine partially mediated (37%) the decreased survival in RVP-HF patients. In conclusion, RVP-HF had a distinct CMR phenotype, which has important implications for the selection of LV pacing sites in CRT upgrades, and only chronic kidney disease mediated the decreased survival after CRT in RVP-HF.
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Affiliation(s)
- Derek J. Bivona
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Pim J. A. Oomen
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92617, USA;
| | - Yu Wang
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USA; (Y.W.); (M.A.); (F.H.E.)
| | - Frances L. Morales
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USA; (Y.W.); (M.A.); (F.H.E.)
| | - Xu Gao
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Rohit Malhotra
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Andrew Darby
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Nishaki Mehta
- Department of Medicine, William Beaumont Oakland University School of Medicine, Royal Oak, MI 48309, USA;
| | - Oliver J. Monfredi
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - J. Michael Mangrum
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Pamela K. Mason
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Wayne C. Levy
- Department of Medicine, University of Washington, Seattle, WA 98195, USA;
| | - Sula Mazimba
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Amit R. Patel
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USA; (Y.W.); (M.A.); (F.H.E.)
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Kenneth C. Bilchick
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
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5
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Kim J, Hong YJ, Han K, Kim JY, Lee HJ, Hur J, Kim YJ, Choi BW. Chemotherapy-Related Cardiac Dysfunction: Quantitative Cardiac Magnetic Resonance Image Parameters and Their Prognostic Implications. Korean J Radiol 2023; 24:838-848. [PMID: 37634639 PMCID: PMC10462900 DOI: 10.3348/kjr.2023.0095] [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: 10/28/2022] [Revised: 06/09/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To quantitatively analyze the cardiac magnetic resonance imaging (CMR) characteristics of chemotherapy-related cardiac dysfunction (CTRCD) and explore their prognostic value for major adverse cardiovascular events (MACE). MATERIALS AND METHODS A total of 145 patients (male:female = 76:69, mean age = 63.0 years) with cancer and heart failure who underwent CMR between January 2015 and January 2021 were included. CMR was performed using a 3T scanner (Siemens). Biventricular functions, native T1 T2, extracellular volume fraction (ECV) values, and late gadolinium enhancement (LGE) of the left ventricle (LV) were compared between those with and without CTRCD. These were compared between patients with mild-to-moderate CTRCD and those with severe CTRCD. Cox proportional hazard regression analysis was used to evaluate the association between the CMR parameters and MACE occurrence during follow-up in the CTRCD patients. RESULTS Among 145 patients, 61 had CTRCD and 84 did not have CTRCD. Native T1, ECV, and T2 were significantly higher in the CTRCD group (1336.9 ms, 32.5%, and 44.7 ms, respectively) than those in the non-CTRCD group (1303.4 ms, 30.5%, and 42.0 ms, respectively; P = 0.013, 0.010, and < 0.001, respectively). They were not significantly different between patients with mild-to-moderate and severe CTRCD. Indexed LV mass was significantly smaller in the CTRCD group (65.0 g/m² vs. 78.9 g/m²; P < 0.001). According to the multivariable Cox regression analysis, T2 (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01-1.27; P = 0.028) and quantified LGE (HR: 1.07, 95% CI: 1.01-1.13; P = 0.021) were independently associated with MACE in the CTRCD patients. CONCLUSION Quantitative parameters from CMR have the potential to evaluate myocardial changes in CTRCD. Increased T2 with reduced LV mass was demonstrated in CTRCD patients even before the development of severe cardiac dysfunction. T2 and quantified LGE may be independent prognostic factors for MACE in patients with CTRCD.
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Affiliation(s)
- Jinhee Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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6
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Baggiano A, Conte E, Spiritigliozzi L, Mushtaq S, Annoni A, Carerj ML, Cilia F, Fazzari F, Formenti A, Frappampina A, Fusini L, Gaudenzi Asinelli M, Junod D, Mancini ME, Mantegazza V, Maragna R, Marchetti F, Penso M, Tassetti L, Volpe A, Baessato F, Guglielmo M, Rossi A, Rovera C, Andreini D, Rabbat MG, Guaricci AI, Pepi M, Pontone G. Quantification of extracellular volume with cardiac computed tomography in patients with dilated cardiomyopathy. J Cardiovasc Comput Tomogr 2023; 17:261-268. [PMID: 37147147 DOI: 10.1016/j.jcct.2023.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Cardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECVCCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECVCMR as the reference technique. METHODS 39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECVCMR and ECVCCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed. RESULTS Mean age of enrolled patients was 62 ± 11 years, and mean LVEF at CMR was 35.4 ± 10.7%. Overall radiation exposure for ECV estimation was 2.1 ± 1.1 mSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECVCCT demonstrated slightly lower values compared to ECVCMR (all segments, 31.8 ± 6.5% vs 33.9 ± 8.0%, p < 0.001). At regression analysis, strong correlations were described (all segments, r = 0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECVCMR and ECVCCT for global analysis was 2.1 (95% CI: -6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECVCCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively). CONCLUSIONS ECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.
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Affiliation(s)
- Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Spiritigliozzi
- Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Policlinico Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | | | | | | | | | | | | | - Marco Penso
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | | | | | - Francesca Baessato
- Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, the Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA; Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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Tat E, Ball C, Camren GP, Wroblewski I, Dajani KA, Goldberg A, Kinno M, Sanagala T, Syed MA, Wilber DJ, Rabbat M. Impact of late gadolinium enhancement extent, location, and pattern on ventricular tachycardia and major adverse cardiac events in patients with ischemic vs. non-ischemic cardiomyopathy. Front Cardiovasc Med 2022; 9:1026215. [PMID: 36330014 PMCID: PMC9622951 DOI: 10.3389/fcvm.2022.1026215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Left ventricular late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) has been associated with increased risk for life-threatening ventricular tachyarrhythmias. The differences in association between LGE characteristics and prognosis in patients with ischemic (ICM) vs. non-ischemic (NICM) cardiomyopathy is incompletely understood. Methods A total of 168 consecutive patients who underwent CMR imaging with either ICM or NICM were included in our study. LGE extent, location and pattern were examined for association to the primary endpoint of ventricular tachycardia (VT) and secondary endpoint of major adverse cardiac events (MACE). Results Of 68 (41%) patients with ICM and 97 (59%) patients with NICM, median LGE mass was 15% (IQR 9–28) for the ICM group and 10% (IQR 6–15) for the NICM group. On multivariate analysis for both groups, LGE characteristics were prognostic while LVEF was not. In patients with ICM, septal and apical segment LGE, and involvement of multiple walls predicted both endpoints on multivariate analysis. LGE extent (≥median) and inferior wall LGE independently predicted the primary endpoint. In patients with NICM, anterior, inferior and apical segment LGE, and involvement of multiple walls predicted both endpoints on multivariate analysis. LGE extent (≥median, number of LGE segments, LGE stratified per 5% increase) and midwall LGE were independent predictors of the primary endpoint. Conclusions Although LGE was an independent predictor of prognosis in both groups, LGE extent, location, and pattern characteristics were more powerful correlates to worse outcomes in patients with NICM than ICM.
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Affiliation(s)
- Emily Tat
- Department of Internal Medicine, Columbia University Medical Center, New York, NY, United States
| | - Caroline Ball
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Gerald P. Camren
- Department of Radiology, Loyola University Medical Center, Maywood, IL, United States
| | - Igor Wroblewski
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Khaled A. Dajani
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Ari Goldberg
- Department of Radiology, Loyola University Medical Center, Maywood, IL, United States
| | - Menhel Kinno
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Thriveni Sanagala
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Mushabbar A. Syed
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - David J. Wilber
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
| | - Mark Rabbat
- Division of Cardiology, Loyola University Medical Center, Maywood, IL, United States
- *Correspondence: Mark Rabbat
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The Role of Cardiac Magnetic Resonance in Aortic Stenosis and Regurgitation. J Cardiovasc Dev Dis 2022; 9:jcdd9040108. [PMID: 35448084 PMCID: PMC9030119 DOI: 10.3390/jcdd9040108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is a well-set diagnostic technique for assessment of valvular heart diseases and is gaining ground in current clinical practice. It provides high-quality images without the administration of ionizing radiation and occasionally without the need of contrast agents. It offers the unique possibility of a comprehensive stand-alone assessment of the heart including biventricular function, left ventricle remodeling, myocardial fibrosis, and associated valvulopathies. CMR is the recognized reference for the quantification of ventricular volumes, mass, and function. A particular strength is the ability to quantify flow, especially with new techniques which allow accurate measurement of stenosis and regurgitation. Furthermore, tissue mapping enables the visualization and quantification of structural changes in the myocardium. In this way, CMR has the potential to yield important prognostic information predicting those patients who will progress to surgery and impact outcomes. In this review, the fundamentals of CMR in assessment of aortic valve diseases (AVD) are described, together with its strengths and weaknesses. This state-of-the-art review provides an updated overview of CMR potentials in all AVD issues, including valve anatomy, flow quantification, ventricular volumes and function, and tissue characterization.
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