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Telli T, Hosseini A, Settelmeier S, Kersting D, Kessler L, Weber WA, Rassaf T, Herrmann K, Varasteh Z. Imaging of Cardiac Fibrosis: How Far Have We Moved From Extracellular to Cellular? Semin Nucl Med 2024; 54:686-700. [PMID: 38493001 DOI: 10.1053/j.semnuclmed.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Myocardial fibrosis plays an important role in adverse outcomes such as heart failure and arrhythmias. As the pathological response and degree of scarring, and therefore clinical presentation varies from patient to patient, early detection of fibrosis is crucial for identifying the appropriate treatment approach and forecasting the progression of a disease along with the likelihood of disease-related mortality. Current imaging modalities provides information about either decreased function or extracellular signs of fibrosis. Targeting activated fibroblasts represents a burgeoning approach that could offer insights prior to observable functional alterations, presenting a promising focus for potential anti-fibrotic therapeutic interventions at cellular level. In this article, we provide an overview of imaging cardiac fibrosis and discuss the role of different advanced imaging modalities with the focus on novel non-invasive imaging of activated fibroblasts.
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Affiliation(s)
- Tugce Telli
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Atefeh Hosseini
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Stephan Settelmeier
- Westgerman Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Tienush Rassaf
- Westgerman Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Zohreh Varasteh
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
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Leone O, Agostini V, Foà A, Cerbelli B, di Gioia CRT, Aromatario M, Ciallella C, Lucena J, d'Amati G. Cardiac pathologic findings in 3 unusual cases of sudden cardiac death related to anorexiant drugs. Hum Pathol 2017; 69:101-109. [PMID: 29024685 DOI: 10.1016/j.humpath.2017.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 12/23/2022]
Abstract
Amphetamine congeners can be prescribed as anorexiant drugs despite their potential adverse effects, including cardiac toxicity. However, the morphologic features of cardiac damage related to protracted use of these compounds are unknown. We provide a detailed description of cardiac autopsy findings in 3 cases of sudden death associated with protracted use of high doses of phendimetrazine and/or phenylpropanolamine or bupropion prescribed as anorexiants, in association with other compounds. The main cardiac findings were similar in all 3 cases: (1) mild-moderate hypertrophy of the left ventricle and/or the septum; (2) myocardial nonischemic scarring (midmural and/or subepicardial) appearing as discrete foci or with a bandlike morphology; (3) mild-moderate intramural small vessel disease in the absence of significant epicardial coronary artery stenosis; and (4) acute/recent inflammatory lesions consistent with toxic myocarditis. In summary, the detailed pathology examination of the heart in these 3 cases revealed myocardial lesions identical to those reported in catecholamine myocardial damage in all their various stages of evolution. In the presence of a clinical history of long-term intake of anorexiants of this category, it is most important at autopsy to recognize and correctly interpret the acute and chronic myocardial lesions of the type herein described because they represent an anatomical substrate for arrhythmic death.
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Affiliation(s)
- Ornella Leone
- Department of Pathology, S. Orsola-Malpighi University Hospital, Bologna, 40138, Italy.
| | - Valentina Agostini
- Department of Pathology, S. Orsola-Malpighi University Hospital, Bologna, 40138, Italy
| | - Alberto Foà
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, 40138, Italy
| | - Bruna Cerbelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, 00161, Italy
| | | | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza, University of Rome, Rome, 00161, Italy
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza, University of Rome, Rome, 00161, Italy
| | - Joaquin Lucena
- Department of Forensic Pathology, Institute of Legal Medicine and Forensic Sciences, Seville, 41015, Spain
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, 00161, Italy.
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Correlation of left ventricular wall thickness, heart mass, serological parameters and late gadolinium enhancement in cardiovascular magnetic resonance imaging of myocardial inflammation in an experimental animal model of autoimmune myocarditis. Int J Cardiovasc Imaging 2012; 28:1983-97. [DOI: 10.1007/s10554-012-0020-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/17/2012] [Indexed: 12/26/2022]
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Korkusuz H, Esters P, Naguib N, Nour Eldin NE, Lindemayr S, Huebner F, Koujan A, Bug R, Ackermann H, Vogl TJ. Acute myocarditis in a rat model: late gadolinium enhancement with histopathological correlation. Eur Radiol 2009; 19:2672-8. [DOI: 10.1007/s00330-009-1454-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 03/17/2009] [Accepted: 03/26/2009] [Indexed: 02/08/2023]
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Psaltis PJ, Carbone A, Nelson A, Lau DH, Manavis J, Finnie J, Teo KS, Mackenzie L, Sanders P, Gronthos S, Zannettino AC, Worthley SG. An Ovine Model of Toxic, Nonischemic Cardiomyopathy—Assessment by Cardiac Magnetic Resonance Imaging. J Card Fail 2008; 14:785-95. [DOI: 10.1016/j.cardfail.2008.06.449] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 06/17/2008] [Accepted: 06/30/2008] [Indexed: 11/29/2022]
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Grosse-Wortmann L, Macgowan CK, Vidarsson L, Yoo SJ. Late gadolinium enhancement of the right ventricular myocardium: is it really different from the left ? J Cardiovasc Magn Reson 2008; 10:20. [PMID: 18466606 PMCID: PMC2430565 DOI: 10.1186/1532-429x-10-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 05/08/2008] [Indexed: 01/01/2023] Open
Abstract
It has been suggested that, in late gadolinium enhancement, the signal of right ventricular myocardium is nulled at a shorter inversion time than the left. While we initially made the same observation, we believe that the difference is not real, but results from artifacts. We present 7 cases as well as computer simulations to describe the nature of these artifacts and explain how they can create the impression of different inversion times for the right and left ventricle. At inversion times that are shorter than ideal for the myocardium a black rim can be seen at the border of the myocardium with blood on the inside and with fat on the outside. This is most likely a partial volume effect. The thin myocardium of the right ventricle is sandwiched between these black rims and, at a low spatial resolution, is no longer visible. In this case, the adjacent black rims may then be misinterpreted as myocardium. While black rims also occur on the left side, the myocardium is thicker and remains discernable as a separate layer. As a consequence, the optimal inversion time for the right ventricle only appears different from that for the left. In fact, in the presence of hypertrophy of the right ventricle or during systolic wall thickening we did not find a difference in inversion times between the left and right ventricle. We conclude that sufficient spatial resolution is important for adequate late gadolinium enhancement of the right ventricle.
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Affiliation(s)
- Lars Grosse-Wortmann
- Section of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
- Department of Pediatric Cardiology, RWTH University of Aachen, Germany
| | - Christopher K Macgowan
- Department of Medical Biophysics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
- Department of Medical Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
| | - Logi Vidarsson
- Section of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
| | - Shi-Joon Yoo
- Section of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto, Toronto, Canada
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