The Auxiliary Role of Cardiac Magnetic Resonance Feature-Tracking Parameters in the Differentiation between Cardiac Amyloidosis and Constrictive Pericarditis

The Value of Cardiac MRI Strain Measures in Predicting Adverse Events in Hypertrophic Cardiomyopathy Patients: A Multiparametric Retrospective Cohort Study

RATIONALE AND OBJECTIVES

We aimed to investigate the role of cardiac magnetic resonance (CMR) imaging parameters, especially strain values, in predicting adverse events in patients with hypertrophic cardiomyopathy (HCM).

MATERIALS AND METHODS

CMR and clinical data of 221 definite cases of HCM were evaluated retrospectively. A combined outcome, comprising sudden cardiac death (SCD), aborted SCD, the insertion of an implantable cardioverter-defibrillator (ICD), and the deterioration of left ventricular (LV) systolic function, was registered during a median (interquartile range) follow-up time of 25.8 (23.7) months. Intergroup differences were estimated utilizing a t test, and the predictive values of variables were investigated using the Cox proportional hazard regression analysis. The receiver operating curve analysis demonstrated the best cutoff value for potent predictors.

RESULTS

Sixty (27.1%) out of the 221 patients (mean±SD age =44.58±16.85 y, 131 men) demonstrated endpoints on follow-up. Multiple CMR parameters predicted adverse events in the univariate analysis. LV global longitudinal and radial strain (GLS and GRS) values were the most robust predictors in the multivariate Cox regression analysis (HR [confidence interval], 1.26 [1.16 to 1.36] and 1.02 [1.00 to 1.04], respectively; P<0.05). LV GLS ≥ -12.96% predicted adverse events with a sensitivity of 78% and a specificity of 76% (area under the curve =0.81; P<0.001).

CONCLUSION

Multiple CMR parameters predicted adverse events in HCM patients, with feature tracking-CMR values, LV GLS, and LV GRS being the most robust predictors.

Rapid progression of monoclonal gammopathy of undetermined significance to cardiac amyloidosis with intracardiac thrombus: Unveiling via cardiac magnetic resonance

We present the case of a 67-year-old male diagnosed with Monoclonal Gammopathy of Undetermined Significance (MGUS) who developed progressive peripheral edema and abdominal distension, raising concerns for right-sided heart failure. Initial investigations, including electrocardiography and transthoracic echocardiography (TTE), revealed findings suggestive of restrictive diastolic dysfunction, including low-voltage QRS complexes, concentric left ventricular hypertrophy, left atrial enlargement, and valvular thickening, despite a preserved ejection fraction (EF) of 62%. These findings raised suspicion for AL-type cardiac amyloidosis in the context of the patient's recent MGUS diagnosis. Although no thrombus was detected on TTE, cardiac magnetic resonance imaging (CMR) conducted 2 weeks later demonstrated findings supportive of cardiac amyloidosis, such as myocardial infiltration and increased extracellular volume, and identified a left atrial appendage thrombus which was not visualized on the initial TTE. This case highlights the diagnostic superiority of CMR over TTE in detecting intracardiac thrombi. While transesophageal echocardiography (TEE) remains the gold standard for thrombus detection, its semi-invasive nature limits its routine use in initial evaluations. The findings underscore the importance of early utilization of CMR in suspected cardiac amyloidosis cases, emphasizing its comprehensive noninvasive assessment capabilities for guiding timely diagnosis and management.

The Role of Cardiac Magnetic Resonance Imaging Parameters in Prognostication of Systemic Sclerosis in Patients with Cardiac Involvement: A Systematic Review of the Literature

BACKGROUND

Systemic sclerosis (SSc) is an immune dysregulation disorder affecting multiple organs. Cardiac involvement, prevalently myocardial, is associated with poor outcomes in SSc patients. Several investigations explored the role of cardiac magnetic resonance (CMR) imaging in the diagnosis of scleroderma-related cardiomyopathy and analyzed the clinical, radiologic, and pathologic correlations utilizing CMR examinations. However, fewer studies investigated the role of traditional and novel CMR parameters, including functional values, strain, late gadolinium enhancement (LGE), and parametric mapping variables, in predicting outcomes in SSc patients. We aimed to review the literature to seek for the role of different CMR features in outcome prediction of SSc patients.

METHODS

We systematically reviewed PubMed/Medline, EMBASE, Web of Science, and Scopus databases to find publications that analyzed the prognostic value of CMR-derived parameters for adverse events, particularly all-cause mortality, in SSc patients published from January of 1960, up to the May 1, 2023. In this regard, we excluded the reviews, editorials, case reports, and case series. Also, we excluded the studies with the target population possessing obstructive coronary artery disease, other rheumatologic conditions, moderate to severe pulmonary hypertension and history of intervention for arrhythmia. Two of the authors principally extracted data, and disagreements were resolved through consensus. Information from each investigation was registered. Two of the authors utilized the Quality in Prognostic Studies (QUIPS) tool for risk of bias assessment, and a third reviewer was involved in cases of inconsistencies. Consequently, the main findings of the conducted projects were outlined and depicted in tables.

RESULTS

The initial search yielded 4623 papers. After removing duplicates and irrelevant titles/abstracts, 120 full-text articles were reviewed. Nine studies met the criteria with study population ranging from 24 to 260 patients in included studies. The following CMR parameters were powerful predictors of all-cause mortality: myocardial LGE, native T1 value, extracellular volume (ECV), and ventricular strain. Although less studied, left atrial strain, diffusion/perfusion, and stress-CMR parameters were also predictors of outcomes.

DISCUSSION

In SSc patients, CMR findings, including myocardial LGE, native T1 value, ECV, and ventricular strain values, were robust predictors of adverse outcomes. Other CMR parameters, consisting of diffusion/perfusion and stress-CMR values, were less studied. A drawback encountered while we were reviewing the studies was the versatility of measurement criteria among the included studies that precluded us from driving a meta-analysis. Further longitudinal multiparametric CMR studies are required to investigate the prognostic role of CMR examination in SSc patients.

REGISTRATION

The systematic review protocol containing the planned methods was registered in PROSPERO before starting the review process (PROSPERO, registration ID: CRD42023446391).

Advances in the Diagnosis and Management of Cardiac Amyloidosis: A Literature Review

Cardiac amyloidosis, increasingly recognized for its significant impact on global heart health and patient survival, demands a thorough review to understand its complexity and the urgency of improved management strategies. As a cause of cardiomyopathy and heart failure, particularly in patients with aortic stenosis and atrial fibrillation, this condition also relates to higher incidences of dementia in the affected populations. The objective of this review was to integrate and discuss the latest advancements in diagnostics and therapeutics for cardiac amyloidosis, emphasizing the implications for patient prognosis. We evaluated the latest literature from major medical databases such as PubMed and Scopus, focusing on research from 2020 to 2024, to gather comprehensive insights into the current landscape of this condition. Insights from our review highlight the complex pathophysiology of cardiac amyloidosis and the diagnostic challenges it presents. We detail the effectiveness of emerging treatments, notably gene silencing therapies like patisiran and vutrisiran, which offer transformative potential by targeting the production of amyloidogenic proteins. Additionally, the stabilization therapy acoramidis shows promise in modifying disease progression and improving clinical outcomes. This review underscores the critical need for updated clinical guidelines and further research to expand access to groundbreaking therapies and enhance disease management. Advocating for continued research and policy support, we emphasize the importance of advancing diagnostic precision and treatment effectiveness, which are vital for improving patient outcomes and addressing this debilitating disease globally.

The relationship of myocardial and liver T2* values with cardiac function and laboratory findings in transfusion-dependent thalassemia major patients: A retrospective cardiac MRI study

Introduction

Cardiac complications are the leading cause of death in thalassemia patients. It is assumed that progressive iron accumulation results in myocyte damage. Myocardial T2* measurement by cardiac MRI quantifies iron overload. We aimed to study the association between left and right ventricular (LV and RV) function and iron deposition estimation by cardiac MRI T2* in a sample of Iranian patients.

Methods

Cardiac MRI exams of 118 transfusion-dependent thalassemia major patients were evaluated retrospectively. Biventricular function and volume and myocardial and liver T2* values were measured. The demographic and lab data were registered. Poisson and chi-square regression analyses investigated the correlation between the T2* value and ventricular dysfunction.

Results

The study participants' mean (SD) age was 32.7y (9.02), and 47.46% were female. Forty-nine cases (41.52%) revealed at least uni-ventricular dysfunction. LV dysfunction was noted in 20 cases, whereas 47 patients revealed RV dysfunction. The risk of LV dysfunction was 5.3-fold higher in patients with cardiac T2* value less than 10msec (RR=5.3, 95% CI=1.6, 17.1, P<0.05). No association was found between age, liver T2* value, serum ferritin level, and chelation therapy with the risk of LV and RV dysfunction.

Conclusion

Cardiac MRI T2* measure is a good indicator of LV dysfunction. Moreover, MRI parameters, especially RV functional measures, may have a substantial role in patient management. Therefore, cardiac MRI should be included in beta-thalassemia patients' management strategies.

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

Purpose of Review

The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP.

Recent Findings

Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques.

Summary

Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.

Cardiac Magnetic Resonance Imaging Techniques and Applications for Pericardial Diseases

Cardiac magnetic resonance imaging plays a central role among multimodality imaging modalities in the assessment, diagnosis, and surveillance of pericardial diseases. Clinicians and imagers should have a foundational understanding of the utilities, advantages, and limitations of cardiac magnetic resonance imaging and how they integrate with other diagnostic tools involved in the evaluation and management of pericardial diseases. This review aims to outline the contemporary magnetic resonance imaging sequences used to evaluate the pericardium, followed by exploring the main clinical applications of magnetic resonance imaging for identifying pericardial inflammation, constriction, and effusion.