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Kidoh M, Oda S, Takashio S, Morioka M, Kuyama N, Oguni T, Nakaura T, Nagayama Y, Izumiya Y, Tsujita K, Hirai T. MRI-Extracellular Volume Fraction Versus Histological Amyloid Load in Cardiac Amyloidosis: The Importance of T2 Mapping. Circ Cardiovasc Imaging 2025; 18:e017427. [PMID: 40116000 DOI: 10.1161/circimaging.124.017427] [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: 08/03/2024] [Accepted: 02/03/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-derived myocardial extracellular volume fraction (ECV) is elevated in the presence of fibrosis, amyloid deposition, inflammation, and edema. In patients with cardiac amyloidosis and prolonged T2 due to concomitant inflammation or edema, MRI-ECV may not correctly reflect histological amyloid load. The authors sought to determine whether MRI-ECV can accurately reflect histological amyloid load in 2 groups of patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM), with and without T2 prolongation. METHODS This retrospective study included consecutive patients with ATTRwt-CM who underwent endomyocardial biopsy and cardiac MRI from March 2017 to October 2021 for initial evaluation of ATTRwt-CM. We measured MRI-ECV and T2, and evaluated correlation between MRI-ECV and amyloid load from endomyocardial biopsy by means of Pearson correlation analysis. RESULTS Of 44 patients (mean age, 75±6 years [SD]; 40 men), 24 showed T2 prolongation (T2≥50 milliseconds). All specimens obtained by endomyocardial biopsy were suitable for analysis. The interval between endomyocardial biopsy and cardiac MRI examination was a median of 3 days (interquartile range, 2-4). In the absence of T2 prolongation due to increased water content, MRI-ECV and amyloid load showed a moderately significant correlation (Spearman ρ=0.50, P=0.03). However, in the presence of T2 prolongation, there was no significant correlation between MRI-ECV and amyloid load (Spearman ρ=-0.05, P=0.83). CONCLUSIONS In patients with ATTRwt-CM and prolonged T2, MRI-ECV did not accurately reflect histological amyloid load. Our findings underscore the need for a multiparametric imaging approach, combining both ECV and T2 mapping, to better characterize myocardial tissue in patients with ATTRwt-CM, and further prospective research in larger and more diverse cohorts is needed to validate our results.
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Affiliation(s)
- Masafumi Kidoh
- Department of Diagnostic Radiology (M.K., S.O., T.N., Y.N., T.H.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology (M.K., S.O., T.N., Y.N., T.H.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine (S.T., M.M., N.K., T.O., Y.I., K.T.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Mami Morioka
- Department of Cardiovascular Medicine (S.T., M.M., N.K., T.O., Y.I., K.T.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Naoto Kuyama
- Department of Cardiovascular Medicine (S.T., M.M., N.K., T.O., Y.I., K.T.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Tetsuya Oguni
- Department of Cardiovascular Medicine (S.T., M.M., N.K., T.O., Y.I., K.T.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology (M.K., S.O., T.N., Y.N., T.H.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology (M.K., S.O., T.N., Y.N., T.H.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine (S.T., M.M., N.K., T.O., Y.I., K.T.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine (S.T., M.M., N.K., T.O., Y.I., K.T.), Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology (M.K., S.O., T.N., Y.N., T.H.), Graduate School of Medical Sciences, Kumamoto University, Japan
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Arya A, Di Biase L, Bazán V, Berruezo A, d'Avila A, Della Bella P, Enriquez A, Hocini M, Kautzner J, Pak HN, Stevenson WG, Zeppenfeld K, Sepehri Shamloo A. Epicardial ventricular arrhythmia ablation: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology and the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society. Europace 2025; 27:euaf055. [PMID: 40163515 PMCID: PMC11956854 DOI: 10.1093/europace/euaf055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Accepted: 03/10/2025] [Indexed: 04/02/2025] Open
Abstract
Epicardial access during electrophysiology procedures offers valuable insights and therapeutic options for managing ventricular arrhythmias (VAs). The current clinical consensus statement on epicardial VA ablation aims to provide clinicians with a comprehensive understanding of this complex clinical scenario. It offers structured advice and a systematic approach to patient management. Specific sections are devoted to anatomical considerations, criteria for epicardial access and mapping evaluation, methods of epicardial access, management of complications, training, and institutional requirements for epicardial VA ablation. This consensus is a joint effort of collaborating cardiac electrophysiology societies, including the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.
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Affiliation(s)
- Arash Arya
- Department of Cardiology, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Health System, Albert Einstein College of Medicine, New York, USA
| | - Victor Bazán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Andrea d'Avila
- Harvard-Thorndike Arrhythmia Institute and Division of Cardiovascular Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Paolo Della Bella
- Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy
| | - Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Mélèze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Yonsei University Health System, Seoul, Republic of Korea
| | - William G Stevenson
- Department of Cardiology, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alireza Sepehri Shamloo
- Department of Cardiology, Deutsches Herzzentrum der Charité-Medical Heart Center of Charité, German Heart Institute Berlin, Berlin, Germany
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Huang S, Wang X, Li Q, Xiong X, He C, Feng K, Jing J, Ma J. Sigmoid ventricular septum treated with endocardial ablation to improve left ventricular outflow: cases report. Front Cardiovasc Med 2024; 11:1439504. [PMID: 39421158 PMCID: PMC11484014 DOI: 10.3389/fcvm.2024.1439504] [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: 05/28/2024] [Accepted: 09/23/2024] [Indexed: 10/19/2024] Open
Abstract
Background Sigmoid Ventricular Septum (SVS) is a type of hypertrophic cardiomyopathy characterized by a reduced angle between the basal interventricular septum and the ascending aorta, and SVS can lead to dynamic Left Ventricular Outflow Tract obstruction (LVOTO) during hypercontractile states. Patients experiencing LVOTO may manifest symptoms such as angina, syncope, etc. Radiofrequency ablation (RFA) has been utilized to treat patients with hypertrophic obstructive cardiomyopathy, but there is no reports on its use in treating LVOTO resulting from SVS. Our report describes two cases of SVS treated with endocardial ablation to improve LVOTO. Case report Case 1: A 74-year-old female patient with angina and syncope was admitted to the hospital and diagnosed with SVS by transthoracic echocardiogram. The patient exhibited LVOTO and Systolic Anterior Motion (SAM) phenomena during the administration of the dobutamine stress test. After RFA was performed, the patient's symptoms significantly improved. Additionally, septum decreased from 16 to 13 mm after ten months, and the morphological changes associated with SVS also disappeared. Case 2: A 57-year-old female was admitted to the hospital due to recurrent chest pain after physical activity for more than four years. The transthoracic echocardiogram indicated that the patient met the diagnostic criteria for SVS, and LVOTO and SAM phenomenaoccurred following dobutamine stress test. The patient had significant improvement in symptoms after undergoing RFA treatment. Conclusions These two cases represent the first documented instances where dynamic LVOTO caused by SVS could be effectively managed through endocardial RFA.
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Affiliation(s)
- Shen Huang
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xiuyu Wang
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Qiyan Li
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - XinLin Xiong
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chuan He
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Kun Feng
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jiafa Jing
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jun Ma
- Department of Cardiology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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