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Yamamoto A, Nagao M, Kawakubo M, Nakao R, Matsuo Y, Sakai A, Kaneko K, Fukushima K, Momose M, Sakai S, Yamaguchi J. Risk Stratification Using Right Ventricular Longitudinal Strain Ratio Derived from 13N-Ammonia PET in Patients with Ischemic Heart Disease. Radiol Cardiothorac Imaging 2024; 6:e230298. [PMID: 38814185 DOI: 10.1148/ryct.230298] [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] [Indexed: 05/31/2024]
Abstract
Purpose To investigate whether right ventricular (RV) myocardial strain ratio (RVMSR) assessed using nitrogen 13 ammonia (13N-NH3) PET can predict cardiovascular events in patients with ischemic heart disease (IHD). Materials and Methods This retrospective study included 480 consecutive patients (mean age, 66 years ± 12 [SD]; 334 males and 146 females) with IHD who underwent 13N-NH3 PET. RVMSR was defined as the ratio of RV strain during stress to that at rest. The primary end point was major adverse cardiac events (MACEs), defined as cardiac death or heart failure hospitalization. The ability of RVMSR to predict MACE was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) with 95% CIs. Results ROC curve analysis identified a sensitivity and specificity of 84% and 82%, respectively, for predicting MACE from RVMSR. Patients with reduced RVMSR (<110.2) displayed a significantly higher rate of MACE than those with a preserved RVMSR (34 of 240 vs four of 240; P < .001). Cox proportional hazards regression analysis of imaging parameters, including myocardial flow reserve, indicated that RVMSR was an independent predictor of MACE (HR, 0.94 [95% CI: 0.92, 0.97]; P < .001). Conclusion RVMSR was an independent predictor of MACE and has potential to aid in the risk stratification of patients with IHD. Keywords: Right Ventricular Myocardial Strain Ratio, Myocardial Flow Reserve, Ischemic Heart Disease, 13N-Ammonia Positron Emission Tomography Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Atsushi Yamamoto
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Michinobu Nagao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Masateru Kawakubo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Risako Nakao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Yuka Matsuo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Akiko Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Koichiro Kaneko
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Kenji Fukushima
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Mitsuru Momose
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Shuji Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
| | - Junichi Yamaguchi
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K., M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan (K.F.)
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Larsen CK, Smiseth OA, Duchenne J, Galli E, Aalen JM, Lederlin M, Bogaert J, Kongsgaard E, Linde C, Penicka M, Donal E, Voigt JU, Hopp E. Cardiac Magnetic Resonance Identifies Responders to Cardiac Resynchronization Therapy with an Assessment of Septal Scar and Left Ventricular Dyssynchrony. J Clin Med 2023; 12:7182. [PMID: 38002795 PMCID: PMC10672328 DOI: 10.3390/jcm12227182] [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: 10/11/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
Background: The response to cardiac resynchronization therapy (CRT) depends on septal viability and correction of abnormal septal motion. This study investigates if cardiac magnetic resonance (CMR) as a single modality can identify CRT responders with combined imaging of pathological septal motion (septal flash) and septal scar. Methods: In a prospective, multicenter, observational study of 136 CRT recipients, septal scar was assessed using late gadolinium enhancement (LGE) (n = 127) and septal flash visually from cine CMR sequences. The primary endpoint was CRT response, defined as ≥15% reduction in LV end-systolic volume with echocardiography after 6 months. The secondary endpoint was heart transplantation or death of any cause assessed after 39 ± 13 months. Results: Septal scar and septal flash were independent predictors of CRT response in multivariable analysis (both p < 0.001), while QRS duration and morphology were not. The combined approach of septal scar and septal flash predicted CRT response with an area under the curve of 0.86 (95% confidence interval (CI): 0.78-0.94) and was a strong predictor of long-term survival without heart transplantation (hazard ratio 0.27, 95% CI: 0.10-0.79). The accuracy of the approach was similar in the subgroup with intermediate (130-150 ms) QRS duration. The combined approach was superior to septal scar and septal flash alone (p < 0.01). Conclusions: The combined assessment of septal scar and septal flash using CMR as a single-image modality identifies CRT responders with high accuracy and predicts long-term survival.
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Affiliation(s)
- Camilla Kjellstad Larsen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway; (C.K.L.); (O.A.S.); (J.M.A.)
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Otto A. Smiseth
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway; (C.K.L.); (O.A.S.); (J.M.A.)
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium (J.-U.V.)
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Elena Galli
- Department of Cardiology, University Hospital of Rennes, 35000 Rennes, France; (E.G.); (E.D.)
| | - John Moene Aalen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway; (C.K.L.); (O.A.S.); (J.M.A.)
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Mathieu Lederlin
- Department of Radiology, University Hospital of Rennes, 35000 Rennes, France;
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Erik Kongsgaard
- Department of Cardiology, Oslo University Hospital, 0027 Oslo, Norway;
| | - Cecilia Linde
- Department of Cardiology, Karolinska University Hospital, 171 64 Solna, Sweden;
| | | | - Erwan Donal
- Department of Cardiology, University Hospital of Rennes, 35000 Rennes, France; (E.G.); (E.D.)
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium (J.-U.V.)
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0027 Oslo, Norway
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Pola K, Roijer A, Borgquist R, Ostenfeld E, Carlsson M, Bakos Z, Arheden H, Arvidsson PM. Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy. J Cardiovasc Magn Reson 2023; 25:45. [PMID: 37620886 PMCID: PMC10463519 DOI: 10.1186/s12968-023-00955-8] [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: 04/22/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients with heart failure and left bundle branch block (LBBB) may receive cardiac resynchronization therapy (CRT), but current selection criteria are imprecise, and many patients have limited treatment response. Hemodynamic forces (HDF) have been suggested as a marker for CRT response. The aim of this study was therefore to investigate left ventricular (LV) HDF as a predictive marker for LV remodeling after CRT. METHODS Patients with heart failure, EF < 35% and LBBB (n = 22) underwent CMR with 4D flow prior to CRT. LV HDF were computed in three directions using the Navier-Stokes equations, reported in median N [interquartile range], and the ratio of transverse/longitudinal HDF was calculated for systole and diastole. Transthoracic echocardiography was performed before and 6 months after CRT. Patients with end-systolic volume reduction ≥ 15% were defined as responders. RESULTS Non-responders had smaller HDF than responders in the inferior-anterior direction in systole (0.06 [0.03] vs. 0.07 [0.03], p = 0.04), and in the apex-base direction in diastole (0.09 [0.02] vs. 0.1 [0.05], p = 0.047). Non-responders had larger diastolic HDF ratio compared to responders (0.89 vs. 0.67, p = 0.004). ROC analysis of diastolic HDF ratio for identifying CRT non-responders had AUC of 0.88 (p = 0.005) with sensitivity 57% and specificity 100% for ratio > 0.87. Intragroup comparison found higher HDF ratio in systole compared to diastole for responders (p = 0.003), but not for non-responders (p = 0.8). CONCLUSION Hemodynamic force ratio is a potential marker for identifying patients with heart failure and LBBB who are unlikely to benefit from CRT. Larger-scale studies are required before implementation of HDF analysis into clinical practice.
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Affiliation(s)
- Karin Pola
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Roijer
- Heart Failure and Valvular Heart Disease Section, Skåne University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Zoltan Bakos
- Cardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Per M Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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