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Cavus E, Schneider JN, di Carluccio E, Ziegler A, Haack A, Ojeda F, Chevalier C, Jahnke C, Riedl KA, Radunski UK, Twerenbold R, Kirchhof P, Blankenberg S, Adam G, Tahir E, Lund GK, Muellerleile K. Unrecognized myocardial scar by late-gadolinium-enhancement cardiovascular magnetic resonance: Insights from the population-based Hamburg City Health Study. J Cardiovasc Magn Reson 2024; 26:101008. [PMID: 38341145 PMCID: PMC10944257 DOI: 10.1016/j.jocmr.2024.101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent "unrecognized myocardial scar" (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns, and risk factors of UMS. METHODS The study population consisted of 1064 consecutive Hamburg City Health Study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR. RESULTS Median age was 66 [quartiles 59, 71] years and 37% (388/1064) were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal inferolateral left-ventricular (LV) myocardium (75%). Two participants (1%) had coincident ischemic and non-ischemic scar. The presence of any UMS was independently associated with LV ejection fraction (odds ratios (OR) per standard deviation (SD) 0.77 (confidence interval (CI) 0.65-0.90), p = 0.002) and LV mass (OR per SD 1.54 (CI 1.31-1.82), p < 0.001). Ischemic UMS was independently associated with LV ejection fraction (OR per SD 0.58 (CI 0.39-0.86), p = 0.007), LV mass (OR per SD 1.74 (CI 1.25-2.45), p = 0.001), and diabetes (OR 4.91 (CI 1.66-13.03), p = 0.002). Non-ischemic UMS was only independently associated with LV mass (OR per SD 1.44 (CI 1.24-1.69), p < 0.001). CONCLUSION UMS, in particular with a non-ischemic pattern, is frequent in individuals without known cardiac disease and predominantly involves the basal inferolateral LV myocardium. Presence of UMS is independently associated with a lower LVEF, a higher LV mass, and a history of diabetes.
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Affiliation(s)
- Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany.
| | - Jan N Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Eleonora di Carluccio
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Cardio-Care, Medizincampus Davos, Davos, Switzerland
| | - Andreas Ziegler
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Cardio-Care, Medizincampus Davos, Davos, Switzerland; School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Alena Haack
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Katharina A Riedl
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Ulf K Radunski
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany; University Center of Cardiovascular Science, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
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Zhao L, Chen M, Chen X, Yu L, Du SG, Gan Q, Yang WZ, Jiang C, Xiao M. Ectopic pheochromocytomas in the third trimester: A case report and literature review. Medicine (Baltimore) 2024; 103:e36127. [PMID: 38306535 PMCID: PMC10843473 DOI: 10.1097/md.0000000000036127] [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: 08/17/2023] [Accepted: 10/25/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION To investigate the clinical features, pregnancy care, timing, and approaches of pregnancy termination as well as the perinatal management of pregnant women with ectopic pheochromocytomas (EPCC) (paragangliomas, PGL). METHODS We report the diagnosis and treatment of a pregnant women with EPCC which was confirmed in the third trimester in our hospital. Literature in relation to EPCC during pregnancy both in and outside China was searched for data analysis such as maternal clinical features and maternal and fetal prognosis. RESULTS A total of 20 papers including 21 cases (plus ours) were retrieved. The average age of pregnant patients was 28 years old (from 21 to 37). Two patients presented no hypertension. Nineteen had hypertension in various extent with the accompany of headache (11 cases, 57.9%), palpitations (8 cases, 42.1%), sweating (6 cases, 31.6%), nausea (6 cases), abdominal pain (2 cases), etc. The tumor was found in the chest in 3 patients, in the upper abdomen in 1 patient, in the middle abdomen in 10 patients, between the lower abdomen and pelvic cavity in 3 patients and in the pelvic cavity in 3 patients. Five patients had a surgical removal of the tumor before delivery, 3 during cesarean section and 10 after giving birth. CONCLUSION EPCC (PGL) during pregnancy is a rare extra-adrenal tumor, whose manifestations are often confused with those of pregnancy-induced hypertension. It is extremely hard to diagnosis the disease before surgery. Patients still have an opportunity of undergoing spontaneous delivery if their tumors have been removed before labor. However, for patients whose pheochromocytomas is localized before labor, it is better to terminate their pregnancy via cesarean section in a proper time according to their obstetric conditions, while under the supervision of multidisciplinary specialists. The preparations of both α and β adrenergic receptor blocker treatment that is normally carried out before PGL removal surgery are unnecessary to be overemphasized before the cesarean section.
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Affiliation(s)
- Lei Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Miaomiao Chen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xiaohong Chen
- Department of Internal Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Ling Yu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Shu Guo Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Quan Gan
- Department of Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Wen Zhong Yang
- Department of Medical Imaging, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Chengcheng Jiang
- Department of Medical Imaging, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Mei Xiao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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Bukas C, Galter I, da Silva-Buttkus P, Fuchs H, Maier H, Gailus-Durner V, Müller CL, Hrabě de Angelis M, Piraud M, Spielmann N. Echo2Pheno: a deep-learning application to uncover echocardiographic phenotypes in conscious mice. Mamm Genome 2023; 34:200-215. [PMID: 37221250 PMCID: PMC10290584 DOI: 10.1007/s00335-023-09996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023]
Abstract
Echocardiography, a rapid and cost-effective imaging technique, assesses cardiac function and structure. Despite its popularity in cardiovascular medicine and clinical research, image-derived phenotypic measurements are manually performed, requiring expert knowledge and training. Notwithstanding great progress in deep-learning applications in small animal echocardiography, the focus has so far only been on images of anesthetized rodents. We present here a new algorithm specifically designed for echocardiograms acquired in conscious mice called Echo2Pheno, an automatic statistical learning workflow for analyzing and interpreting high-throughput non-anesthetized transthoracic murine echocardiographic images in the presence of genetic knockouts. Echo2Pheno comprises a neural network module for echocardiographic image analysis and phenotypic measurements, including a statistical hypothesis-testing framework for assessing phenotypic differences between populations. Using 2159 images of 16 different knockout mouse strains of the German Mouse Clinic, Echo2Pheno accurately confirms known cardiovascular genotype-phenotype relationships (e.g., Dystrophin) and discovers novel genes (e.g., CCR4-NOT transcription complex subunit 6-like, Cnot6l, and synaptotagmin-like protein 4, Sytl4), which cause altered cardiovascular phenotypes, as verified by H&E-stained histological images. Echo2Pheno provides an important step toward automatic end-to-end learning for linking echocardiographic readouts to cardiovascular phenotypes of interest in conscious mice.
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Affiliation(s)
- Christina Bukas
- Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany
| | - Isabella Galter
- Institute of Experimental Genetics, German Research Center for Environmental Health, Neuherberg, Germany
| | - Patricia da Silva-Buttkus
- Institute of Experimental Genetics, German Mouse Clinic, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Helmut Fuchs
- Institute of Experimental Genetics, German Mouse Clinic, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Holger Maier
- Institute of Experimental Genetics, German Research Center for Environmental Health, Neuherberg, Germany
| | - Valerie Gailus-Durner
- Institute of Experimental Genetics, German Mouse Clinic, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Christian L Müller
- Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Statistics, LMU München, Munich, Germany
- Center for Computational Mathematics, Flatiron Institute, New York, USA
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics, German Mouse Clinic, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
- Chair of Experimental Genetics, TUM School of Life Sciences, Technische Universität München, Freising, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
| | - Marie Piraud
- Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nadine Spielmann
- Institute of Experimental Genetics, German Mouse Clinic, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
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Marketou ME, Kapsoritakis N, Bourogianni O, Patrianakos A, Kochiadakis G, Plevritaki A, Papadaki S, Zervakis S, Parthenakis F, Koukouraki S. Hybrid imaging of neuroendocrine tumors in the heart: Union is strength. J Nucl Cardiol 2023; 30:298-312. [PMID: 34622428 DOI: 10.1007/s12350-021-02804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
Cardiac neuroendocrine tumors (NETs) are particularly rare tumors that can lead to a very poor clinical outcome, partly because of metastases but mainly because of manifestations of the hormonal activity they exhibit. Prompt diagnosis is important in order to start the most effective treatment for their removal or management, with the fewest complications. They are often difficult to diagnose, especially in their early stages. One of the reasons for this is that the heart is an organ with a high rate of metabolism and is located in close proximity to other high-metabolism organs. In addition, the anatomic location and their small size render their diagnosis extremely challenging. In recent years, hybrid imaging methods have revolutionized the diagnostic approach to oncology patients and have established a place in the diagnosis of cardiac NETs, because they provide both anatomical and functional information at the same time. Positron emission tomography/computed tomography (PET/CT), PET/magnetic resonance imaging (PET/MRI) and single-photon emission computed tomography/CT (SPECT/CT) are widely used in clinical practice because of the very important metabolic information, the high sensitivity and specificity. However, prospective studies are needed to confirm the true clinical and prognostic value of various hybrid imaging diagnostic techniques in cardiac NETs.
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Affiliation(s)
- Maria E Marketou
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece.
| | - Nikolaos Kapsoritakis
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Olga Bourogianni
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandros Patrianakos
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - George Kochiadakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Anthoula Plevritaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Papadaki
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Stelios Zervakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Fragiskos Parthenakis
- Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Greece
| | - Sophia Koukouraki
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Multimodality Imaging of Benign Primary Cardiac Tumor. Diagnostics (Basel) 2022; 12:diagnostics12102543. [PMID: 36292232 PMCID: PMC9601182 DOI: 10.3390/diagnostics12102543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.
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Huang WP, Gao G, Chen Z, Qiu YK, Gao JB, Kang L. Multimodality Imaging Evaluation of Primary Right Atrial Paraganglioma: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:942558. [PMID: 35847796 PMCID: PMC9280297 DOI: 10.3389/fmed.2022.942558] [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: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCardiac paraganglioma (CPGL) accounts for 1–3% of cardiac tumors and is usually benign. In total, 35–50% of CPGL lesions secrete catecholamines, causing hypertension, excessive sweating, palpitations, headache, and other symptoms. Preoperative imaging evaluation is important to determine the location of the cardiac mass, its blood supply vessels, and the relationship with surrounding structures. Multimodal imaging techniques combine with morphological and functional information to provide powerful methods for preoperative diagnosis and lesion localization. Furthermore, they can assist to reduce the incidence of intraoperative and postoperative complications and improve patient prognosis.Case ReportA 67-year-old woman suffered from paroxysmal palpitations with a heart rate of 110 beats per minute 1 month ago. Urine catecholamine and methoxyepinephrine levels were significantly increased. The patient had a 5-year history of hypertension with a maximum blood pressure of 160/100 mmHg. Computed tomography (CT) examination found a soft tissue mass in the right atrium with heterogeneous and significant enhancement, whose blood supply was from the left ileal branch artery. The patient then underwent cardiac magnetic resonance (CMR). The lesion showed inhomogeneous iso signals on the T1-weighted image (T1WI), slightly high signals on the T2 fat-suppression image, inhomogeneous high signals on the diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) images. The mass exhibited heterogeneous and significant enhancement on the first perfusion and delayed scans after intravenous contrast injection. However, abnormal signals were surprisingly found in the patient’s right lung, and the possibility of metastatic lesions could not be excluded. The patient underwent F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) to rule out metastatic lesions. A fluorodeoxyglucose (FDG)-avid soft tissue mass was shown in the right atrium, with the maximum standardized uptake value (SUVmax) at about 15.2, as well as a pathological intake of brown fat throughout the body. Combined with clinical symptoms, CPGL was considered without significant sign of metastasis in 18F-FDG PET/CT. Finally, the patient underwent surgical resection and the post-operative pathology confirmed a CPGL.ConclusionThe combination of 18F-FDG PET/CT with the CMR containing different image acquisition sequences provides a powerful aid for preoperative non-invasive diagnosis, localization, and staging of CPGL, which helps to reduce intraoperative and postoperative complications and improve patient prognosis.
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Affiliation(s)
- Wen-peng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Ge Gao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Yong-kang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Jian-bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
- *Correspondence: Lei Kang,
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Arcos L, Bustos J, Acuña J, Cely A, Forero J, Jaimes C. Cardiac Paraganglioma: Advantages of Cardiovascular Multimodality Imaging. CASE (PHILADELPHIA, PA.) 2018; 2:266-272. [PMID: 30582088 PMCID: PMC6302035 DOI: 10.1016/j.case.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac paragangliomas are infrequent tumors. The most common location is in the left atrium. Cardiovascular morbidity and mortality without treatment are high. Different imaging techniques help determine the relation with adjacent structures. Multimodal cardiovascular imaging is an essential tool for diagnosis and therapy.
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Affiliation(s)
- Laura Arcos
- Universidad del Rosario Escuela de Medicina y Ciencias de la Salud, Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | - Jorge Bustos
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | | | | | - Julián Forero
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
| | - Claudia Jaimes
- Fundación Cardioinfantil, Instituto de Cardiología, Bogota, Colombia
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Saporito S, Houthuizen P, Aben JPMM, Westenberg JJM, van Den Bosch HCM, van Assen HC, Mischi M. Endocardial center motion for quantification of left ventricular discoordination in heart failure using cine MRI. Physiol Meas 2018; 39:025009. [PMID: 29369050 DOI: 10.1088/1361-6579/aaaaa0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare a novel cardiovascular magnetic resonance technique for the assessment of left ventricular (LV) mechanical discoordination by characterizing the endocardial center motion (ECM) in short-axis cine MRI in healthy volunteers and heart failure patients with left bundle branch block (HF-LBBB). APPROACH To evaluate ECM analysis as mechanical discoordination measure, we retrospectively compared spatial and temporal features of the ECM between a group of healthy volunteers (n = 14) and conduction defect patients (HF-LBBB, n = 31). We tracked the center of the endocardial borders on short-axis view MRI cine loops during the cardiac cycle. From the ECM trajectory we calculated the overall traveled distance, the enclosed area, the eccentricity of the trajectory, and the maximum traveled distance. The ECM can be visualized in spatial coordinates as well as by its temporal behavior. We evaluated the classification performance of these measures for LBBB detection. We also quantified the coherence of the ECM on the longitudinal direction by considering the variability of the ECM measures between different short-axis slices. MAIN RESULTS Patients with LBBB showed significantly higher traveled distance (p < 0.0001), enclosed area (p < 0.002), eccentricity (p < 0.02), and peak displacement (p < 0.02) of the endocardial center. Patients with positive late gadolinium enhancement showed a higher variability of ECM measures across different slices (p < 0.05). SIGNIFICANCE ECM analysis is feasible and it allows the assessment of left ventricular mechanical discoordination. Differences in ECM measures permit one to distinguish between LBBB and healthy volunteers.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, Netherlands
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Krämer M, Motaal AG, Herrmann KH, Löffler B, Reichenbach JR, Strijkers GJ, Hoerr V. Cardiac 4D phase-contrast CMR at 9.4 T using self-gated ultra-short echo time (UTE) imaging. J Cardiovasc Magn Reson 2017; 19:39. [PMID: 28359292 PMCID: PMC5374606 DOI: 10.1186/s12968-017-0351-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/02/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Time resolved 4D phase contrast (PC) cardiovascular magnetic resonance (CMR) in mice is challenging due to long scan times, small animal ECG-gating and the rapid blood flow and cardiac motion of small rodents. To overcome several of these technical challenges we implemented a retrospectively self-gated 4D PC radial ultra-short echo-time (UTE) acquisition scheme and assessed its performance in healthy mice by comparing the results with those obtained with an ECG-triggered 4D PC fast low angle shot (FLASH) sequence. METHODS Cardiac 4D PC CMR images were acquired at 9.4 T in healthy mice using the proposed self-gated radial center-out UTE acquisition scheme (TE/TR of 0.5 ms/3.1 ms) and a standard Cartesian 4D PC imaging sequence (TE/TR of 2.1 ms/5.0 ms) with a four-point Hadamard flow encoding scheme. To validate the proposed UTE flow imaging technique, experiments on a flow phantom with variable pump rates were performed. RESULTS The anatomical images and flow velocity maps of the proposed 4D PC UTE technique showed reduced artifacts and an improved SNR (left ventricular cavity (LV): 8.9 ± 2.5, myocardium (MC): 15.7 ± 1.9) compared to those obtained using a typical Cartesian FLASH sequence (LV: 5.6 ± 1.2, MC: 10.1 ± 1.4) that was used as a reference. With both sequences comparable flow velocities were obtained in the flow phantom as well as in the ascending aorta (UTE: 132.8 ± 18.3 cm/s, FLASH: 134.7 ± 13.4 cm/s) and pulmonary artery (UTE: 78.5 ± 15.4 cm/s, FLASH: 86.6 ± 6.2 cm/s) of the animals. Self-gated navigator signals derived from information of the oversampled k-space center were successfully extracted for all animals with a higher gating efficiency of time spent on acquiring gated data versus total measurement time (UTE: 61.8 ± 11.5%, FLASH: 48.5 ± 4.9%). CONCLUSIONS The proposed self-gated 4D PC UTE sequence enables robust and accurate flow velocity mapping of the mouse heart in vivo at high magnetic fields. At the same time SNR, gating efficiency, flow artifacts and image quality all improved compared to the images obtained using the well-established, ECG-triggered, 4D PC FLASH sequence.
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Affiliation(s)
- M. Krämer
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, D-07743 Jena, Germany
| | - A. G. Motaal
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - K-H. Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, D-07743 Jena, Germany
| | - B. Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - J. R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, D-07743 Jena, Germany
- Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Jena, Germany
- Abbe School of Photonics, Friedrich Schiller University Jena, Jena, Germany
- Center of Medical Optics and Photonics, Friedrich Schiller University Jena, Jena, Germany
| | - G. J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, Netherlands
| | - V. Hoerr
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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10
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Bhojwani N, Huang J, Garg V, Yang M, Oliveira GH, Rajiah P. Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Imaging in the Diagnosis of Cardiac Paraganglioma. Indian J Nucl Med 2017; 32:380-382. [PMID: 29142369 PMCID: PMC5672773 DOI: 10.4103/ijnm.ijnm_93_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cardiac paragangliomas are rare tumors of neural crest origin, most frequently seen in the left atrium. There are mixed opinions regarding the most appropriate imaging study for diagnosis and evaluation. We describe the novel utility of 18-F-Fluorodeoxyglucose positron emission tomography/magnetic resonance imaging in the case of a 42-year-old male with cardiac paraganglioma.
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Affiliation(s)
- Nicholas Bhojwani
- Division of Musculoskeletal Radiology, Medical Diagnostic Imaging Group, Phoenix, AZ 85029, USA
| | - Jennifer Huang
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Vasant Garg
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michael Yang
- Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Guilherme H Oliveira
- Department of Cardiology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Prabhakar Rajiah
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
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11
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Knechtle B, Valeri F, Nikolaidis PT, Zingg MA, Rosemann T, Rüst CA. Do women reduce the gap to men in ultra-marathon running? SPRINGERPLUS 2016; 5:672. [PMID: 27350909 PMCID: PMC4899381 DOI: 10.1186/s40064-016-2326-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/11/2016] [Indexed: 01/03/2023]
Abstract
The aim of the present study was to examine sex differences across years in performance of runners in ultra-marathons lasting from 6 h to 10 days (i.e. 6, 12, 24, 48, 72, 144, and 240 h). Data of 32,187 finishers competing between 1975 and 2013 with 93,109 finishes were analysed using multiple linear regression analyses. With increasing age, the sex gap for all race durations increased. Across calendar years, the gap between women and men decreased in 6, 72, 144 and 240 h, but increased in 24 and 48 h. The men-to-women ratio differed among age groups, where a higher ratio was observed in the older age groups, and this relationship varied by distance. In all durations of ultra-marathon, the participation of women and men varied by age (p < 0.001), indicating a relatively low participation of women in the older age groups. In summary, between 1975 and 2013, women were able to reduce the gap to men for most of timed ultra-marathons and for those age groups where they had relatively high participation.
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Affiliation(s)
- Beat Knechtle
- Gesundheitszentrum St. Gallen, Vadianstrasse 26, 9001 St. Gallen, Switzerland ; Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Pantelis T Nikolaidis
- Department of Physical and Cultural Education, Hellenic Army Academy, Athens, Greece
| | - Matthias A Zingg
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Christoph A Rüst
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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12
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Lafountain RA, da Silveira JS, Varghese J, Mihai G, Scandling D, Craft J, Swain CB, Franco V, Raman SV, Devor ST, Simonetti OP. Cardiopulmonary exercise testing in the MRI environment. Physiol Meas 2016; 37:N11-25. [DOI: 10.1088/0967-3334/37/4/n11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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13
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Pereira T, Correia C, Cardoso J. Novel Methods for Pulse Wave Velocity Measurement. J Med Biol Eng 2015; 35:555-565. [PMID: 26500469 PMCID: PMC4609308 DOI: 10.1007/s40846-015-0086-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/14/2015] [Indexed: 12/22/2022]
Abstract
The great incidence of cardiovascular (CV) diseases in the world spurs the search for new solutions to enable an early detection of pathological processes and provides more precise diagnosis based in multi-parameters assessment. The pulse wave velocity (PWV) is considered one of the most important clinical parameters for evaluate the CV risk, vascular adaptation, and therapeutic efficacy. Several studies were dedicated to find the relationship between PWV measurement and pathological status in different diseases, and proved the relevance of this parameter. The commercial devices dedicate to PWV estimation make a regional assessment (measured between two vessels), however a local measurement is more precise evaluation of artery condition, taking into account the differences in the structure of arteries. Moreover, the current devices present some limitations due to the contact nature. Emerging trends in CV monitoring are moving away from more invasive technologies to non-invasive and non-contact solutions. The great challenge is to explore the new instrumental solutions that allow the PWV assessment with fewer approximations for an accurately evaluation and relatively inexpensive techniques in order to be used in the clinical routine.
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Affiliation(s)
- Tânia Pereira
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
| | - Carlos Correia
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
| | - João Cardoso
- Physics Department, Instrumentation Center, University of Coimbra, Rua Larga, 3004-516 Coimbra, Portugal
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14
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Affiliation(s)
- Ji-Gang Wang
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao China
| | - Jing Han
- Department of Pathology; Zhongshan Hospital, Fudan University; Shanghai China
| | - Tao Jiang
- Department of Oncology; The Affiliated Hospital of Qingdao University; Qingdao China
| | - Yu-Jun Li
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao China
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15
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González López MT, González SG, García ES, Romero SG, de Loma JG. Surgical excision with left atrial reconstruction of a primary functioning retrocardiac paraganglioma. J Cardiothorac Surg 2013; 8:22. [PMID: 23360571 PMCID: PMC3599281 DOI: 10.1186/1749-8090-8-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/11/2013] [Indexed: 01/27/2023] Open
Abstract
About 2% of all paragangliomas are located in the chest, and a few have been described to be found in the heart. Primary cardiac paragangliomas are extremely uncommon tumors and surgical experience with this neoplasm is limited. Treatment strategies described in the literature have included simple excision, excision with reconstruction, autotransplantation after excision of the tumor and even orthotopic cardiac transplantation, depending on the extent of disease. A primary retrocardiac paraganglioma catecholamine-productive was identified in an asymptomatic 49–year old female associated to familial pheochromocytoma-paraganglioma syndrome caused by germline mutation of the gen which codifies for the subunit B of succinate dehydrogenase enzyme (SDHB). The neoplasm was surgically excised from the posterior surface of the left atrium via median sternotomy using cardiopulmonary bypass. Direct ligation of feeding vessels of the tumor along with left atrial reinforcement using a pericardial patch was performed. The post-operative course was uneventful, with normalization of catecholamine secretion and no recurrence at three-month follow-up. We review the current literature about this exceptional cardiac tumor, pathophysiological conditions and options for surgical management.
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Affiliation(s)
- María Teresa González López
- Cardiovascular Surgery Department, Carlos Haya Regional Hospital, Carlos Haya Avenue, s/n, 29010 Málaga, Spain.
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16
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Pennell DJ, Carpenter JP, Firmin DN, Kilner PJ, Mohiaddin RH, Prasad SK. Review of Journal of Cardiovascular Magnetic Resonance 2011. J Cardiovasc Magn Reson 2012; 14:78. [PMID: 23158097 PMCID: PMC3519784 DOI: 10.1186/1532-429x-14-78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 12/15/2022] Open
Abstract
There were 83 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2011, which is an 11% increase in the number of articles since 2010. The quality of the submissions continues to increase. The editors had been delighted with the 2010 JCMR Impact Factor of 4.33, although this fell modestly to 3.72 for 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, we remain very pleased with the progress of the journal's impact over the last 5 years. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors feel it is useful to summarize the papers for the readership into broad areas of interest or theme, which we feel would be useful, so that areas of interest from the previous year can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - John Paul Carpenter
- CMR Unit Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - David N Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Philip J Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Raad H Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Sanjay K Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
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17
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Quantifying vaginal tissue elasticity under normal and prolapse conditions by tactile imaging. Int Urogynecol J 2011; 23:459-66. [PMID: 22072417 DOI: 10.1007/s00192-011-1592-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 10/17/2011] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Vaginal tactile imaging (VTI) is based on principles similar to those of manual palpation. The objective of this study is to assess the clinical suitability of new approach for imaging and tissue elasticity quantification under normal and prolapse conditions. METHODS The study subjects included 31 women with normal and prolapse conditions. The tissue elasticity (Young's modulus) was calculated from spatial gradients in the resulting 3-D tactile images. RESULTS Average values for tissue elasticity for the anterior and posterior compartments for normal conditions were 7.4 ± 4.3 kPa and 6.2 ± 3.1 kPa respectively. For Stage III prolapse the average values for tissue elasticity for anterior and posterior compartments were 1.8 ± 0.7 kPa and 1.8 ± 0.5 kPa respectively. CONCLUSIONS VTI may serve as a means for 3-D imaging of the vagina and a quantitative assessment of vaginal tissue elasticity, providing important information for furthering our understanding of pelvic organ prolapse and surgical treatment.
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Prasad SK. Review of journal of cardiovascular magnetic resonance 2010. J Cardiovasc Magn Reson 2011; 13:48. [PMID: 21914185 PMCID: PMC3182946 DOI: 10.1186/1532-429x-13-48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/13/2011] [Indexed: 12/15/2022] Open
Abstract
There were 75 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2010, which is a 34% increase in the number of articles since 2009. The quality of the submissions continues to increase, and the editors were delighted with the recent announcement of the JCMR Impact Factor of 4.33 which showed a 90% increase since last year. Our acceptance rate is approximately 30%, but has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. Last year for the first time, the Editors summarized the papers for the readership into broad areas of interest or theme, which we felt would be useful to practitioners of cardiovascular magnetic resonance (CMR) so that you could review areas of interest from the previous year in a single article in relation to each other and other recent JCMR articles 1. This experiment proved very popular with a very high rate of downloading, and therefore we intend to continue this review annually. The papers are presented in themes and comparison is drawn with previously published JCMR papers to identify the continuity of thought and publication in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - David N Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Philip J Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Raad H Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Sanjay K Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
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