1
|
Innocenzi A, Rangel I, Póvoa-Corrêa M, Parente DB, Perez R, Rodrigues RS, Fukuyama LT, Barroso JM, Oliveira Neto JA, Silvestre de Sousa A, Luiz RR, Barbosa RCP, Camargo GC, Moll-Bernardes R. Cardiac and Liver Fibrosis Assessed by Multiparametric MRI in Patients with Fontan Circulation. Pediatr Cardiol 2024:10.1007/s00246-024-03522-9. [PMID: 38771376 DOI: 10.1007/s00246-024-03522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
The abnormal hemodynamics in Fontan circulation due to persistently increased systemic venous pressure results in hepatic venous congestion and Fontan-associated liver disease. Combined assessment of cardiac and liver fibrosis and cardiac remodeling using multiparametric MRI in this context have not been fully explored. To evaluate cardiac and liver fibrosis and cardiac remodeling using multiparametric MRI in patients who have undergone Fontan procedures. Thirty-eight patients and 23 controls underwent cardiac and liver MRI examinations in a 3.0-T scanner. Mann-Whitney, Fisher exact test, and Spearman's correlation were applied to evaluate myocardial volumes, function, native cardiac and liver T1 mapping, ECVs and liver stiffness. The mean native cardiac T1 value (p = 0.018), cardiac ECV (p < 0.001), liver native T1 (p < 0.001), liver ECV (p < 0.001), and liver stiffness (p < 0.001) were higher in patients than controls. The indexed end-diastolic volume (EDVi) correlated with the myocardial ECV (r = 0.356; p = 0.033), native liver T1 (r = 0.571; p < 0.001), and with liver stiffness (r = 0.391; p = 0.015). In addition, liver stiffness correlated with liver ECV (r = 0.361; p = 0.031) and native liver T1 (r = 0.458; p = 0.004). An association between cardiac remodeling and cardiac and liver fibrosis were found in this population. The usefulness of MRI to follow cardiac and liver involvement in these patients is critical to improve treatment strategies and to prevent the need for combined liver and heart transplantation.
Collapse
Affiliation(s)
- Adriana Innocenzi
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Isabela Rangel
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Pro Criança Cardiaca, Rio de Janeiro, RJ, Brazil
- Clínica Cardiológica Infantil, Rio de Janeiro, RJ, Brazil
| | - Mariana Póvoa-Corrêa
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Federal University of Rio de Janeiro (UFRJ), Macaé, RJ, Brazil
| | - Daniella Braz Parente
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Renata Perez
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rosana Souza Rodrigues
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Lúcia Tomoko Fukuyama
- Pro Criança Cardiaca, Rio de Janeiro, RJ, Brazil
- Clínica Cardiológica Infantil, Rio de Janeiro, RJ, Brazil
| | - Julia Machado Barroso
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Jaime Araújo Oliveira Neto
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Andréa Silvestre de Sousa
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Gabriel Cordeiro Camargo
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Renata Moll-Bernardes
- D'Or Institute for Research and Education (IDOR), Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil.
| |
Collapse
|
2
|
Sakhi H, Soulat G, Craiem D, Gencer U, Lamy J, Stipechi V, Puscas T, Hulot JS, Hagege A, Mousseaux E. Association of Impaired Left Ventricular Mitral Filling from 4D Flow Cardiac MRI and Prognosis of Hypertrophic Cardiomyopathy. Radiol Cardiothorac Imaging 2024; 6:e230198. [PMID: 38512023 PMCID: PMC11058532 DOI: 10.1148/ryct.230198] [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: 07/20/2023] [Revised: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024]
Abstract
Purpose To investigate whether the peak early filling rate normalized to the filling volume (PEFR/FV) estimated from four-dimensional (4D) flow cardiac MRI may be used to assess impaired left ventricular (LV) filling and predict clinical outcomes in individuals with hypertrophic cardiomyopathy (HCM). Materials and Methods Cardiac MRI with a 4D flow sequence and late gadolinium enhancement (LGE), as well as echocardiography, was performed in 88 individuals: 44 participants with HCM from a French prospective registry (ClinicalTrials.gov; NCT01091480) and 44 healthy volunteers matched for age and sex. In participants with HCM, a composite primary end point was assessed at follow-up, including unexplained syncope, new-onset atrial fibrillation, hospitalization for congestive heart failure, ischemic stroke, sustained ventricular arrhythmia, septal reduction therapy, and cardiac death. A Cox proportional hazard model was used to analyze associations with the primary end point. Results PEFR/FV was significantly lower in the HCM group (mean age, 51.8 years ± 18.5 [SD]; 29 male participants) compared with healthy volunteers (mean, 3.35 sec-1 ± 0.99 [0.90-5.20] vs 4.42 sec-1 ± 1.68 [2.74-11.86]; P < .001) and correlated with both B-type natriuretic peptide (BNP) level (r = -0.31; P < .001) and the ratio of pulsed Doppler early transmitral inflow to Doppler tissue imaging annulus velocities (E/E'; r = -0.54; P < .001). At a median follow-up of 2.3 years (IQR, 1.7-3.3 years), the primary end point occurred in 14 (32%) participants. A PEFR/FV of 2.61 sec-1 or less was significantly associated with occurrence of the primary end point (hazard ratio, 9.46 [95% CI: 2.61, 45.17; P < .001] to 15.21 [95% CI: 3.51, 80.22; P < .001]), independently of age, BNP level, E/E', LGE extent, and LV and left atrial strain according to successive bivariate models. Conclusion In HCM, LV filling evaluated with 4D flow cardiac MRI correlated with Doppler and biologic indexes of diastolic dysfunction and predicted clinical outcomes. Keywords: Diastolic Function, Left Ventricular Filling, Hypertrophic Cardiomyopathy, Cardiac MRI, 4D Flow Sequence Clinical trial registration no. NCT01091480 Supplemental material is available for this article. © RSNA, 2024.
Collapse
Affiliation(s)
- Hichem Sakhi
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Gilles Soulat
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Damian Craiem
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Umit Gencer
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Jérôme Lamy
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Valentina Stipechi
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Tania Puscas
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Jean-Sébastien Hulot
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Albert Hagege
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Elie Mousseaux
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| |
Collapse
|
3
|
Ong LT, Fan SWD. Prevalence and clinical significance of late gadolinium enhancement in children and adolescents with hypertrophic cardiomyopathy: a systematic review and meta-analysis. Cardiol Young 2024:1-10. [PMID: 38433549 DOI: 10.1017/s1047951124000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death among the paediatric population. The aim of this study is to investigate the prevalence and clinical significance of late gadolinium enhancement, as assessed by cardiac MRI, in paediatric hypertrophic cardiomyopathy. METHODS A systematic literature search was conducted in PubMed, SCOPUS, and Ovid SP to identify relevant studies. Pooled estimates with a 95% confidence interval were calculated using the random-effects generic inverse variance model. Statistical analysis was performed using Review Manager v5.4 and R programming. RESULTS Seventeen studies were included in this meta-analysis, encompassing a total of 778 patients. Late gadolinium enhancement was highly prevalent in paediatric hypertrophic cardiomyopathy, with a pooled prevalence of 51% (95% confidence interval, 40-62%). The estimated extent of focal fibrosis expressed as a percentage of left ventricular mass was 4.70% (95% confidence interval, 2.11-7.30%). The presence of late gadolinium enhancement was associated with an increased risk of adverse cardiac events (pooled odds ratio 3.49, 95% confidence interval 1.10-11.09). The left ventricular mass index of late gadolinium enhancement-positive group was higher than the negative group, with a standardised mean difference of 0.91 (95% confidence interval, 0.42-1.41). CONCLUSION This meta-analysis demonstrates that prevalence of late gadolinium enhancement in paediatric hypertrophic cardiomyopathy is similar to that in the adult population. The presence and extent of late gadolinium enhancement are independent predictors of adverse cardiac events, underscoring their prognostic significance among the paediatric population.
Collapse
Affiliation(s)
- Leong Tung Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, WP, Malaysia
| | - Si Wei David Fan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, WP, Malaysia
| |
Collapse
|
4
|
Fries RC. Current use of cardiac MRI in animals. J Vet Cardiol 2023; 51:13-23. [PMID: 38052149 DOI: 10.1016/j.jvc.2023.11.006] [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: 11/04/2022] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
Cardiovascular magnetic resonance (CMR) imaging has evolved to become an indispensable tool in human cardiology. It is a non-invasive technique that enables objective assessment of myocardial function, size, and tissue composition. Recent innovations in magnetic resonance imaging scanner technology and parallel imaging techniques have facilitated the generation of parametric mapping to explore tissue characteristics, and the emergence of strain imaging has enabled cardiologists to evaluate cardiac function beyond conventional metrics. As veterinary cardiology continues to utilize CMR beyond the reference standard, clinical application of CMR will further expand our capabilities. This article describes the current use of CMR and adoption of more recent advances such as T1/T2 mapping in veterinary cardiology.
Collapse
Affiliation(s)
- R C Fries
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign College of Veterinary Medicine, Urbana, IL, USA.
| |
Collapse
|
5
|
Fries R. Hypertrophic Cardiomyopathy-Advances in Imaging and Diagnostic Strategies. Vet Clin North Am Small Anim Pract 2023; 53:1325-1342. [PMID: 37423845 DOI: 10.1016/j.cvsm.2023.05.010] [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: 07/11/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most important and prevalent cardiac disease in cats. Due to the highly variable nature of HCM, a multimodal approach including physical examination, genetic evaluation, cardiac biomarkers, and imaging are all essential elements to appropriate and timely diagnosis. These foundational elements are advancing rapidly in veterinary medicine. Newer biomarkers such as galectin-3 are currently being researched and advances in tissue speckle-tracking and contrast-enhanced echocardiography are readily available. Advanced imaging techniques, such as cardiac MRI, are providing previously unavailable information about myocardial fibrosis and paving the way for enhanced diagnostic capabilities and risk-stratification in cats with HCM.
Collapse
Affiliation(s)
- Ryan Fries
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008 West Hazelwood Drive, Urbana, IL 61802, USA.
| |
Collapse
|
6
|
Zheng X, Liu L, Liu J, Zhang C, Zhang J, Qi Y, Xie L, Zhang C, Yao G, Bu P. Fibulin7 Mediated Pathological Cardiac Remodeling through EGFR Binding and EGFR-Dependent FAK/AKT Signaling Activation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2207631. [PMID: 37344348 PMCID: PMC10460860 DOI: 10.1002/advs.202207631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 05/19/2023] [Indexed: 06/23/2023]
Abstract
Adverse remodeling after myocardial infarction (MI) result in heart failure and sudden cardiac death. Fibulin7 (FBLN7) is an adhesion protein excreted into the extracellular matrix that functions in multiple biological processes. However, whether and how FBLN7 affects post-MI cardiac remodeling remains unclear. Here, the authors identify FBLN7 as a critical profibrotic regulator of adverse cardiac remodeling. They observe significantly upregulated serum FBLN7 levels in MI patients with left ventricular remodeling compared to those without MI. Microarray dataset analysis reveal FBLN7 is upregulated in human heart samples from patients with dilated and hypertrophic cardiomyopathy compared with non-failing hearts. The authors demonstrate that FBLN7 deletion attenuated post-MI cardiac remodeling, leading to better cardiac function and reduced myocardial fibrosis, whereas overexpression of FBLN7 results in the opposite effects. Mechanistically, FBLN7 binds to the epidermal growth factor receptor (EGFR) through its EGF-like domain, together with the EGF-like calcium-binding domain, and induces EGFR autophosphorylation at tyrosine (Y) 1068 and Y1173, which activates downstream focal adhesion kinase/AKT signaling, thereby leading to fibroblast-to-myofibroblast transdifferentiation. In addition, FBLN7-EGFR mediates this signal transduction, and the fibrotic response is effectively suppressed by the inhibition of EGFR activity. Taken together, FBLN7 plays an important role in cardiac remodeling and fibrosis after MI.
Collapse
Affiliation(s)
- Xuehui Zheng
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Lingxin Liu
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Jing Liu
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
- Department of CardiologyHeze Municipal HospitalHeze274000China
| | - Chen Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Jie Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Yan Qi
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Lin Xie
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Chunmei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Guoqing Yao
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| | - Peili Bu
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu HospitalCheeloo College of MedicineShandong UniversityJinan250012China
| |
Collapse
|
7
|
Deraz SE, Esmat OD, El-Hmid RGA, Amin SA. Evaluation of diastolic dysfunction in children with hypertrophic cardiomyopathy and its relationship with development of myocardial fibrosis. Egypt Heart J 2023; 75:54. [PMID: 37389694 DOI: 10.1186/s43044-023-00382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy may develop symptoms of shortness of breathing due to diastolic dysfunction which is not related to the severity of left ventricular outflow tract obstruction. As these patients usually develop a non-ischemic pattern of myocardial fibrosis, this may represent a mechanism for increased myocardial stiffness leading to impaired diastolic filling. The study aimed to determine the prevalence of myocardial fibrosis assessed by magnetic resonance imaging in children with hypertrophic cardiomyopathy and to evaluate its relationship with echocardiographic parameters including left ventricle diastolic dysfunction and to find echocardiographic indices which correlates with myocardial fibrosis as detected by cardiac magnetic resonance. A cross-sectional study was done for data of 50 children with hypertrophic cardiomyopathy from July 2018 to July 2021, patients were divided into (group 1) having myocardial fibrosis and (group 2) with no myocardial fibrosis, and results of echocardiographic parameters were compared between the two groups. RESULTS Results showed strong relationship between presence of myocardial fibrosis and each of the following: Interventricular septum thickness, lower lateral and septal early diastolic tissue velocities (E'), E/E' ratio, presence of left ventricular out flow tract obstruction and the grade of diastolic dysfunction. CONCLUSIONS The trans-mitral lateral and septal E/E' (early mitral inflow to early diastolic mitral annular velocity ratio) allows early detection of left ventricular diastolic dysfunction in children with hypertrophic cardiomyopathy. The prevalence of diastolic dysfunction is higher in obstructive hypertrophic cardiomyopathy. The diastolic dysfunction severity is higher in patients with myocardial fibrosis.
Collapse
Affiliation(s)
- Salem Elsayed Deraz
- Pediatric Department, Menoufia University, Menoufia, Egypt.
- Pediatric Cardiology Department, Aswan Heart Centre, Aswan, Egypt.
| | - Omar Deyaa Esmat
- Pediatric Cardiology Department, Aswan Heart Centre, Aswan, Egypt
| | | | | |
Collapse
|
8
|
Segre CAW, de Lemos JA, Assunção Junior AN, Nomura CH, Favarato D, Strunz CMC, Villa AV, Parga Filho JR, Rezende PC, Hueb W, Ramires JAF, Kalil Filho R, Serrano Junior CV. Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease. Medicine (Baltimore) 2023; 102:e33548. [PMID: 37083772 PMCID: PMC10118361 DOI: 10.1097/md.0000000000033548] [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: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping. METHODS We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness. RESULTS A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means ± standard deviations) increased across tertiles: nativeT1 (1006 ± 27 ms vs 1016 ± 27 ms vs 1034 ± 37 ms, ptrend = 0.006) and ECV (22 ± 3% vs 23 ± 1.9% vs 25 ± 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis. CONCLUSION In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
Collapse
Affiliation(s)
| | - James A. de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Cesar Higa Nomura
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Desiderio Favarato
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | | | | | - Paulo Cury Rezende
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | - Whady Hueb
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | | - Roberto Kalil Filho
- Heart Institute (InCor) University of São Paulo Clinics Hospital, Sao Paulo, Brazil
| | | |
Collapse
|
9
|
Langa P, Marszalek RJ, Warren CM, Chowdhury SK, Halas M, Batra A, Rafael-Clyke K, Bacon A, Goldspink PH, Solaro RJ, Wolska BM. Altered coronary artery function, arteriogenesis and endothelial YAP signaling in postnatal hypertrophic cardiomyopathy. Front Physiol 2023; 14:1136852. [PMID: 37064918 PMCID: PMC10102353 DOI: 10.3389/fphys.2023.1136852] [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: 01/03/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction: Hypertrophic cardiomyopathy (HCM) is a cardiovascular genetic disease caused largely by sarcomere protein mutations. Gaps in our understanding exist as to how maladaptive sarcomeric biophysical signals are transduced to intra- and extracellular compartments leading to HCM progression. To investigate early HCM progression, we focused on the onset of myofilament dysfunction during neonatal development and examined cardiac dynamics, coronary vascular structure and function, and mechano-transduction signaling in mice harboring a thin-filament HCM mutation. Methods: We studied postnatal days 7-28 (P7-P28) in transgenic (TG) TG-cTnT-R92Q and non-transgenic (NTG) mice using skinned fiber mechanics, echocardiography, biochemistry, histology, and immunohistochemistry. Results: At P7, skinned myofiber bundles exhibited an increased Ca2+-sensitivity (pCa50 TG: 5.97 ± 0.04, NTG: 5.84 ± 0.01) resulting from cTnT-R92Q expression on a background of slow skeletal (fetal) troponin I and α/β myosin heavy chain isoform expression. Despite the transition to adult isoform expressions between P7-P14, the increased Ca2+- sensitivity persisted through P28 with no apparent differences in gross morphology among TG and NTG hearts. At P7 significant diastolic dysfunction was accompanied by coronary flow perturbation (mean diastolic velocity, TG: 222.5 ± 18.81 mm/s, NTG: 338.7 ± 28.07 mm/s) along with localized fibrosis (TG: 4.36% ± 0.44%, NTG: 2.53% ± 0.47%). Increased phosphorylation of phospholamban (PLN) was also evident indicating abnormalities in Ca2+ homeostasis. By P14 there was a decline in arteriolar cross-sectional area along with an expansion of fibrosis (TG: 9.72% ± 0.73%, NTG: 2.72% ± 0.2%). In comparing mechano-transduction signaling in the coronary arteries, we uncovered an increase in endothelial YAP expression with a decrease in its nuclear to cytosolic ratio at P14 in TG hearts, which was reversed by P28. Conclusion: We conclude that those early mechanisms that presage hypertrophic remodeling in HCM include defective biophysical signals within the sarcomere that drive diastolic dysfunction, impacting coronary flow dynamics, defective arteriogenesis and fibrosis. Changes in mechano-transduction signaling between the different cellular compartments contribute to the pathogenesis of HCM.
Collapse
Affiliation(s)
- Paulina Langa
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Richard J. Marszalek
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Chad M. Warren
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Shamim K. Chowdhury
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Monika Halas
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Ashley Batra
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Koreena Rafael-Clyke
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Angelie Bacon
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Paul H. Goldspink
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - R. John Solaro
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Beata M. Wolska
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Department of Medicine, Division of Cardiology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
10
|
Yang S, Chen X, Zhao K, Yu S, Dong W, Wang J, Yang K, Yang Q, Ma X, Dong Z, Liu L, Song Y, Lu M, Wang S, Zhao S. Reverse remodeling of left atrium assessed by cardiovascular magnetic resonance feature tracking in hypertrophic obstructive cardiomyopathy after septal myectomy. J Cardiovasc Magn Reson 2023; 25:13. [PMID: 36775820 PMCID: PMC9923913 DOI: 10.1186/s12968-023-00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Assessing the structure and function of left atrium (LA) is crucial in hypertrophic obstructive cardiomyopathy (HOCM) because LA remodeling correlates with atrial fibrillation. However, few studies have investigated the potential effect of myomectomy on LA phasic remodeling in HOCM after myectomy using cardiovascular magnetic resonance (CMR) feature tracking (FT). This study aims to evaluate the LA structural and functional remodeling with HOCM after myectomy by CMR-FT and to further investigate the determinants of LA reverse remodeling. METHODS In this single-center study, we retrospectively studied 88 patients with HOCM who received CMR before and after myectomy between January 2011 and June 2021. Preoperative and postoperative LA parameters derived from CMR-FT were compared, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster function (booster EF, active strain [εa], late peak negative strain rate [SRa]). Eighty-six healthy participants were collected for comparison. Univariate and multivariate linear regression identified variables associated with the rate of change of εa. RESULTS Compared with preoperative parameters, LA reservoir function (total EF, εs, SRs), booster function (booster EF, εa, SRa), and SRe were significantly improved after myectomy (all P < 0.05), while no significant differences were observed in passive EF and εe. Postoperative patients with HOCM still had larger LA and worse LA function than healthy controls (all P < 0.05). After analyzing the rates of change in LA parameters, LA boost function, especially εa, showed the most dramatic improvement beyond the improvements in reservoir function, conduit function, and volume. In multivariable regression analysis, minimum LA volume index (adjusted β = - 0.39, P < 0.001) and Δleft ventricular outflow tract (LVOT) pressure gradient (adjusted β = - 0.29, P = 0.003) were significantly related to the rate of change of εa. CONCLUSIONS Patients with HOCM after septal myectomy showed LA reverse remodeling with a reduction in LA size and restoration in LA reservoir and booster function but unchanged LA conduit function. Among volumetric and functional changes, booster function had the greatest improvement postoperatively. Besides, preoperative LAVmin index and ΔLVOT might be potential factors associated with the degree of improvement in εa.
Collapse
Affiliation(s)
- Shujuan Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Xiuyu Chen
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, 518055, China
| | - Shiqin Yu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Wenhao Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Jiaxin Wang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Kai Yang
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Qiulan Yang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Xuan Ma
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Zhixiang Dong
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Lele Liu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Yanyan Song
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China
| | - Shuiyun Wang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China.
| | - Shihua Zhao
- MR Center, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beilishi Rd 167, Xicheng District, Beijing, 100037, China.
| |
Collapse
|
11
|
Song Y, Bi X, Chen L, Yang K, Chen X, Dong Z, Wang J, Kong X, Zhao K, Wang H, Duru F, Lu M, Ma L, Qiao S, Zhao S. Reduced myocardial septal function assessed by cardiac magnetic resonance feature tracking in patients with hypertrophic obstructive cardiomyopathy: associated with histological myocardial fibrosis and ventricular arrhythmias. Eur Heart J Cardiovasc Imaging 2022; 23:1006-1015. [PMID: 35167663 DOI: 10.1093/ehjci/jeac032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Echocardiographic studies suggest that strain is related to myocardial fibrosis (MF) and ventricular arrhythmias (VA) in hypertrophic cardiomyopathy (HCM) patients. Cardiac magnetic resonance feature tracking (CMR-FT) also allows strain analysis, but little is known whether it provides incremental value to late gadolinium enhancement imaging (LGE). This study aimed to explore the relationship between CMR-FT-derived strain parameters and histopathology MF and VA and its incremental value to LGE in obstructive HCM (HOCM) patients undergoing septal myectomy. METHODS AND RESULTS One hundred and twenty-three symptomatic HOCM patients underwent CMR examination, followed by septal myectomy. The abnormally increased histological MF was defined as higher than the mean + 2 standard deviation (SD) of nine control autopsy subjects who had no history of cardiovascular disease. Septal strain parameters and septal LGE were evaluated at the site of surgical myectomy. Among HOCM patients without LGE, septal circumferential (P = 0.003), longitudinal (P = 0.001), and radial (P = 0.02) strains were significantly impaired in patients with increased histological MF than those without. Histological MF was significantly associated with septal circumferential strain (r = 0.32, P < 0.001), septal longitudinal strain (r = 0.42, P < 0.001), and septal radial strain (r = -0.27, P = 0.003). On multivariate analysis, septal longitudinal strain was independently associated with histological MF [β, 0.19 (0.05-0.34); P = 0.01], and VA [odds ratio, 1.10 (1.01-1.19); P = 0.02]. Moreover, septal longitudinal strain was incremental to septal %LGE in detecting increased MF (P = 0.001) and VA (P = 0.048). CONCLUSIONS Septal longitudinal strain at CMR is independently related to histological MF and occurrence of VA in HOCM patients. Moreover, it provides incremental value over LGE in detecting increased MF and VA.
Collapse
Affiliation(s)
- Yanyan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Xuanye Bi
- Department of Cardiovascular Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Liang Chen
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Jiaxin Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Xiangyong Kong
- Department of Cardiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 1 Swan Lake Road, Hefei 230001, Anhui, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Hongyue Wang
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, Zurich 8091, Switzerland
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Likun Ma
- Department of Cardiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 1 Swan Lake Road, Hefei 230001, Anhui, China
| | - Shubin Qiao
- Department of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China
| |
Collapse
|
12
|
O'Hara RP, Binka E, Prakosa A, Zimmerman SL, Cartoski MJ, Abraham MR, Lu DY, Boyle PM, Trayanova NA. Personalized computational heart models with T1-mapped fibrotic remodeling predict sudden death risk in patients with hypertrophic cardiomyopathy. eLife 2022; 11:73325. [PMID: 35076018 PMCID: PMC8789259 DOI: 10.7554/elife.73325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is associated with risk of sudden cardiac death (SCD) due to ventricular arrhythmias (VAs) arising from the proliferation of fibrosis in the heart. Current clinical risk stratification criteria inadequately identify at-risk patients in need of primary prevention of VA. Here, we use mechanistic computational modeling of the heart to analyze how HCM-specific remodeling promotes arrhythmogenesis and to develop a personalized strategy to forecast risk of VAs in these patients. We combine contrast-enhanced cardiac magnetic resonance imaging and T1 mapping data to construct digital replicas of HCM patient hearts that represent the patient-specific distribution of focal and diffuse fibrosis and evaluate the substrate propensity to VA. Our analysis indicates that the presence of diffuse fibrosis, which is rarely assessed in these patients, increases arrhythmogenic propensity. In forecasting future VA events in HCM patients, the imaging-based computational heart approach achieved 84.6%, 76.9%, and 80.1% sensitivity, specificity, and accuracy, respectively, and significantly outperformed current clinical risk predictors. This novel VA risk assessment may have the potential to prevent SCD and help deploy primary prevention appropriately in HCM patients.
Collapse
Affiliation(s)
- Ryan P O'Hara
- Department of Biomedical Engineering, Johns Hopkins University
| | - Edem Binka
- Division of Pediatric Cardiology, Johns Hopkins University
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University
| | | | - Mark J Cartoski
- Division of Pediatric Cardiology, Alfred I. duPont Hospital for Children
| | | | - Dai-Yin Lu
- Division of Cardiology, University of California, San Francisco
| | | | | |
Collapse
|
13
|
Ibrahim ESH, Dennison J, Frank L, Stojanovska J. Diastolic Cardiac Function by MRI-Imaging Capabilities and Clinical Applications. Tomography 2021; 7:893-914. [PMID: 34941647 PMCID: PMC8706325 DOI: 10.3390/tomography7040075] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 02/05/2023] Open
Abstract
Most cardiac studies focus on evaluating left ventricular (LV) systolic function. However, the assessment of diastolic cardiac function is becoming more appreciated, especially with the increasing prevalence of pathologies associated with diastolic dysfunction like heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction is an indication of abnormal mechanical properties of the myocardium, characterized by slow or delayed myocardial relaxation, abnormal LV distensibility, and/or impaired LV filling. Diastolic dysfunction has been shown to be associated with age and other cardiovascular risk factors such as hypertension and diabetes mellitus. In this context, cardiac magnetic resonance imaging (MRI) has the capability for differentiating between normal and abnormal myocardial relaxation patterns, and therefore offers the prospect of early detection of diastolic dysfunction. Although diastolic cardiac function can be assessed from the ratio between early and atrial filling peaks (E/A ratio), measuring different parameters of heart contractility during diastole allows for evaluating spatial and temporal patterns of cardiac function with the potential for illustrating subtle changes related to age, gender, or other differences among different patient populations. In this article, we review different MRI techniques for evaluating diastolic function along with clinical applications and findings in different heart diseases.
Collapse
Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Correspondence:
| | - Jennifer Dennison
- Department of Medicine, Medical College of Wisconsin, Wausau, WI 54401, USA;
| | - Luba Frank
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | | |
Collapse
|
14
|
Alis D, Guler A, Asmakutlu O, Topel C, Sahin AA. The Association between the Extent of Late Gadolinium Enhancement and Diastolic Dysfunction in Hypertrophic Cardiomyopathy. Indian J Radiol Imaging 2021; 31:284-290. [PMID: 34556909 PMCID: PMC8448239 DOI: 10.1055/s-0041-1734333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) patients is a frequent, yet poorly understood phenomenon.
Purpose
The purpose of this study is to assess the relationship between the myocardial fibrosis and diastolic dysfunction in patients with HCM.
Materials and Methods
We retrospectively investigated the impact of the myocardial fibrosis, as assessed by the extent of late gadolinium enhancement (LGE-%) on cardiac magnetic resonance imaging (CMRI), on diastolic dysfunction in 110 patients with HCM. The diastolic dysfunction was evaluated by the left atrial (LA) volume index measured on CMRI and lateral septal E/E′ ratio calculated on echocardiography.
Results
: There was a moderate correlation between the LGE-% and LA volume (
r
= 0.59,
p
< 0.0001). The logistic regression model of LGE-%, mitral regurgitation, and total left ventricular mass that investigated the independent predictors of LA volume identified LGE-% as the only independent parameter associated with the LA volume index (
β
= 0.30,
p
= 0.003). No correlation was observed between the LGE-% and E/E′(
r
= 0.24,
p
= 0.009).
Conclusions
Myocardial fibrosis in HCM patients is associated with a chronic diastolic burden as represented by increased LA volume. However, the fibrosis does not influence the E/E′ ratio, which is a well-known parameter of ventricular relaxation, restoring forces, and filling pressure.
Collapse
Affiliation(s)
- Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Arda Guler
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/ Istanbul, Turkey
| | - Ozan Asmakutlu
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/ Istanbul, Turkey
| | - Cagdas Topel
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/ Istanbul, Turkey
| | - Ahmet A Sahin
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Halkali/ Istanbul, Turkey
| |
Collapse
|
15
|
Gaspar AS, Maltês S, Marques H, Nunes RG, Ferreira A. Myocardial T1 mapping with magnetic resonance imaging – a useful tool to understand the diseased heart. Rev Port Cardiol 2021; 41:61-69. [DOI: 10.1016/j.repc.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 01/19/2023] Open
|
16
|
Electrophysiologic and imaging evidence for an occult myopathic substrate in patients with idiopathic ventricular arrhythmias. Int J Cardiol 2021; 336:60-66. [PMID: 34048856 DOI: 10.1016/j.ijcard.2021.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/02/2021] [Accepted: 05/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Idiopathic VA are traditionally considered benign, although occasional patients develop an ectopy-mediated cardiomyopathy (EMC). It is unclear whether patients with idiopathic VA in the absence of left ventricular (LV) dysfunction harbor a subclinical cardiomyopathy. We aim to assess for cardiomyopathic substrate in patients with idiopathic ventricular arrhythmias (VA) using imaging and electrophysiologic markers of early fibrosis. METHODS Cardiac magnetic resonance (CMR) imaging and ventricular electroanatomic mapping was performed in 3 groups: patients undergoing ablation for idiopathic VA without (Group 1, n = 17) and with LV dysfunction (Group 2 [presumed EMC], n = 12) plus a control group undergoing ablation of supraventricular tachycardia (Group 3, n = 16). Global LV strain, T1 mapping and extended electrogram (EGM) characteristics were compared. RESULTS Global strain was impaired in patients with presumed EMC (Group 2, p < 0.001). Native T1 times did not differ between groups, however patients in both idiopathic VA groups (Groups 1 and 2) had shorter post-contrast T1 times at 8 min compared to SVT controls (Group 3, p = 0.04). Similarly, the duration of the bipolar EGM was subtly prolonged in both Group 1 and 2 compared to Group 3 (p = 0.002). There were no between group differences in unipolar or bipolar voltage, the no. of bipolar EGM deflections or the maximal unipolar EGM dV/dt. CONCLUSION Patients with idiopathic VAs and apparently structurally normal hearts may have subtle CMR and electrophysiologic changes similar in magnitude to that seen in frank presumed EMC, possibly suggestive of an occult cardiomyopathic process.
Collapse
|
17
|
Vullaganti S, Levine J, Raiker N, Syed AA, Collins JD, Carr JC, Bonow RO, Choudhury L. Fibrosis in Hypertrophic Cardiomyopathy Patients With and Without Sarcomere Gene Mutations. Heart Lung Circ 2021; 30:1496-1501. [PMID: 34023176 DOI: 10.1016/j.hlc.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) and an identified sarcomere mutation have worse outcomes than those without though the underlying mechanism is incompletely understood. The presence of replacement fibrosis measured by late gadolinium enhancement (LGE) and diffuse fibrosis measured by extracellular volume (ECV) using cardiac magnetic resonance imaging (CMR) are associated with ventricular arrhythmias and cardiac mortality. We aimed to associate these two forms of fibrosis with identified sarcomere mutations. METHODS AND RESULTS Three hundred and thirty-six (336) patients with HCM underwent CMR at a single quaternary referral centre between January 2012 and February 2017. Genetic testing was performed in 73 of these patients, yielding an identified sarcomeric mutation in 29 (G+), no mutation in 39 (G-), and a variant of unknown significance (VUS) in five. LGE was more prevalent in G+ compared to G- patients (86 vs. 56%, OR 4.3, p=0.01) and was more extensive (7.5±5.5% of left ventricular [LV] mass vs. 3.0±3.0%, p<0.001). Global ECV from myocardial segments excluding LGE was similar among both groups (26.9±2.9 vs. 25.6±2.8%, p=0.46). However, in G+ patients ECV was greater in the hypertrophied regions of the basal anteroseptum (30.2±7.0 vs. 26.8±3.6%, p=0.004) and basal inferoseptum (28.1±4.3 vs. 26.2±2.9%, p=0.005). CONCLUSIONS Genotyped HCM patients with an identified sarcomere mutation have greater LGE and greater regional, but not global, ECV than HCM patients without an identified mutation. This difference in fibrosis may contribute to worse outcomes in patients with an identified HCM mutation.
Collapse
Affiliation(s)
- Sirish Vullaganti
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jonathan Levine
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nisha Raiker
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amer Ahmed Syed
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert O Bonow
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lubna Choudhury
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
18
|
Corden B, Lim WW, Song W, Chen X, Ko NSJ, Su L, Tee NGZ, Adami E, Schafer S, Cook SA. Therapeutic Targeting of Interleukin-11 Signalling Reduces Pressure Overload-Induced Cardiac Fibrosis in Mice. J Cardiovasc Transl Res 2021; 14:222-228. [PMID: 32592090 DOI: 10.1007/s12265-020-10054-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
There are currently no specific treatments for cardiac fibrosis. We tested the efficacy of a neutralising anti-IL11 antibody (X203) to reduce cardiac fibrosis in two preclinical models: transverse aortic constriction (TAC) and chronic angiotensin II infusion (AngII). In the first model, male C57BL/6J mice were subjected to TAC for 2 weeks. In the second model, mice received continuous angiotensin II for 4 weeks via subcutaneous pump. In both models, mice received either 20 mg/kg of X203 or isotype-control antibody twice-weekly, starting 24 h after surgery. Cardiac fibrosis and extracellular matrix gene expression were assessed by RT-qPCR, Western blot, histology and collagen (hydroxyproline) assays. In both models, X203 significantly reduced pro-fibrotic gene expression and myocardial fibrosis (TAC: 51% reduction in total collagen, P < 0.001, 39% in perivascular fibrosis, P < 0.001; AngII: 17% reduction in total collagen, P = 0.04, 83% in perivascular fibrosis, P < 0.001). Pharmacological targeting of IL11 reduces cardiac fibrosis in preclinical models. Figa Graphical Abstract.
Collapse
Affiliation(s)
- Ben Corden
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Wei-Wen Lim
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Weihua Song
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Xie Chen
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Nicole S J Ko
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liping Su
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Nicole G Z Tee
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Eleonora Adami
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Sebastian Schafer
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Stuart A Cook
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore.
- National Heart and Lung Institute, Imperial College London, London, UK.
| |
Collapse
|
19
|
Fries RC, Kadotani S, Keating SCJ, Stack JP. Cardiac extracellular volume fraction in cats with preclinical hypertrophic cardiomyopathy. J Vet Intern Med 2021; 35:812-822. [PMID: 33634479 PMCID: PMC7995366 DOI: 10.1111/jvim.16067] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
Background Cardiac magnetic resonance imaging (CMR) allows for detection of fibrosis in hypertrophic cardiomyopathy (HCM) by quantification of the extracellular volume fraction (ECV). Hypothesis/Objectives To quantify native T1 mapping and ECV in cats. We hypothesize that native T1 mapping and ECV will be significantly increased in HCM cats compared with healthy cats. Animals Seventeen healthy and 12 preclinical HCM, age‐matched, client‐owned cats. Methods Prospective observational study. Tests performed included indirect blood pressure, CBC, biochemical analysis including total thyroid, urinalysis, transthoracic echocardiogram, and CMR. Cats were considered healthy if all tests were within normal limits and a diagnosis of HCM was determined by the presence of left ventricular concentric hypertrophy ≥6 mm on echocardiography. Results There were statistically significant differences in LV mass (healthy = 5.87 g, HCM = 10.3 g, P < .0001), native T1 mapping (healthy = 1122 ms, HCM = 1209 ms, P = .004), and ECV (healthy = 26.0%, HCM = 32.6%, P < .0001). Variables of diastolic function including deceleration time of early diastolic transmitral flow (DTE), ratio between peak velocity of early diastolic transmitral flow and peak velocity of late diastolic transmitral flow (E : A), and peak velocity of late diastolic transmitral flow (A wave) were significantly correlated with ECV (DTE; r = 0.73 P = .007, E : A; r = −0.75 P = .004, A wave; r = 0.76 P = .004). Conclusions and Clinical Importance Quantitative assessment of cardiac ECV is feasible and can provide additional information not available using echocardiography.
Collapse
Affiliation(s)
- Ryan C Fries
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Saki Kadotani
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Stephanie C J Keating
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| | - Jonathan P Stack
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA
| |
Collapse
|
20
|
Arslan F, Akdim F, Ten Berg JM. Reverse remodeling after percutaneous transluminal septal myocardial ablation in severe but asymptomatic LVOT obstruction (RASTA) study: Rationale and design of transcatheter septal reduction in asymptomatic patients with severe hypertrophic obstructive cardiomyopathy. Catheter Cardiovasc Interv 2021; 97:488-492. [PMID: 32808736 DOI: 10.1002/ccd.29178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/05/2020] [Accepted: 07/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the impact of percutaneous transluminal septal myocardial ablation (PTSMA) on remodeling in asymptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) and severe left ventricular outflow tract (LVOT) obstruction. BACKGROUND Symptoms justify invasive treatment in HOCM patients with LVOT obstruction. Adverse structural and functional changes (remodeling) in the heart occur preceding heart failure and sudden cardiac death. Early invasive treatment in asymptomatic patients may reverse adverse remodeling to the same extent as in symptomatic patients. METHODS Reverse remodeling after PTSMA in severe but asymptomatic LVOT obstruction (RASTA) study is a prospective single-blind randomized trial (ClinicalTrials.gov number: NCT04230551). Ten asymptomatic HOCM patients with an exertional LVOT gradient ≥50 mmHg (or >30 mmHg in rest) are randomized 1:1 to PTSMA versus conservative therapy, in the absence of mitral valve disease or other indications for cardiac surgery. Five symptomatic (reference group) will undergo PTSMA according to the current guidelines. RESULTS Remodeling is assessed using extensive cardiac imaging with transthoracic echocardiography and late gadolinium enhancement cardiac magnetic resonance at baseline and during follow-up at 1, 12, and 24 months. Extracellular volume fraction, global, and regional strain analysis, geometry, pressure gradients and changes in four-dimensional velocity mapping are primary parameters to study (reversal of) adverse remodeling. CONCLUSIONS The RASTA study gives insight in cardiac remodeling that may occur in asymptomatic patients after PTSMA. It will provide arguments whether to pursue (or not) a larger trial with clinical endpoints in asymptomatic HOCM patients with severe LVOT obstruction.
Collapse
Affiliation(s)
- Fatih Arslan
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Fatima Akdim
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| |
Collapse
|
21
|
Zhou F, Wu T, Wang W, Cheng W, Wan S, Tian H, Chen T, Sun J, Ren Y. CMR-Verified Myocardial Fibrosis Is Associated With Subclinical Diastolic Dysfunction in Primary Aldosteronism Patients. Front Endocrinol (Lausanne) 2021; 12:672557. [PMID: 34054733 PMCID: PMC8160454 DOI: 10.3389/fendo.2021.672557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The main cardiac features of primary aldosteronism (PA) are impaired left ventricular (LV) diastolic function, and some articles also reported more cardiac fibrosis in PA patients. However, the correlation between LV dysfunction and diffuse myocardial fibrosis in PA remains unknown. METHODS We enrolled 84 PA patients and 28 essential hypertension (EH) patients in West China Hospital. Cardiac magnetic resonance imaging (CMR) contrast enhancement was arranged for all subjects. Postcontrast T1 time and left ventricular myocardial strains and strain rates were measured. RESULTS 76 PA patients and 27 essential hypertension (EH) patients were included in the final analysis. Blood pressure, LV mass indexes, and LV ejection fractions were comparable in both groups, while the global circumferential peak diastolic strain rate (PDSR) was lower (0.9 ± 0.3 vs. 1.1 ± 0.4, p <0.01) and the postcontrast T1 time was shorter (520 ± 38 vs. 538 ± 27, p = 0.01) in PA patients than those in EH patients. Postcontrast T1 time (p = 0.01) was independently related to global circumferential PDSR after adjusting for age and duration of hypertension in PA patients. Furthermore, plasma aldosterone concentration was negatively associated with postcontrast T1 time (R = -0.253, p = 0.028) in PA patients. CONCLUSIONS The global circumferential PDSR derived by CMR is decreased, and the diffuse myocardial fibrosis is increased in PA patients compared to those in blood pressure matched EH patients. The severity of cardiac diastolic dysfunction independently relates to the degree of diffuse myocardial fibrosis in PA patients, and the diffuse myocardial fibrosis may be caused by high PAC level. CLINICAL TRIAL REGISTRATION http://www.chictr.org.cn/listbycreater.asp, identifier ChiCTR2000031792.
Collapse
Affiliation(s)
- Fangli Zhou
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wu
- Departments of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Cheng
- Departments of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuang Wan
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Haoming Tian
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Chen
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Sun
- Departments of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Adrenal Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yan Ren,
| |
Collapse
|
22
|
Myocardial tissue characterization by gadolinium-enhanced cardiac magnetic resonance imaging for risk stratification of adverse events in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2020; 36:1147-1156. [PMID: 32166506 DOI: 10.1007/s10554-020-01808-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/25/2020] [Indexed: 12/21/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy with a wide spectrum of clinical manifestations. Patients can be asymptomatic or suffer major adverse events including sudden cardiac death, ventricular arrhythmias, and heart failure. Identification of individuals with HCM who are at risk for these complications remains challenging. While echocardiography remains the mainstay of diagnostic evaluation, cardiac magnetic resonance imaging (CMR) is an important adjunctive diagnostic modality with emerging applications for risk-stratification of adverse events in the HCM population. Although not included in current guidelines for HCM management, there is increasing evidence to support the use of CMR for routine prognostic assessment of HCM patients. In this review we discuss the use of CMR techniques, including late gadolinium enhancement, T1 mapping, and quantification of extracellular volume fraction, for the risk stratification of three major adverse events in HCM: sudden cardiac death, ventricular arrhythmias, and congestive heart failure.
Collapse
|
23
|
Arcari L, Hinojar R, Engel J, Freiwald T, Platschek S, Zainal H, Zhou H, Vasquez M, Keller T, Rolf A, Geiger H, Hauser I, Vogl TJ, Zeiher AM, Volpe M, Nagel E, Puntmann VO. Native T1 and T2 provide distinctive signatures in hypertrophic cardiac conditions - Comparison of uremic, hypertensive and hypertrophic cardiomyopathy. Int J Cardiol 2020; 306:102-108. [PMID: 32169347 DOI: 10.1016/j.ijcard.2020.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
AIMS Profound left ventricular (LV) hypertrophy with diastolic dysfunction and heart failure is the cardinal manifestation of heart remodelling in chronic kidney disease (CKD). Previous studies related increased T1 mapping values in CKD with diffuse fibrosis. Native T1 is a non-specific readout that may also relate to increased intramyocardial fluid. We examined concomitant T1 and T2 mapping signatures and undertook comparisons with other hypertrophic conditions. METHODS In this prospective multicentre study, consecutive CKD patients (n = 154) undergoing routine clinical cardiac magnetic resonance (CMR) imaging were compared with patients with hypertensive (HTN, n = 163) and hypertrophic cardiomyopathy (HCM, n = 158), and normotensive controls (n = 133). RESULTS Native T1 was significantly higher in all patient groups, whereas native T2 in CKD only (p < 0.001 vs. all groups). Native T1 and T2 were interrelated in patient groups and the strength of association was condition-specific (CKD r = 0.558, HTN r = 0.324, both p < 0.001; HCM r = 0.157, p = 0.05). Native T1 and T2 were similarly correlated in all CKD stages (S3 r = 0.501, S4 0.586, S5 r = 0.424, p < 0.001 for all). Native T1 was the strongest myocardial discriminator between patients and controls (area under the curve, AUC HCM: 0.97; CKD: 0.97, HTN 0.98), native T2 between CKD vs HCM (AUC 0.90) and native T1 and T2 between CKD vs HTN (AUC: 0.83 and 0.80 respectively), p < 0.001 for all. CONCLUSIONS Our findings reveal different CMR signatures of common hypertrophic cardiac phenotypes. Native T1 was raised in all conditions, indicating the presence of pathologic hypertrophic remodelling. Markedly raised native T2 was CKD-specific, suggesting a prominent role of intramyocardial fluid.
Collapse
Affiliation(s)
- Luca Arcari
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Rocio Hinojar
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Juergen Engel
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Tilo Freiwald
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Steffen Platschek
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Hafisyatul Zainal
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Universiti Teknologi MARA (UiTM), Sg. Buloh, Malaysia
| | - Hui Zhou
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Moises Vasquez
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - Till Keller
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Helmut Geiger
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Ingeborg Hauser
- Department of Nephrology, Goethe University Hospital Frankfurt, Frankfuret-am Main, Germany
| | - Thomas J Vogl
- Department of Radiology, Goethe University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Andreas M Zeiher
- Department of Radiology, Goethe University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Massimo Volpe
- Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt-am Main, Germany.
| |
Collapse
|
24
|
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common cardiovascular disease with genetic transmission, characterized by the hypertrophy of any segment of the left ventricle (LV), not totally explained by improper loading conditions, with LV systolic function preserved, increased, or reduced. The histopathological mechanism involved in HCM refers to the primary injury of the myocardium, as follows: disorganized array of myocytes, extracellular matrix modification, microvascular dysfunction, with subsequent appearance of myocardial fibrosis. Multiple sarcomere proteins mutations are responsible for HCM, but two of them are involved in 70% of the cases of HCM: β-myosin heavy chain (MYH7) and myosin-binding protein C (MYBPC3). The development of new genetic techniques involving genome editing is promising to discover a gene therapy for patients with HCM. Clinical presentation may differ from asymptomatic to sudden cardiac death (SCD), the last one targeting younger adults. In this case, the diagnosis and evaluation of SCD risk factors is extremely important. The common method of diagnosis is transthoracic echocardiography, but cardiac magnetic resonance (CMR) imaging represents "gold standard" in the evaluation of HCM patients. Treatment includes pharmacological therapy, surgery, alcohol ablation, and not least SCD prevention.
Collapse
Affiliation(s)
- Ioana Danuta Muresan
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor, 400006, Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor, 400006, Cluj-Napoca, Romania.
| |
Collapse
|
25
|
Xu J, Zhuang B, Sirajuddin A, Li S, Huang J, Yin G, Song L, Jiang Y, Zhao S, Lu M. MRI T1 Mapping in Hypertrophic Cardiomyopathy: Evaluation in Patients Without Late Gadolinium Enhancement and Hemodynamic Obstruction. Radiology 2019; 294:275-286. [PMID: 31769741 DOI: 10.1148/radiol.2019190651] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background The value of native myocardial T1 mapping and extracellular volume (ECV) fraction in patients who have hypertrophic cardiomyopathy (HCM) but no late gadolinium enhancement (LGE) and no hemodynamic obstruction are currently unknown. Purpose To evaluate myocardial fibrosis in patients with nonobstructive HCM and no LGE by using native myocardial T1 mapping and ECV fraction and to study their relationships to left ventricular (LV) function and LV hypertrophy. Materials and Methods Patients with HCM who underwent cardiac MRI between 2012 and 2015 were retrospectively evaluated. Patients were included if they had no LGE at MRI, LV ejection fraction greater than or equal to 45%, and no LV outflow tract obstruction. Healthy participants had similar age and sex distribution. Native myocardial T1 and ECV were measured with MRI. Results A total of 258 patients with HCM (mean age ± standard deviation, 49 years ± 15; 74% men) and 122 healthy participants (mean age, 50 years ± 14; 76% men) were evaluated. Native myocardial T1 was longer and ECV fraction was higher in the patients with HCM relative to the healthy participants (mean native T1, 950 msec ± 48 vs 913 msec ± 46; mean ECV, 24.5% ± 2.8 vs 23.0% ± 2.7; both P < .001). Maximum T1 and ECV values correlated strongly with LV mass index for the entire patient cohort with HCM (both r = 0.86; P < .001) and for the subgroups (r = 0.86 and 0.85 for interventricular septal group and r = 0.88 and 0.86 for apical group; all P < .001). Conclusion Prolonged myocardial T1 and elevated extracellular volume in hypertrophic cardiomyopathy suggests diffuse myocardial fibrosis, even in the absence of regionally apparent late gadolinium enhancement and hemodynamic obstruction, and is associated with left ventricular hypertrophy. © RSNA, 2019 See also the editorial by Bluemke and Lima in this issue.
Collapse
Affiliation(s)
- Jing Xu
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Baiyan Zhuang
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Arlene Sirajuddin
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Shuang Li
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Jinghan Huang
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Gang Yin
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Lei Song
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Yong Jiang
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| | - Minjie Lu
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China (J.X., B.Z., S.L., G.Y., S.Z., M.L.); Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.S., M.L.); Department of Heart-Lung Testing Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (J.H.); Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease (L.S.); and Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing, China (Y.J.)
| |
Collapse
|
26
|
Eijgenraam TR, Silljé HHW, de Boer RA. Current understanding of fibrosis in genetic cardiomyopathies. Trends Cardiovasc Med 2019; 30:353-361. [PMID: 31585768 DOI: 10.1016/j.tcm.2019.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022]
Abstract
Myocardial fibrosis is the excessive deposition of extracellular matrix proteins, including collagens, in the heart. In cardiomyopathies, the formation of interstitial fibrosis and/or replacement fibrosis is almost always part of the pathological cardiac remodeling process. Different forms of cardiomyopathies show particular patterns of myocardial fibrosis that can be considered as distinctive hallmarks. Although formation of fibrosis is initially aimed to be a reparative mechanism, in the long term, on-going and excessive myocardial fibrosis may lead to arrhythmias and stiffening of the heart wall and subsequently to diastolic dysfunction. Ultimately, adverse remodeling with progressive myocardial fibrosis can lead to heart failure. Not surprisingly, the presence of fibrosis in cardiomyopathies, even when subtle, has consistently been associated with complications and adverse outcomes. In the last decade, non-invasive in vivo techniques for visualization of myocardial fibrosis have emerged, and have been increasingly used in research and in the clinic. In this review, we will describe the epidemiology, distribution, and role of myocardial fibrosis in genetic cardiomyopathies, including hypertrophic, dilated, arrhythmogenic, and non-compaction cardiomyopathy, and a few specific forms of genetic cardiomyopathies.
Collapse
Affiliation(s)
- Tim R Eijgenraam
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Herman H W Silljé
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands.
| |
Collapse
|
27
|
Tsai TH, Lin CJ, Hang CL, Chen WY. Calcitriol Attenuates Doxorubicin-Induced Cardiac Dysfunction and Inhibits Endothelial-to-Mesenchymal Transition in Mice. Cells 2019; 8:E865. [PMID: 31405028 PMCID: PMC6721693 DOI: 10.3390/cells8080865] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023] Open
Abstract
Doxorubicin (Dox) is an effective anti-neoplasm drug, but its cardiac toxicity limits its clinical use. Endothelial-to-mesenchymal transition (EndMT) has been found to be involved in the process of heart failure. It is unclear whether EndMT contributes to Dox-induced cardiomyopathy (DoIC). Calcitriol, an active form Vitamin D3, blocks the growth of cancer cells by inhibiting the Smad pathway. To investigate the effect of calcitriol via inhibiting EndMT in DoIC, C57BL/6 mice and endothelial-specific labeled mice were intraperitoneally administered Dox twice weekly for 4 weeks (32 mg/kg cumulative dose) and were subsequently treated with or without calcitriol for 12 weeks. Echocardiography revealed diastolic dysfunction at 13 weeks following the first Dox treatment, accompanied by increased myocardial fibrosis and up-regulated pro-fibrotic proteins. Calcitriol attenuated Dox-induced myocardial fibrosis, down-regulated pro-fibrotic proteins and improved diastolic function. Endothelial fate tracing revealed that EndMT-derived cells contributed to Dox-induced cardiac fibrosis. In vitro, human umbilical vein endothelial cells and mouse cardiac fibroblasts were treated with Transforming growth factor (TGF)-β with or without calcitriol. Morphological, immunofluorescence staining, and Western blot analyses revealed that TGF-β-induced EndMT and fibroblast-to-myofibroblast transition (FMT) were attenuated by calcitriol by the inhibition of the Smad2 pathway. Collectively, calcitriol attenuated DoIC through the inhibition of the EndMT and FMT processes.
Collapse
Affiliation(s)
- Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Wei-Yu Chen
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| |
Collapse
|
28
|
Oikonomou E, Vogiatzi G, Karlis D, Siasos G, Chrysohoou C, Zografos T, Lazaros G, Tsalamandris S, Mourouzis K, Georgiopoulos G, Toutouza M, Tousoulis D. Effects of omega-3 polyunsaturated fatty acids on fibrosis, endothelial function and myocardial performance, in ischemic heart failure patients. Clin Nutr 2019; 38:1188-1197. [DOI: 10.1016/j.clnu.2018.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/11/2018] [Accepted: 04/25/2018] [Indexed: 12/28/2022]
|
29
|
Satriano A, Heydari B, Guron N, Fenwick K, Cheung M, Mikami Y, Merchant N, Lydell CP, Howarth AG, Fine NM, White JA. 3-Dimensional regional and global strain abnormalities in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2019; 35:1913-1924. [PMID: 31144257 DOI: 10.1007/s10554-019-01631-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/18/2019] [Indexed: 12/28/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by myocardial disarray, hypertrophy, and fibrosis. Reduced global longitudinal strain and presence of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMR) have been associated with an adverse prognosis. This study evaluated 3D principal and conventional strain characteristics of non-enhanced myocardium in patients with HCM. 3D principal and conventional strain analysis was conducted in 51 HCM patients and 38 healthy controls. Principal strain was reduced within the non-enhanced myocardium of HCM as compared with controls (maximum principal: 51.5 ± 23.7 vs. 75.1 ± 21.4%, P < 0.0001; minimum principal: - 18.4 ± 4.0 vs. - 20.1 ± 2.9%, P < 0.05). Principal strain within the non-enhanced myocardium was incrementally reduced in HCM patients with extensive global LGE ( ≥ 15%) (maximum principal: 41.6 ± 17.5 vs. 56.9 ± 25.9%, P < 0.05; minimum principal: - 16.9 ± 3.9 vs. - 19.1 ± 4.0%, P = 0.1), as was longitudinal ( - 10.5 ± 2.6 vs. - 12.7 ± 2.6%, P < 0.05) and circumferential strain ( - 11.0 ± 2.7 vs. - 14.0 ± 2.9%, P < 0.01). Principal strain within non-enhanced myocardium was significantly correlated with indexed LV mass (P < 0.0001), maximum (P = 0.0008), and mean wall thickness (P < 0.0001), but not LGE (P = 0.0841). In adjusted analysis, all strain measures within non-enhanced myocardium were independently associated with indexed LV mass (maximum principal: P = 0.0003; minimum principal: P = 0.0039; longitudinal: P = 0.0015; circumferential: P = 0.0002; radial: P = 0.0023). 3D principal strain of non-enhanced myocardium was significantly reduced in HCM patients as compared with controls, and was incrementally reduced among patients with more extensive global LGE. Comprehensive strain assessment may be considered in routine CMR assessment of HCM patients.
Collapse
Affiliation(s)
- Alessandro Satriano
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Bobak Heydari
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada. .,Foothills Medical Centre, Suite 0700, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada.
| | - Namrata Guron
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Kate Fenwick
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Matthew Cheung
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Yoko Mikami
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Naeem Merchant
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada.,Department of Diagnostic Imaging, University of Calgary, Calgary, Canada
| | - Carmen P Lydell
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada.,Department of Diagnostic Imaging, University of Calgary, Calgary, Canada
| | - Andrew G Howarth
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| |
Collapse
|
30
|
Gastl M, Gotschy A, von Spiczak J, Polacin M, Bönner F, Gruner C, Kelm M, Ruschitzka F, Alkadhi H, Kozerke S, Manka R. Cardiovascular magnetic resonance T2* mapping for structural alterations in hypertrophic cardiomyopathy. Eur J Radiol Open 2019; 6:78-84. [PMID: 30775414 PMCID: PMC6365365 DOI: 10.1016/j.ejro.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 12/28/2022] Open
Abstract
HCM patients exhibited significantly decreased T2* values compared to controls. Within HCM patients, those with myocardial fibrosis presented with decreased T2* values. T2* provided good diagnostic accuracy to diagnose HCM with fibrosis. T2* may add information for identifying a higher risk sub-group of HCM patients.
Purpose Hypertrophic cardiomyopathy (HCM) is characterized by a heterogeneous morphology and variable prognosis. A mismatch between left ventricular mass (LVM) and microvascular circulation with corresponding relative ischemia has been implicated to cause myocardial replacement fibrosis that deteriorates prognosis. Besides parametric T1 mapping, Cardiovascular Magnetic Resonance (CMR) T2* mapping is able to identify ischemia as well as fibrosis in cardiac and extracardiac diseases. Therefore, we aimed to investigate the value of T2* mapping to characterize structural alterations in patients with HCM. Methods CMR was performed on a 1.5 T MR imaging system (Achieva, Philips, Best, Netherlands) using a 5-channel coil in patients with HCM (n = 103, 50.6 ± 16.4 years) and in age- and gender-matched controls (n = 20, 44.8 ± 16.9 years). T2* mapping (1 midventricular short axis slice) was acquired in addition to late gadolinium enhancement (LGE). T2* values were compared between patients with HCM and controls as well as between HCM patients with- and without fibrosis. Results HCM patients showed significantly decreased T2* values compared to controls (26.2 ± 4.6 vs. 31.3 ± 4.3 ms, p < 0.001). Especially patients with myocardial fibrosis presented with decreased T2* values in comparison to those without fibrosis (25.2 ± 4.0 vs. 28.7 ± 5.3 ms, p = 0.003). A regression model including maximum wall thickness, LVM and T2* values provided good overall diagnostic accuracy of 80% to diagnose HCM with and without fibrosis. Conclusion In this study, parametric mapping identified lower T2* values in HCM patients compared to controls, especially in a sub-group of patients with myocardial fibrosis. As myocardial fibrosis has been suggested to influence prognosis of patients with HCM, T2* mapping may add information for identifying a higher risk sub-group of HCM patients.
Collapse
Affiliation(s)
- Mareike Gastl
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
- Dept. Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
- Corresponding author.
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Malgorzata Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Florian Bönner
- Dept. Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Christiane Gruner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Malte Kelm
- Dept. Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich Gloriastrasse 35, 8092 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
31
|
Galli E, Vitel E, Schnell F, Le Rolle V, Hubert A, Lederlin M, Donal E. Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis. Echocardiography 2018; 36:74-82. [DOI: 10.1111/echo.14210] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Elena Galli
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| | - Emilie Vitel
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| | - Frédéric Schnell
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| | - Virginie Le Rolle
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| | - Arnaud Hubert
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| | - Mathieu Lederlin
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| | - Erwan Donal
- University of Rennes; CHU Rennes; Inserm, LTSI - UMR 1099; Rennes France
| |
Collapse
|
32
|
Wiese S, Hove J, Mo S, Mookerjee RP, Petersen CL, Vester-Andersen MK, Mygind ND, Goetze JP, Kjaer A, Bendtsen F, Møller S. Myocardial extracellular volume quantified by magnetic resonance is increased in cirrhosis and related to poor outcome. Liver Int 2018; 38:1614-1623. [PMID: 29714035 DOI: 10.1111/liv.13870] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/19/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS The underlying pathogenesis of cirrhotic cardiomyopathy remains unclear. Structural myocardial changes including diffuse fibrosis may be involved and can be accurately assessed by cardiac MRI (CMR) with quantification of the extracellular volume (ECV).This is the first application of this technique in patients with cirrhosis. We aimed to investigate the presence of diffuse myocardial fibrosis and to determine the relation to disease severity, cardiac function and outcome. METHODS A prospective study including 52 cirrhotic patients and 10 healthy controls. All patients underwent CMR with ECV quantification, tissue Doppler echocardiography, and biochemical assessments. Patients were followed up for a median of 25 months with registration of death and liver transplantation (LT). RESULTS Myocardial ECV was higher in the patients compared with healthy controls (31.2 ± 6 vs 27.4 ± 3%, P = .04). Furthermore, ECV increased across the Child Pugh A/B/C classes (26.9 ± 4/31.5 ± 5/34.4 ± 6%, P = .02). Four-teen patients experienced the composite end-point of death/LT during follow-up and these patients had higher ECV (33.2 ± 4 vs 30.4 ± 6%, P = .04). In a univariate Cox regression analysis ECV was associated with poor transplant-free survival (HR 3.6 [1.1-11.6]; P = .03). However, MELD and CRP remained the strongest predictors in a multivariate analysis. ECV correlated with cardiac index (r = 0.44, P = .001), CRP (r = 0.46, P = .001), proANP (r = 0.50, P < .001), and proBNP (r = 0.40, P = .005). CONCLUSIONS Myocardial ECV is increased in patients with cirrhosis and seems related to disease severity and transplant-free survival. These changes most likely reflect subclinical diffuse myocardial fibrosis and may represent a structural element of cirrhotic cardiomyopathy.
Collapse
Affiliation(s)
- Signe Wiese
- Department of Clinical Physiology and Nuclear Medicine, Center of Functional Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Jens Hove
- Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Silje Mo
- Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Rajeshwar P Mookerjee
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
| | - Claus L Petersen
- Department of Clinical Physiology and Nuclear Medicine, Center of Functional Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | | | - Naja D Mygind
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine, Center of Functional Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Physiology, Nuclear Medicine, PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bendtsen
- Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center of Functional Imaging and Research, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| |
Collapse
|
33
|
Seemann F, Baldassarre LA, Llanos‐Chea F, Gonzales RA, Grunseich K, Hu C, Sugeng L, Meadows J, Heiberg E, Peters DC. Assessment of diastolic function and atrial remodeling by MRI - validation and correlation with echocardiography and filling pressure. Physiol Rep 2018; 6:e13828. [PMID: 30187654 PMCID: PMC6125607 DOI: 10.14814/phy2.13828] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrosis can be estimated noninvasively by magnetic resonance imaging (MRI) using late gadolinium enhancement (LGE), but diastolic dysfunction is clinically assessed by transthoracic echocardiography (TTE), and rarely by MRI. This study aimed to evaluate well-established diastolic parameters using MRI, and validate them with TTE and left ventricular (LV) filling pressures, and to study the relationship between left atrial (LA) remodeling and parameters of diastolic function. The study retrospectively included 105 patients (53 ± 16 years, 39 females) who underwent 3D LGE MRI between 2012 and 2016. Medical charts were reviewed for the echocardiographic diastolic parameters E, A, and e' by TTE, and pressure catheterizations. E and A were measured from in-plane phase-contrast cardiac MRI images, and e' by feature-tracking, and validated with TTE. Interobserver and intraobserver variability was examined. Furthermore, LA volumes, function, and atrial LGE was correlated with diastolic parameters. Evaluation of e' in MRI had strong agreement with TTE (r = 0.75, P < 0.0001), and low interobserver and intraobserver variability. E and A by TTE showed strong agreement to MRI (r = 0.77, P = 0.001; r = 0.73, P = 0.003, for E and A, respectively). Agreement between E/e' by TTE and MRI was strong (r = 0.85, P = 0.0004), and E/e' by TTE correlated moderately to invasive pressures (r = 0.59, P = 0.03). There was a strong relationship between LA LGE and pulmonary capillary wedge pressure (r = 0.81, P = 0.01). In conclusion, diastolic parameters can be measured with good reproducibility by cardiovascular MRI. LA LGE exhibited a strong relationship with pulmonary capillary wedge pressure, an indicator of diastolic function.
Collapse
Affiliation(s)
- Felicia Seemann
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- Department of Clinical PhysiologySkane University HospitalLund UniversityLundSweden
- Department of Biomedical EngineeringFaculty of EngineeringLund UniversityLundSweden
| | - Lauren A. Baldassarre
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- Department of CardiologyYale UniversityNew HavenConnecticut
| | | | - Ricardo A. Gonzales
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- Department of Electrical EngineeringUniversidad de Ingenieria y Tecnologia ‐ UTECLimaPeru
| | - Karl Grunseich
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Chenxi Hu
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
| | - Lissa Sugeng
- Section of Cardiovascular MedicineDepartment of MedicineYale UniversityNew HavenConnecticut
| | - Judith Meadows
- Section of Cardiovascular MedicineDepartment of MedicineYale UniversityNew HavenConnecticut
| | - Einar Heiberg
- Department of Clinical PhysiologySkane University HospitalLund UniversityLundSweden
- Department of Biomedical EngineeringFaculty of EngineeringLund UniversityLundSweden
- Wallenberg Center for Molecular MedicineLund UniversityLundSweden
| | - Dana C. Peters
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
| |
Collapse
|
34
|
Nguyen MN, Su Y, Vizi D, Fang L, Ellims AH, Zhao WB, Kiriazis H, Gao XM, Sadoshima J, Taylor AJ, McMullen JR, Dart AM, Kaye DM, Du XJ. Mechanisms responsible for increased circulating levels of galectin-3 in cardiomyopathy and heart failure. Sci Rep 2018; 8:8213. [PMID: 29844319 PMCID: PMC5973942 DOI: 10.1038/s41598-018-26115-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
Galectin-3 is a biomarker of heart disease. However, it remains unknown whether increase in galectin-3 levels is dependent on aetiology or disease-associated conditions and whether diseased heart releases galectin-3 into the circulation. We explored these questions in mouse models of heart disease and in patients with cardiomyopathy. All mouse models (dilated cardiomyopathy, DCM; fibrotic cardiomyopathy, ischemia-reperfusion, I/R; treatment with β-adrenergic agonist isoproterenol) showed multi-fold increases in cardiac galectin-3 expression and preserved renal function. In mice with fibrotic cardiomyopathy, I/R or isoproterenol treatment, plasma galectin-3 levels and density of cardiac inflammatory cells were elevated. These models also exhibited parallel changes in cardiac and plasma galectin-3 levels and presence of trans-cardiac galectin-3 gradient, indicating cardiac release of galectin-3. DCM mice showed no change in circulating galectin-3 levels nor trans-cardiac galectin-3 gradient or myocardial inflammatory infiltration despite a 50-fold increase in cardiac galectin-3 content. In patients with hypertrophic cardiomyopathy or DCM, plasma galectin-3 increased only in those with renal dysfunction and a trans-cardiac galectin-3 gradient was not present. Collectively, this study documents the aetiology-dependency and diverse mechanisms of increment in circulating galectin-3 levels. Our findings highlight cardiac inflammation and enhanced β-adrenoceptor activation in mediating elevated galectin-3 levels via cardiac release in the mechanism.
Collapse
Affiliation(s)
- My-Nhan Nguyen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Yidan Su
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Donna Vizi
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Lu Fang
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Andris H Ellims
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Wei-Bo Zhao
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Helen Kiriazis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Xiao-Ming Gao
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Junichi Sadoshima
- Department of Cell Biology and Molecular Medicine Rutgers, New Jersey Medical School, New Jersey, USA
| | - Andrew J Taylor
- Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Anthony M Dart
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Cardiovascular Medicine, the Alfred Hospital, Melbourne, Australia
| | - Xiao-Jun Du
- Baker Heart and Diabetes Institute, Melbourne, Australia. .,Central Clinical School, Monash University, Melbourne, Australia.
| |
Collapse
|
35
|
Mohammed Yusof NL, Zainalabidin S, Mohd Fauzi N, Budin SB. Hibiscus sabdariffa (roselle) polyphenol-rich extract averts cardiac functional and structural abnormalities in type 1 diabetic rats. Appl Physiol Nutr Metab 2018; 43:1224-1232. [PMID: 29726706 DOI: 10.1139/apnm-2018-0084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus is often associated with cardiac functional and structural alteration, an initial event leading to cardiovascular complications. Roselle (Hibiscus sabdariffa) has been widely proven as an antioxidant and recently has incited research interest for its potential in treating cardiovascular disease. Therefore, this study aimed to determine the cardioprotective effects of H. sabdariffa (roselle) polyphenol-rich extract (HPE) in type-1-induced diabetic rats. Twenty-four male Sprague-Dawley rats were randomized into 4 groups (n = 6/group): nondiabetic, diabetic alone (DM), diabetic supplemented with HPE (DM+HPE), and diabetic supplemented with metformin. Type-1 diabetes was induced with streptozotocin (55 mg/kg intraperitoneally). Rats were forced-fed with HPE (100 mg/kg) and metformin (150 mg/kg) daily for 8 weeks. Results showed that HPE supplementation improved hyperglycemia and dyslipidemia significantly (p < 0.05) in the DM+HPE compared with the DM group. HPE supplementation attenuated cardiac oxidative damage in the DM group, indicated by low malondialdehyde and advanced oxidation protein product. As for the antioxidant status, HPE significantly (p < 0.05) increased glutathione level, as well as catalase and superoxide dismutase 1 and 2 activities. These findings correlate with cardiac function, whereby left ventricle developed pressure in DM+HPE (79.13 ± 3.08 mm Hg) was higher significantly compared with DM (45.84 ± 1.65 mm Hg). Coronary flow of DM+HPE (17.43 ± 0.62 mL/min) was also greater compared with DM (13.02 ± 0.6 mL/min), showing that HPE supplementation improved cardiac contractility and relaxation rate significantly (p < 0.05). Histological analysis showed a marked decrease in cardiomyocyte hypertrophy and fibrosis in DM+HPE compared with the DM group. Ultrastructural changes and impairment of mitochondria induced by diabetes were minimized by HPE supplementation. Collectively, these findings suggest that HPE is a potential cardioprotective agent in a diabetic setting through its hypoglycemic, anti-hyperlipidemia, and antioxidant properties.
Collapse
Affiliation(s)
- Nur Liyana Mohammed Yusof
- a Programme of Biomedical Science, School of Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Satirah Zainalabidin
- a Programme of Biomedical Science, School of Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Norsyahida Mohd Fauzi
- b Faculty of Pharmacy, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Siti Balkis Budin
- a Programme of Biomedical Science, School of Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| |
Collapse
|
36
|
|
37
|
Kvernby S, Rönnerfalk M, Warntjes M, Carlhäll CJ, Nylander E, Engvall J, Tamás É, Ebbers T. Longitudinal changes in myocardial T 1 and T 2 relaxation times related to diffuse myocardial fibrosis in aortic stenosis; before and after aortic valve replacement. J Magn Reson Imaging 2018; 48:799-807. [PMID: 29473982 DOI: 10.1002/jmri.25980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/27/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Diffuse myocardial fibrosis is associated with adverse outcomes, although detection and quantification is challenging. Cardiac MR relaxation times mapping represents a promising imaging biomarker for diffuse myocardial fibrosis. PURPOSE To investigate whether relaxation times can detect longitudinal changes in myocardial tissue composition associated with diffuse fibrosis in patients with severe aortic stenosis (AS) before and after aortic valve replacement (AVR). STUDY TYPE Prospective longitudinal study. POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL Fifteen patients with severe AS. FIELD STRENGTH/SEQUENCE 3T / 3(3)3(3)5-MOLLI, T2 -GraSE, and 3D-QALAS. ASSESSMENT Patients underwent MR examinations at three timepoints: before AVR, as well as 3 and 12 months after AVR. Data from each patient was analyzed in 16 myocardial segments. STATISTICAL TESTS The segment-wise T1 and T2 data were analyzed over time after surgery using linear mixed models for repeated measures analysis. RESULTS The results showed that T1 relaxation times were significantly (P < 0.05) shorter 3 and 12 months postoperative than preoperative and that the T2 relaxation times were significantly (P < 0.05) longer 3 and 12 months postoperative than preoperative for both 3D and 2D mapping methods. No significant changes were seen between 3 and 12 months postoperative for any of the methods (P = 0.06/0.19 for T1 with 3D-QALAS/MOLLI and P = 0.09/0.25 for T2 with 3D-QALAS/GraSE). DATA CONCLUSION We demonstrated that changes in myocardial relaxation times and thus tissue characteristics can be observed within 3 months after AVR surgery. The significant changes in relaxation times from preoperative examinations to the follow-up may be interpreted as a reduction of interstitial fibrosis in the left ventricular wall. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018.
Collapse
Affiliation(s)
- Sofia Kvernby
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
| | - Mattias Rönnerfalk
- Department of Cardiothoracic and Vascular Surgery and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marcel Warntjes
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- SyntheticMR AB, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Éva Tamás
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
- Department of Cardiothoracic and Vascular Surgery and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
38
|
Valor diagnóstico y pronóstico del mapeo de T 1 mediante RMC de los pacientes con insuficiencia cardiaca y fracción de eyección conservada. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
39
|
Mavrogeni S, Apostolou D, Argyriou P, Velitsista S, Papa L, Efentakis S, Vernardos E, Kanoupaki M, Kanoupakis G, Manginas A. T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”. Cardiology 2017; 138:207-217. [DOI: 10.1159/000478901] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/21/2017] [Indexed: 12/24/2022]
Abstract
The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing.
Collapse
|
40
|
Structural and Functional Correlates of Myocardial T1 Mapping in 321 Patients With Hypertrophic Cardiomyopathy. J Comput Assist Tomogr 2017; 41:653-660. [PMID: 27997439 DOI: 10.1097/rct.0000000000000564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the structural and functional correlates of T1 mapping in 321 patients with hypertrophic cardiomyopathy (HCM). METHODS Three hundred twenty-one patients with HCM who underwent cardiac magnetic resonance from 2003 to 2013 were retrospectively identified from our institution's HCM registry. Left ventricular volume, function, late gadolinium enhancement (LGE), and Look-Locker T1 time were quantified. T1 time was normalized to blood pool to calculate T1 ratio. Correlations between LGE%, T1 ratio, and structural and functional features were performed using Pearson correlation coefficient. RESULTS Late gadolinium enhancement showed stronger correlation with left ventricular mass index (r = 0.41, P < 0.001) compared with T1 ratio (r = -0.17, P = 0.004). Both LGE% and T1 ratio correlated with ejection fraction (r = -0.18 and P = 0.002 vs r = 0.21 and P < 0.001, respectively). E/e' showed correlation with LGE% but not with T1 ratio. CONCLUSIONS Late gadolinium enhancement was more strongly correlated with the phenotypic expression of HCM compared with T1 ratio.
Collapse
|
41
|
Left ventricular function in patients with hypertrophic cardiomyopathy and its relation to myocardial fibrosis and exercise tolerance. Int J Cardiovasc Imaging 2017; 34:121-129. [DOI: 10.1007/s10554-017-1214-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/15/2017] [Indexed: 10/19/2022]
|
42
|
Mazurkiewicz Ł, Ziółkowska L, Petryka J, Śpiewak M, Małek Ł, Kubik A, Marczak M, Misko J, Brzezińska-Rajszys G. Left-ventricular mechanics in children with hypertrophic cardiomyopathy. CMR study. Magn Reson Imaging 2017; 43:56-65. [PMID: 28688952 DOI: 10.1016/j.mri.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To assess the magnitude of myocardial displacement abnormalities and their alterations with the fibrosis, left-ventricular (LV) outflow tract obstruction (LVOTO) and hypertrophy in juveniles with hypertrophic cardiomyopathy (HCM). STUDY DESIGN Fifty-five children [age 12,5±4.6years, 38 (69,1%) males, 19 (34,5%) with LVOTO] with HCM and 20 controls underwent cardiovascular magnetic resonance. The LV feature tracking (FT) derived strain and strain rates were quantified. Results of FT analysis were compared between HCM subjects and controls and between children with and without LVOTO. RESULTS Children with HCM exhibited decreased strain in both hypertrophied and nonhypertrophied segments versus controls. LV global longitudinal strain (LVGLS) rate (-0.69±0.04 vs -0.91±0.05, p=0,04), LV circumferential strain (LVCR) rate (-0.98±0.09 vs -1.27±0.06, p=0,02), LV radial strain (LVR) (18,5±1.9 vs 27,4±1.4, p<0,01) and LVR rate (0,98±0.1 vs 1,53±0.08, p<0,01) were substantially compromised in subjects with LVOTO vs without. In multivariable regression all LV myocardial dynamics markers, except for LVCR, exhibited a significant association with the degree of LVOTO. LVCR rate (β=0,31, p=0,02) and LVR (β=-0.24, p=0,04) were related to LV mass and only LVCR rate (β=0,15, p=0,03) was associated with the amount of LV fibrosis. CONCLUSIONS The reduction of all indices of LV myocardial mechanics in juvenile HCM patients was global but particularly pronounced in hypertrophied segments of the LV. The majority of the LV strains and strain rates were substantially compromised in subjects with LVOTO compared to patients without the obstruction. Myocardial mechanics indices seemed to be related to the degree of LVOTO rather than either to mass or the amount of fibrosis.
Collapse
Affiliation(s)
- Łukasz Mazurkiewicz
- Department of Cardiomyopathies, CMR Unit, Institute of Cardiology, Warsaw, Poland.
| | - Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Petryka
- Department of Coronary and Structural Heart Diseases, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Agata Kubik
- CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | | |
Collapse
|
43
|
Prediction of the estimated 5-year risk of sudden cardiac death and syncope or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy using late gadolinium enhancement and extracellular volume CMR. Eur Radiol 2017; 27:5136-5145. [PMID: 28616729 DOI: 10.1007/s00330-017-4869-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/28/2017] [Accepted: 04/27/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To evaluate the ability of late gadolinium enhancement (LGE) and mapping cardiac magnetic resonance (CMR) including native T1 and global extracellular volume (ECV) to identify hypertrophic cardiomyopathy (HCM) patients at risk for sudden cardiac death (SCD) and to predict syncope or non-sustained ventricular tachycardia (VT). METHODS A 1.5-T CMR was performed in 73 HCM patients and 16 controls. LGE size was quantified using the 3SD, 5SD and full width at half maximum (FWHM) method. T1 and ECV maps were generated by a 3(3)5 modified Look-Locker inversion recovery sequence. Receiver-operating curve analysis evaluated the best parameter to identify patients with increased SCD risk ≥4% and patients with syncope or non-sustained VT. RESULTS Global ECV was the best predictor of SCD risk with an area under the curve (AUC) of 0.83. LGE size was significantly inferior to global ECV with an AUC of 0.68, 0.70 and 0.70 (all P < 0.05) for 3SD-, 5SD- and FWHM-LGE, respectively. Combined use of the SCD risk score and global ECV significantly improved the diagnostic accuracy to identify HCM patients with syncope or non-sustained VT. CONCLUSIONS Combined use of the SCD risk score and global ECV has the potential to improve HCM patient selection, benefiting most implantable cardioverter defibrillators. KEY POINTS • Global ECV identified the best HCM patients with increased SCD risk. • Global ECV performed equally well compared to a SCD risk score. • Combined use of the SCD risk score and global ECV improved test accuracy. • Combined use potentially improves selection of HCM patients for ICD implantation.
Collapse
|
44
|
Puntmann VO, Peker E, Chandrashekhar Y, Nagel E. T1 Mapping in Characterizing Myocardial Disease: A Comprehensive Review. Circ Res 2017; 119:277-99. [PMID: 27390332 DOI: 10.1161/circresaha.116.307974] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/20/2016] [Indexed: 01/06/2023]
Abstract
Cardiovascular magnetic resonance provides insights into myocardial structure and function noninvasively, with high diagnostic accuracy and without ionizing radiation. Myocardial tissue characterization in particular gives cardiovascular magnetic resonance a prime role among all the noninvasive cardiovascular investigations. Late gadolinium enhancement imaging is an established method for visualizing replacement scar, providing diagnostic and prognostic information in a variety of cardiac conditions. Late gadolinium enhancement, however, relies on the regional segregation of tissue characteristics to generate the imaging contrast. Thus, myocardial pathology that is diffuse in nature and affecting the myocardium in a rather uniform and global distribution is not well visualized with late gadolinium enhancement. Examples include diffuse myocardial inflammation, fibrosis, hypertrophy, and infiltration. T1 mapping is a novel technique allowing to diagnose these diffuse conditions by measurement of T1 values, which directly correspond to variation in intrinsic myocardial tissue properties. In addition to providing clinically meaningful indices, T1-mapping measurements also allow for an estimation of extracellular space by calculation of extracellular volume fraction. Multiple lines of evidence suggest a central role for T1 mapping in detection of diffuse myocardial disease in early disease stages and complements late gadolinium enhancement in visualization of the regional changes in common advanced myocardial disease. As a quantifiable measure, it may allow grading of disease activity, monitoring progress, and guiding treatment, potentially as a fast contrast-free clinical application. We present an overview of clinically relevant technical aspects of acquisition and processing, and the current state of art and evidence, supporting its clinical use.
Collapse
Affiliation(s)
- Valentina O Puntmann
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Elif Peker
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Y Chandrashekhar
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.)
| | - Eike Nagel
- From the Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging (V.O.P., E.P., E.N.) and Department of Cardiology (V.O.P., E.N.), Goethe University Hospital Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University School of Medicine, Ankara, Turkey (E.P.); and University of Minnesota and VA Medical Centre, Minneapolis (Y.C.).
| |
Collapse
|
45
|
Fulton N, Rajiah P. Utility of magnetic resonance imaging in the evaluation of left ventricular thickening. Insights Imaging 2017; 8:279-293. [PMID: 28281159 PMCID: PMC5359150 DOI: 10.1007/s13244-017-0549-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete's heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establishing aetiology, quantification, identifying prognostic factors, serial follow-up and treatment response. In this article, we review the aetiologies and pathophysiology of LV thickening, and demonstrate the comprehensive role of MRI in the evaluation of LV thickening. TEACHING POINTS • MRI plays an important role in the evaluation of LV thickening. • LV thickening can be due to either hypertrophy or remodelling. • Pathological thickening can be due to pressure/volume overload or infiltrative disorders.
Collapse
Affiliation(s)
- Nicholas Fulton
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA.
- Department of Radiology Cardiothoracic Imaging, UT Southwestern Medical Center, E6.120 B, Mail code 9316, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA.
| |
Collapse
|
46
|
Diagnostic and Prognostic Value of CMR T 1-Mapping in Patients With Heart Failure and Preserved Ejection Fraction. ACTA ACUST UNITED AC 2017; 70:848-855. [PMID: 28314659 DOI: 10.1016/j.rec.2017.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 01/09/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) presents a major challenge in modern cardiology. Although this syndrome is of increasing prevalence and is associated with unfavorable outcomes, treatment trials have failed to establish effective therapies. Currently, solutions to this dilemma are being investigated, including categorizing and characterizing patients more diversely to individualize treatment. In this regard, new imaging techniques might provide important information. Diastolic dysfunction is a diagnostic and pathophysiological cornerstone in HFpEF and is believed to be caused by systemic inflammation with the development of interstitial myocardial fibrosis and myocardial stiffening. Cardiac magnetic resonance (CMR) T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. This review provides an overview of the potential of myocardial tissue characterization with CMR T1 mapping in HFpEF patients, outlining its diagnostic and prognostic implications and discussing future directions. We conclude that CMR T1 mapping is potentially an effective tool for patient characterization in large-scale epidemiological, diagnostic, and therapeutic HFpEF trials beyond traditional imaging parameters.
Collapse
|
47
|
Latus H, Voges I. Quantitative Tissue Characterization in Pediatric Cardiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9405-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
48
|
Ziółkowska L, Petryka J, Boruc A, Kawalec W. Comparison of echocardiography with tissue Doppler imaging and magnetic resonance imaging with delayed enhancement in the assessment of children with hypertrophic cardiomyopathy. Arch Med Sci 2017; 13:328-336. [PMID: 28261285 PMCID: PMC5332448 DOI: 10.5114/aoms.2016.60404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/19/2015] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION In children with hypertrophic cardiomyopathy (HCM) there often occurs a non-ischemic pattern of myocardial fibrosis, which could be the cause of impaired left ventricular (LV) diastolic function assessed by tissue Doppler imaging (TDI). The aim of the study was to determine the prevalence of myocardial fibrosis in children with HCM, and to evaluate its relationship with echocardiographic parameters including LV diastolic dysfunction. MATERIAL AND METHODS Sixty-three children with HCM, mean age 12.2 ±4.5 years, underwent magnetic resonance imaging (MRI) and echocardiographic study from January 2010 to April 2014. The results of MRI, echocardiography, and TDI velocities were analyzed and compared between children with and without myocardial fibrosis. Moreover, correlations between the results of echocardiography and MRI were assessed. RESULTS Our results showed a significant correlation between magnetic resonance and echocardiographic measurements of septal wall thickness, posterior wall thickness, LV mass and left atrial dimension. Children with myocardial fibrosis (60%) had a significantly thicker interventricular septum (21.3 vs. 1.8 mm; p < 0.0001) and larger left atrial dimension (36.7 vs. 27.8 mm; p = 0.0004) and volume index (42.0 vs. 26.6 ml/m²; p = 0.0011). Tissue Doppler imaging demonstrated significantly decreased lateral E' (9.02 vs. 13.53 cm/s; p < 0.0001) and septal E' (7.05 vs. 9.36 cm/s; p = 0.0082) velocities and a significantly increased transmitral lateral (10.34 vs. 6.68; p = 0.0091) and septal (13.1 vs. 9.8; p = 0.046) E/E' ratio in children with myocardial fibrosis. CONCLUSIONS Myocardial fibrosis in children with hypertrophic cardiomyopathy was associated with markers for disease severity such as larger septum thickness, enlargement of the left atrium as well as impairment of left ventricular diastolic function. Tissue Doppler imaging is a helpful tool to detect the presence of left ventricular diastolic dysfunction in children with hypertrophic cardiomyopathy and myocardial fibrosis.
Collapse
Affiliation(s)
- Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Joanna Petryka
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Agnieszka Boruc
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Wanda Kawalec
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| |
Collapse
|
49
|
Choudhury L, Rigolin VH, Bonow RO. Integrated Imaging in Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 119:328-339. [PMID: 27816114 DOI: 10.1016/j.amjcard.2016.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/27/2022]
Abstract
Hypertrophic cardiomyopathy (HC) has a very heterogeneous clinical spectrum and lends itself to multimodality imaging for evaluation and management. This review addresses clinical applications of cardiac imaging in patients with HC. Integrating various techniques of echocardiography and cardiac magnetic resonance (CMR) is discussed in the clinical context such as diagnosis, evaluation, management, risk stratification, and family screening of patients with HC. The utility of periprocedural imaging techniques is highlighted for guiding surgical and transcatheter septal reduction procedures. More limited roles of invasive or computed tomography coronary angiography are discussed for patients with HC with chest pain and risk factors for coronary artery disease. Nuclear techniques although available for decades play a more limited role in contemporary routine management but may assist in risk assessment. Newer CMR and echo imaging techniques are discussed in their emerging roles for further characterization of patients with HC and family members with prospects of preclinical diagnosis. The strengths of the different imaging modalities are presented as well as a flow diagram summarizing integrated imaging in this disease. In conclusion, integrated imaging using the various imaging techniques predominantly echocardiography and CMR based on the clinical picture plays an essential role in the management of patients with HC.
Collapse
|
50
|
Kim PK, Hong YJ, Im DJ, Suh YJ, Park CH, Kim JY, Chang S, Lee HJ, Hur J, Kim YJ, Choi BW. Myocardial T1 and T2 Mapping: Techniques and Clinical Applications. Korean J Radiol 2017; 18:113-131. [PMID: 28096723 PMCID: PMC5240500 DOI: 10.3348/kjr.2017.18.1.113] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/29/2016] [Indexed: 01/02/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging is widely used in various medical fields related to cardiovascular diseases. Rapid technological innovations in magnetic resonance imaging in recent times have resulted in the development of new techniques for CMR imaging. T1 and T2 image mapping sequences enable the direct quantification of T1, T2, and extracellular volume fraction (ECV) values of the myocardium, leading to the progressive integration of these sequences into routine CMR settings. Currently, T1, T2, and ECV values are being recognized as not only robust biomarkers for diagnosis of cardiomyopathies, but also predictive factors for treatment monitoring and prognosis. In this study, we have reviewed various T1 and T2 mapping sequence techniques and their clinical applications.
Collapse
Affiliation(s)
- Pan Ki Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Joo Suh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jin Young Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Suyon Chang
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hye-Jeong Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin Hur
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| |
Collapse
|