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Cardiovascular magnetic resonance for the evaluation of patients with cardiovascular disease: An overview of current indications, limitations, and procedures. Hellenic J Cardiol 2023; 70:53-64. [PMID: 36706867 DOI: 10.1016/j.hjc.2023.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Cardiovascular disease (CVD) is the most common cause of morbidity/mortality worldwide. Early diagnosis is the key to improve CVD prognosis, and cardiovascular imaging plays a crucial role in this direction. Echocardiography is the most commonly used imaging modality. However, the need for early diagnosis/treatment favors the development of modalities providing information about tissue characterization beyond echocardiography. In this context, the rapid evolution of cardiovascular magnetic resonance (CMR) led to the coexistence of cardiologists and radiologists in the CMR field. Our aim was to provide an overview of indications, sequences, and reporting of CMR findings in various CVDs. The indications/limitations of CMR as well as the pathophysiological significance of various sequences in adult/pediatric CVDs are presented and discussed in detail. The role of CMR indices in the evaluation of the most common clinical scenarios in cardiology and their impact on CVD diagnosis/prognosis were analyzed in detail. Additionally, the comparison of CMR versus other imaging modalities is also discussed. Finally, future research directions are presented. CMR can provide cardiac tissue characterization and biventricular/biatrial functional assessment in the same examination, allowing for early and accurate identification of important subclinical abnormalities, before clinically overt CVD takes place.
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2
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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3
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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4
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Zhou R, Wang J, Weller DS, Yang Y, Mugler JP, Salerno M. Free-breathing self-gated continuous-IR spiral T1 mapping: Comparison of dual flip-angle and Bloch-Siegert B1-corrected techniques. Magn Reson Med 2022; 88:1068-1080. [PMID: 35481596 PMCID: PMC9325422 DOI: 10.1002/mrm.29269] [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] [Received: 08/31/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/12/2022]
Abstract
Purpose To develop a B1‐corrrected single flip‐angle continuous acquisition strategy with free‐breathing and cardiac self‐gating for spiral T1 mapping, and compare it to a previous dual flip‐angle technique. Methods Data were continuously acquired using a spiral‐out trajectory, rotated by the golden angle in time. During the first 2 s, off‐resonance Fermi RF pulses were applied to generate a Bloch‐Siegert shift B1 map, and the subsequent data were acquired with an inversion RF pulse applied every 4 s to create a T1* map. The final T1 map was generated from the B1 and the T1* maps by using a look‐up table that accounted for slice profile effects, yielding more accurate T1 values. T1 values were compared to those from inversion recovery (IR) spin echo (phantom only), MOLLI, SAturation‐recovery single‐SHot Acquisition (SASHA), and previously proposed dual flip‐angle results. This strategy was evaluated in a phantom and 25 human subjects. Results The proposed technique showed good agreement with IR spin‐echo results in the phantom experiment. For in‐vivo studies, the proposed technique and the previously proposed dual flip‐angle method were more similar to SASHA results than to MOLLI results. Conclusions B1‐corrected single flip‐angle T1 mapping successfully acquired B1 and T1 maps in a free‐breathing, continuous‐IR spiral acquisition, providing a method with improved accuracy to measure T1 using a continuous Look‐Locker acquisition, as compared to the previously proposed dual excitation flip‐angle technique.
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Affiliation(s)
- Ruixi Zhou
- Department of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China.,Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Junyu Wang
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Yang Yang
- Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John P Mugler
- Radiology & Medical Imaging, Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Medicine, Cardiovascular Medicine and Department of Radiology, Cardiovascular Imaging, Stanford University, Palo Alto, California, USA.,Department of Medicine, Cardiology Division, Radiology and Medical Imaging, and Biomedical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
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5
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Aissiou M, Curnier D, Caru M, Hafyane T, Leleu L, Krajinovic M, Laverdière C, Sinnett D, Andelfinger G, Cheriet F, Périé D. Detection of doxorubicin-induced cardiotoxicity using myocardial T1 and T2 relaxation times in childhood acute lymphoblastic leukemia survivors. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:873-882. [PMID: 34821983 DOI: 10.1007/s10554-021-02472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
Doxorubicin leads to dose-dependent cardiotoxicity in childhood acute lymphoblastic leukemia (ALL) survivors. The first aim was to propose a contour-based estimation of T1 and T2 relaxation times based on the myocardial area, while our second aim was to evaluate native T1, post-gadolinium T1 and T2 relaxation time sensitivity to detect myocardial changes. A total of 84 childhood ALL survivors were stratified in regard to their prognostic risk groups: standard risk (SR), n = 20), high-risk with and without dexrazoxane (HR + DEX, n = 39 and HR, n = 25). Survivors' mean age was of 22.0 ± 6.9 years, with a mean age at cancer diagnosis of 8.0 ± 5.2 years. CMR acquisitions were performed on a 3 T MRI system and included an ECG-gated 3(3)3(3)5 MOLLI sequence for T1 mapping and an ECG-gated T2-prepared TrueFISP sequence for T2 mapping. Myocardial contours were semi-automatically segmented using an interactive implementation of cubic Bezier curves. We found excellent repeatability between operators for native T1 (ICC = 0.91), and good repeatability between operators for post-gadolinium T1 (ICC = 0.84) and T2 (ICC = 0.79). Bland and Altman tests demonstrated a strong agreement between our contour-based method and images analyzed using the CVI42 software on the measure of native T1, post-gadolinium T1, and T2. No significant differences between survivors' prognostic risk groups in native T1 were reported, while we observed significant differences between survivors' prognostic risk groups in post-gadolinium T1 and T2. Significant differences were observed between male and female survivors. Differences between groups were also observed in partition coefficients, but no significant differences were observed between male and female survivors. The use of CMR parameters with native T1, post-gadolinium T1, and T2 allowed to show that survivors at a high-risk prognostic were more exposed to doxorubicin-related cardiotoxicity than those who were at a standard risk prognostic or who received dexrazoxane treatments.
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Affiliation(s)
- Mohamed Aissiou
- Department of Mechanical Engineering, Polytechnique Montreal, Station Centre-Ville, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Daniel Curnier
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Maxime Caru
- Department of Mechanical Engineering, Polytechnique Montreal, Station Centre-Ville, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Tarik Hafyane
- Montreal Heart Institute, Research Center, Montreal, Canada
| | - Louise Leleu
- Department of Mechanical Engineering, Polytechnique Montreal, Station Centre-Ville, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Gregor Andelfinger
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Farida Cheriet
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Computer and Software Engineering, Polytechnique Montreal, Montreal, Canada
| | - Delphine Périé
- Department of Mechanical Engineering, Polytechnique Montreal, Station Centre-Ville, P.O. Box 6079, Montréal, QC, H3C 3A7, Canada.
- Sainte-Justine University Health Center, Research Center, Montreal, Canada.
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6
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Kharabish A, Hosny M, Hassan M, Mahrous MR, Elbayoumy M, Ahmed AE, Deyaa N, El Mozy W, Behairy N. Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema.
Results
Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial coronary lesions and edema were assessed. Myocardial edema was not assessed in thirteen patients (35%) due to significant intra myocardial hemorrhage (T2 mapping < 60 ms). No statistical significance was found between the TIRM and the T2 mapping neither in the total amount of edema (p = 0.79), nor in the LV basal, mid, and apical segments’ edema (p = 0.69, 0.5, and 0.8 respectively). The upper and lower limits of agreements were tested between the TIRM and the T2 mapping of total edema mass, basal segments, mid, and apical ventricular segments were = 18 and − 7.7 g, 11.3 and − 5.1 g, 12.3 and − 5.2 g, and 15.5 and − 7.8 g respectively.
Conclusion
This study supports the proof of the principle that there is no statistical significant difference per myocardial segments between the T2 mapping and routine edema’s sequences. Larger studies are recommended to assess the impact in clinical outcome.
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7
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Thirunavukarasu S, Jex N, Chowdhary A, Hassan IU, Straw S, Craven TP, Gorecka M, Broadbent D, Swoboda P, Witte KK, Cubbon RM, Xue H, Kellman P, Greenwood JP, Plein S, Levelt E. Empagliflozin Treatment Is Associated With Improvements in Cardiac Energetics and Function and Reductions in Myocardial Cellular Volume in Patients With Type 2 Diabetes. Diabetes 2021; 70:2810-2822. [PMID: 34610982 PMCID: PMC8660983 DOI: 10.2337/db21-0270] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022]
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of major adverse cardiovascular (CV) events and hospitalization for heart failure (HF) in patients with type 2 diabetes (T2D). Using CV MRI (CMR) and 31P-MRS in a longitudinal cohort study, we aimed to investigate the effects of the selective SGLT2 inhibitor empagliflozin on myocardial energetics and cellular volume, function, and perfusion. Eighteen patients with T2D underwent CMR and 31P-MRS scans before and after 12 weeks' empagliflozin treatment. Plasma N-terminal prohormone B-type natriuretic peptide (NT-proBNP) levels were measured. Ten volunteers with normal glycemic control underwent an identical scan protocol at a single visit. Empagliflozin treatment was associated with significant improvements in phosphocreatine-to-ATP ratio (1.52 to 1.76, P = 0.009). This was accompanied by a 7% absolute increase in the mean left ventricular ejection fraction (P = 0.001), 3% absolute increase in the mean global longitudinal strain (P = 0.01), 8 mL/m2 absolute reduction in the mean myocardial cell volume (P = 0.04), and 61% relative reduction in the mean NT-proBNP (P = 0.05) from baseline measurements. No significant change in myocardial blood flow or diastolic strain was detected. Empagliflozin thus ameliorates the "cardiac energy-deficient" state, regresses adverse myocardial cellular remodeling, and improves cardiac function, offering therapeutic opportunities to prevent or modulate HF in T2D.
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Affiliation(s)
- Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Imtiaz Ul Hassan
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Sam Straw
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Thomas P Craven
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Miroslawa Gorecka
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - David Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, U.K
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Klaus K Witte
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Richard M Cubbon
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K.
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K
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Scalise RFM, De Sarro R, Caracciolo A, Lauro R, Squadrito F, Carerj S, Bitto A, Micari A, Bella GD, Costa F, Irrera N. Fibrosis after Myocardial Infarction: An Overview on Cellular Processes, Molecular Pathways, Clinical Evaluation and Prognostic Value. Med Sci (Basel) 2021; 9:medsci9010016. [PMID: 33804308 PMCID: PMC7931027 DOI: 10.3390/medsci9010016] [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: 12/30/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
The ischemic injury caused by myocardial infarction activates a complex healing process wherein a powerful inflammatory response and a reparative phase follow and balance each other. An intricate network of mediators finely orchestrate a large variety of cellular subtypes throughout molecular signaling pathways that determine the intensity and duration of each phase. At the end of this process, the necrotic tissue is replaced with a fibrotic scar whose quality strictly depends on the delicate balance resulting from the interaction between multiple actors involved in fibrogenesis. An inflammatory or reparative dysregulation, both in term of excess and deficiency, may cause ventricular dysfunction and life-threatening arrhythmias that heavily affect clinical outcome. This review discusses cellular process and molecular signaling pathways that determine fibrosis and the imaging technique that can characterize the clinical impact of this process in-vivo.
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Affiliation(s)
- Renato Francesco Maria Scalise
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Rosalba De Sarro
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Rita Lauro
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (R.L.); (F.S.); (A.B.)
| | - Francesco Squadrito
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (R.L.); (F.S.); (A.B.)
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Alessandra Bitto
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (R.L.); (F.S.); (A.B.)
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinico “G. Martino”, 98100 Messina, Italy;
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
- Correspondence: ; Tel.: +39-090-221-23-41; Fax: +39-090-221-23-81
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (R.F.M.S.); (R.D.S.); (A.C.); (S.C.); (G.D.B.); (N.I.)
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9
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CMR-derived ECVs vary with myocardial region and associate with the regional wall thickness. Sci Rep 2020; 10:20965. [PMID: 33262487 PMCID: PMC7708504 DOI: 10.1038/s41598-020-78043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 11/02/2020] [Indexed: 12/01/2022] Open
Abstract
This study was designed to identify whether the position and size of the
region of interest (ROI) influence extracellular volume fraction (ECV) measurements.
Patients with localized (n = 203) or infiltrative (n = 215) cardiomyopathies and 36
normal controls were enrolled in this study. ECV measurements at 4 different regions,
including the anterior, septal, posterior and lateral wall regions, were measured, and
all groups were compared. Regional ECV was correlated with the corresponding regional
wall thickness. The diagnostic power to differentiate the myocardial abnormalities was
evaluated for each myocardial region. ECVs measured using five different ROI sizes
within each myocardial region were compared. Our results showed that ECVs varied among
the myocardial regions, and this variation was significantly associated with regional
wall thicknesses. For the detection of myocardial abnormalities, regional ECV revealed
similar results as ECV derived from the whole region except for the anterior region. No
significant difference was found in the ECVs measured using the five different ROI
sizes. In conclusion, CMR-derived ECVs vary with myocardial region, and this variation
is significantly associated with the regional wall thickness. In contrast, the measured
size of the ROI has less of an effect on the ECV.
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10
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Quarta G, Gori M, Iorio A, D'Elia E, Moon JC, Iacovoni A, Burocchi S, Schelbert EB, Brambilla P, Sironi S, Caravita S, Parati G, Gavazzi A, Maisel AS, Butler J, Lam CSP, Senni M. Cardiac magnetic resonance in heart failure with preserved ejection fraction: myocyte, interstitium, microvascular, and metabolic abnormalities. Eur J Heart Fail 2020; 22:1065-1075. [PMID: 32654354 DOI: 10.1002/ejhf.1961] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/11/2022] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a chronic cardiac condition whose prevalence continues to rise, with high social and economic burden, but with no specific approved treatment. Patients diagnosed with HFpEF have a high prevalence of comorbidities and exhibit a high misdiagnosis rate. True HFpEF is likely to have multiple pathophysiological causes - with these causes being clinically ill-defined due to limitations of current measurement techniques. Myocyte, interstitium, microvascular, and metabolic abnormalities have been regarded as key components of the pathophysiology and potential therapeutic targets. Cardiac magnetic resonance (CMR) has the capability to look deeper with a number of tissue characterization techniques which are closer to the underlying specific abnormalities and which could be linked to personalized medicine for HFpEF. This review aims to discuss the potential role of CMR to better define HFpEF phenotypes and to infer measurable therapeutic targets.
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Affiliation(s)
- Giovanni Quarta
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annamaria Iorio
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emilia D'Elia
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - James C Moon
- University College London and Barts Heart Centre, London, UK
| | - Attilio Iacovoni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Simone Burocchi
- Cardiovascular Department, Azienda Ospedaliera S. Andrea, Rome, Italy
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paolo Brambilla
- Diagnostic Radiology, Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Diagnostic Radiology, Papa Giovanni XXIII Hospital, University of Milano-Bicocca, Milan, Italy
| | - Sergio Caravita
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (Bergamo), Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital IRCCS, Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonello Gavazzi
- FROM - Fondazione per la Ricerca dell'Ospedale di Bergamo, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Carolyn S P Lam
- National Heart Centre, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore.,University Medical Centre Groningen, Groningen, The Netherlands
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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11
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Takafuji M, Kitagawa K, Nakamura S, Hamdy A, Goto Y, Ishida M, Sakuma H. Feasibility of extracellular volume fraction calculation using myocardial CT delayed enhancement with low contrast media administration. J Cardiovasc Comput Tomogr 2020; 14:524-528. [PMID: 32094065 DOI: 10.1016/j.jcct.2020.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 01/08/2020] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial extracellular volume fraction (ECV) derived from CT delayed enhancement (CTDE) may allow assessment of diffuse myocardial fibrosis. However, the amount of contrast medium required for ECV estimation has not been established. Since ECV estimation by CT is typically performed in combination with coronary CT angiography (CCTA) in clinical settings, we aimed to investigate whether reliable ECV estimation is possible using the contrast dose optimized for CCTA without additional contrast administration. METHODS Twenty patients with known or suspected coronary artery disease who underwent CTDE with a dual-source scanner using two protocols (Protocols A and B) within 2 years were retrospectively enrolled. In Protocol A, CTDE was obtained with 0.84 ml/kg of iopamidol (370 mgI/ml) injected for CCTA. In Protocol B, stress CT perfusion imaging, which requires 40 ml of contrast medium, was added to Protocol A. ECV values calculated from the two protocols were compared. RESULTS Despite the different contrast doses, no significant difference in mean myocardial ECV was seen between Protocols A and B at the patient level (28.7 ± 4.3% vs. 28.7 ± 4.4%, respectively, P = 0.868). Excellent correlations in ECV were seen between the two protocols (r = 0.942, P < 0.001). Bland-Altman analysis showed slight bias (+0.06%), within a 95% limit of agreement of -2.9% and 3.0%. The coefficient of variation was 5.2%. CONCLUSION Reliable ECV estimation can be achieved with the contrast doses optimized for CCTA. Despite the differing contrast administration schemes and doses, ECV values calculated from the two protocols showed excellent agreement, indicating the robustness of ECV estimation by CT.
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Affiliation(s)
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Hospital, Tsu, Japan.
| | | | - Ahmed Hamdy
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Yoshitaka Goto
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
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12
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Faragli A, Tanacli R, Kolp C, Lapinskas T, Stehning C, Schnackenburg B, Lo Muzio FP, Perna S, Pieske B, Nagel E, Post H, Kelle S, Alogna A. Cardiovascular magnetic resonance feature tracking in pigs: a reproducibility and sample size calculation study. Int J Cardiovasc Imaging 2020; 36:703-712. [PMID: 31950298 PMCID: PMC7125242 DOI: 10.1007/s10554-020-01767-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
Cardiovascular magnetic resonance feature tracking (CMR-FT) is a novel technique for non-invasive assessment of myocardial motion and deformation. Although CMR-FT is standardized in humans, literature on comparative analysis from animal models is scarce. In this study, we measured the reproducibility of global strain under various inotropic states and the sample size needed to test its relative changes in pigs. Ten anesthetized healthy Landrace pigs were investigated. After baseline (BL), two further steps were performed: (I) dobutamine-induced hyper-contractility (Dob) and (II) verapamil-induced hypocontractility (Ver). Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) were assessed. This study shows a good to excellent inter- and intra-observer reproducibility of CMR-FT in pigs under various inotropic states. The highest inter-observer reproducibility was observed for GLS at both BL (ICC 0.88) and Ver (ICC 0.79). According to the sample size calculation for GLS, a small number of animals could be used for future trials.
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Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
| | - R Tanacli
- Department of Internal Medicine / Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Kolp
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - T Lapinskas
- Department of Internal Medicine / Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania
| | - C Stehning
- Clinical Science, Philips Healthcare, Röntgenstr. 24, 22335, Hamburg, Germany
| | - B Schnackenburg
- Clinical Science, Philips Healthcare, Röntgenstr. 24, 22335, Hamburg, Germany
| | - F P Lo Muzio
- Department of Surgery, Dentistry, Paedriatics and Gynaecology, University of Verona, Via S. Francesco 22, 37129, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - S Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir Campus, P.O. Box 32038, Zallaq, Bahrain
| | - B Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Department of Internal Medicine / Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - H Post
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Kaiserstraße 50, 45468, Mülheim, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany
| | - A Alogna
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site, Berlin, Germany.
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13
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Vo HQ, Marwick TH, Negishi K. Pooled summary of native T1 value and extracellular volume with MOLLI variant sequences in normal subjects and patients with cardiovascular disease. Int J Cardiovasc Imaging 2019; 36:325-336. [DOI: 10.1007/s10554-019-01717-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/16/2019] [Indexed: 01/02/2023]
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14
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Cardoso FB, Antunes-Correa LM, Silva TQAC, Silva LM, Toledo C, Ribeiro VC, Paim LR, Neilan TG, Velloso L, Nadruz W, Ramos CD, Dertkigil SS, Schreiber R, Sposito A, Matos-Souza JR, Berwanger O, Jerosch-Herold M, Coelho-Filho OR. Noninvasive imaging assessment of rehabilitation therapy in heart failure with preserved and reduced left ventricular ejection fraction (IMAGING-REHAB-HF): design and rationale. Ther Adv Chronic Dis 2019; 10:2040622319868376. [PMID: 31489153 PMCID: PMC6709440 DOI: 10.1177/2040622319868376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Studies have shown significant benefits of exercise therapy in heart failure
(HF) with a reduced ejection fraction (HFrEF) and HF with a preserved
ejection fraction (HFpEF). The mechanisms responsible for the beneficial
effect of exercise in HFrEF and HFpEF are still unclear. We hypothesized
that the effect of exercise on myocardial remodeling may explain its
beneficial effect. Methods: IMAGING-REHAB-HF is a single-center, randomized, controlled clinical trial
using cardiac magnetic resonance imaging, vasomotor endothelial function,
cardiac sympathetic activity imaging and serum biomarkers to compare the
effect of exercise therapy in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%).
Subjects will be assessed at baseline and after 4 months. The exercise
program will consist of three 60-min exercise sessions/week. The primary
endpoints are the effect of exercise on myocardial extracellular volume
(ECV), left ventricular (LV) systolic function, LV mass, LV mass-to-volume
and LV cardiomyocyte volume. Secondary endpoints include the effect of
exercise on vasomotor endothelial function, cardiac sympathetic activity and
plasmatic biomarkers. Patients will be allocated in a 2:1 fashion to
supervised exercise program or usual care. A total sample size of 90
patients, divided into two groups according to LVEF:HFpEF group (45
patients:30 in the intervention arm and 15 in the control arm) and HFrEF
group (45 patients:30 in the intervention arm and 15 in the control arm) –
will be necessary to achieve adequate power. Conclusion: This will be the first study to evaluate the benefits of a rehabilitation
program on cardiac remodeling in HF patients. The unique design of our study
may provide unique data to further elucidate the mechanisms involved in
reverse cardiac remodeling after exercise in HFpEF and HFrEF patients.
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Affiliation(s)
| | | | | | - Luis Miguel Silva
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Camilla Toledo
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Layde R Paim
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lício Velloso
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wilson Nadruz
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Celso Darío Ramos
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Sergio S Dertkigil
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Roberto Schreiber
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | - Andrei Sposito
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, São Paulo, Brazil
| | | | - Otávio Berwanger
- Instituto Israelita de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Otávio Rizzi Coelho-Filho
- Discipline of Cardiology, Department of Internal Medicine, Hospital de Clínicas, State University of Campinas, UNICAMP, Rua Vital Brasil,251- Cidade Universitária 'Zeferino Vaz', Campinas, SP, CEP:13083-888, Brazil
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15
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Standardized image post-processing of cardiovascular magnetic resonance T1-mapping reduces variability and improves accuracy and consistency in myocardial tissue characterization. Int J Cardiol 2019; 298:128-134. [PMID: 31500864 DOI: 10.1016/j.ijcard.2019.08.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/26/2019] [Accepted: 08/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Myocardial T1-mapping is increasingly used in multicentre studies and trials. Inconsistent image analysis introduces variability, hinders differentiation of diseases, and results in larger sample sizes. We present a systematic approach to standardize T1-map analysis by human operators to improve accuracy and consistency. METHODS We developed a multi-step training program for T1-map post-processing. The training dataset contained 42 left ventricular (LV) short-axis T1-maps (normal and diseases; 1.5 and 3 Tesla). Contours drawn by two experienced human operators served as reference for myocardial T1 and wall thickness (WT). Trainees (n = 26) underwent training and were evaluated by: (a) qualitative review of contours; (b) quantitative comparison with reference T1 and WT. RESULTS The mean absolute difference between reference operators was 8.4 ± 6.3 ms (T1) and 1.2 ± 0.7 pixels (WT). Trainees' mean discrepancy from reference in T1 improved significantly post-training (from 8.1 ± 2.4 to 6.7 ± 1.4 ms; p < 0.001), with a 43% reduction in standard deviation (SD) (p = 0.035). WT also improved significantly post-training (from 0.9 ± 0.4 to 0.7 ± 0.2 pixels, p = 0.036), with 47% reduction in SD (p = 0.04). These experimentally-derived thresholds served to guide the training process: T1 (±8 ms) and WT (±1 pixel) from reference. CONCLUSION A standardized approach to CMR T1-map image post-processing leads to significant improvements in the accuracy and consistency of LV myocardial T1 values and wall thickness. Improving consistency between operators can translate into 33-72% reduction in clinical trial sample-sizes. This work may: (a) serve as a basis for re-certification for core-lab operators; (b) translate to sample-size reductions for clinical studies; (c) produce better-quality training datasets for machine learning.
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16
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Lam CZ, Pagano JJ, Yim D, Yoo SJ, Seed M, Grosse-Wortmann L. Mapping versus source methods for quantifying myocardial T1 in controls and in repaired tetralogy of Fallot: interchangeability and reproducibility in children. Pediatr Radiol 2019; 49:1152-1162. [PMID: 31190110 DOI: 10.1007/s00247-019-04428-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/03/2019] [Accepted: 05/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Myocardial T1 relaxometry can be performed by contouring on individual T1-weighted source images (source method) or on a single T1 map (mapping method). OBJECTIVE This study compares (a) agreement between native T1 and extracellular volume results of the two methods and (b) interobserver reproducibility of the two methods in children without heart disease and those with tetralogy of Fallot (TOF). MATERIALS AND METHODS We retrospectively analyzed pediatric patients (controls and those with repaired TOF) with cardiac magnetic resonance examinations including extracellular volume quantification using the modified Look-Locker inversion recovery (MOLLI) sequence. We compared native T1 and extracellular volume of the entire left ventricle and interventricular septum derived using the source and the mapping approaches. RESULTS In the control group (n=25, median age 14.0 years, interquartile range [IQR] 11.5-16.5 years), the mapping method produced lower native T1 values than the source method in the interventricular septum (mean difference ± standard deviation [SD] = 12±15 ms, P<0.001). In the TOF group (n=50, median age 13.3 years, IQR 9.9-15.0 years), the mapping method produced lower values for native T1 and extracellular volume in the interventricular septum (mean difference 9±14 ms and 0.6±1.1%, P<0.001). In 6-12% of the children, differences were >3 standard deviations from the mean difference. Interobserver reproducibility between the two methods by intraclass correlation coefficients were clinically equivalent. CONCLUSION T1 and extracellular volume values generated by the source and mapping methods show systematic differences and can vary significantly in an individual child, and thus cannot be used interchangeably in clinical practice. The source method might allow for easier detection and, in some cases, mitigation of artifacts that are not infrequent in children and can be difficult to appreciate on the T1 map.
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Affiliation(s)
- Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada.
| | - Joseph J Pagano
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Deane Yim
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Mike Seed
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Ave., 2107C Burton Wing, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto,, Toronto, ON, Canada
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17
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Cornicelli MD, Rigsby CK, Rychlik K, Pahl E, Robinson JD. Diagnostic performance of cardiovascular magnetic resonance native T1 and T2 mapping in pediatric patients with acute myocarditis. J Cardiovasc Magn Reson 2019; 21:40. [PMID: 31307467 PMCID: PMC6631973 DOI: 10.1186/s12968-019-0550-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multiple studies in adult patients suggest that tissue mapping performed by cardiovascular magnetic resonance (CMR) has excellent diagnostic accuracy in acute myocarditis, however, these techniques have not been studied in depth in children. METHODS CMR data on 23 consecutive pediatric patients from 2014 to 2017 with a clinical diagnosis of acute myocarditis were retrospectively analyzed and compared to 39 healthy controls. The CMR protocol included native T1, T2, and extracellular volume fraction (ECV) in addition to standard Lake Louise Criteria (LLC) parameters on a 1.5 T scanner. RESULTS Mean global values for novel mapping parameters were significantly elevated in patients with clinically suspected acute myocarditis compared to controls, with native T1 1098 ± 77 vs 990 ± 34 ms, T2 52.8 ± 4.6 ms vs 46.7 ± 2.6 ms, and ECV 29.8 ± 5.1% vs 23.3 ± 2.6% (all p-values < 0.001). Ideal cutoff values were generated using corresponding ROC curves and were for global T1 1015 ms (AUC 0.936, sensitivity 91%, specificity 86%), for global T2 48.5 ms (AUC 0.908, sensitivity 91%, specificity 74%); and for ECV 25.9% (AUC 0.918, sensitivity 86%, specificity 89%). While the diagnostic yield of the LLC was 57% (13/23) in our patient cohort, 70% (7/10) of patients missed by the LLC demonstrated abnormalities across all three global mapping parameters (native T1, T2, and ECV) and another 20% (2/10) of patients demonstrated at least one abnormal mapping value. CONCLUSIONS Similar to findings in adults, pediatric patients with acute myocarditis demonstrate abnormal CMR tissue mapping values compared to controls. Furthermore, we found CMR parametric mapping techniques measurably increased CMR diagnostic yield when compared with conventional LLC alone, providing additional sensitivity and specificity compared to historical references. Routine integration of these techniques into imaging protocols may aid diagnosis in children.
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Affiliation(s)
- Matthew D. Cornicelli
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago Northwestern University, 737 N. Michigan Avenue, Suite 1600 225 E Chicago Avenue, Box 21, Chicago, IL 60611 USA
| | - Cynthia K. Rigsby
- Department of Medical Imaging, Ann & Robert Lurie Children’s Hospital of Chicago, Chicago, IL USA
- Department of Pediatrics, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Karen Rychlik
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago Northwestern University, 737 N. Michigan Avenue, Suite 1600 225 E Chicago Avenue, Box 21, Chicago, IL 60611 USA
- Statistics Core, Ann and Robert H. Lurie Children’s Hospital of Chicago, Stanley Manne Children’s Research Institute, Chicago, IL USA
| | - Elfriede Pahl
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago Northwestern University, 737 N. Michigan Avenue, Suite 1600 225 E Chicago Avenue, Box 21, Chicago, IL 60611 USA
- Department of Pediatrics, Northwestern University, Chicago, USA
| | - Joshua D. Robinson
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago Northwestern University, 737 N. Michigan Avenue, Suite 1600 225 E Chicago Avenue, Box 21, Chicago, IL 60611 USA
- Department of Pediatrics, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
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18
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Sussman MS, Wintersperger BJ. Modified look-locker inversion recovery (MOLLI) T 1 mapping with inversion group (IG) fitting - A method for improved precision. Magn Reson Imaging 2019; 62:38-45. [PMID: 31170429 DOI: 10.1016/j.mri.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 11/17/2022]
Abstract
MOLLI-based T1 mapping has been applied to a variety of cardiac pathologies. However, conventional MOLLI's requirement for rest periods between inversion groups increases scan time, and limits the choice of inversion groups. The recently developed inversion group (IG) fitting technique eliminates the rest period requirement, and permits complete flexibility of inversion groups. However, a limitation is that its T1 maps have low precision - up to 30% poorer than conventional 3-parameter methods. In the original IG method, T1 maps were derived from the first inversion group only. In the present study, a technique is presented which utilize data from all inversion groups to generate T1 maps. It is hypothesized this "composite-IG" fitting method will provided improved prevision over conventional-IG T1 mapping methods. Simulations, phantom, and in vivo experiments on nine clinical cardiac patients (congenital heart disease, ischemic- and non-ischemic cardiomyopathy) were performed. Imaging was performed on a 1.5 T Siemens scanner. Myocardial T1 mapping precision and reproducibility were calculated for conventional-IG, composite-IG, and 3-parameter techniques. Precision and reproducibility between the techniques was compared using the Wilcoxon Signed Rank test. Statistical significance was set at the 95% confidence level, with the Bonferroni correction for multiple comparisons employed. Composite-IG improves precision by 16-38% over conventional-IG (p < 0.01). Composite-IG T1 maps provided up to 5% better precision than 3-parameter fits (p < 0.01). Composite-IG had better reproducibility than conventional-IG (p < 0.01). However, there was no significant difference between composite-IG and conventional 5(3)3 3-parameter reproducibility.
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Affiliation(s)
- Marshall S Sussman
- Joint Department of Medical Imaging, University Health Network, University, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Bernd J Wintersperger
- Joint Department of Medical Imaging, University Health Network, University, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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19
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20
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Storz C, Hetterich H, Lorbeer R, Heber SD, Schafnitzel A, Patscheider H, Auweter S, Zitzelsberger T, Rathmann W, Nikolaou K, Reiser M, Schlett CL, von Knobelsdorff-Brenkenhoff F, Peters A, Schulz-Menger J, Bamberg F. Myocardial tissue characterization by contrast-enhanced cardiac magnetic resonance imaging in subjects with prediabetes, diabetes, and normal controls with preserved ejection fraction from the general population. Eur Heart J Cardiovasc Imaging 2019; 19:701-708. [PMID: 28950340 DOI: 10.1093/ehjci/jex190] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/10/2017] [Indexed: 01/18/2023] Open
Abstract
Aims To characterize changes in the myocardium in subjects with prediabetes, diabetes, and healthy controls with preserved left ventricular ejection fraction (LVEF) by using cardiac magnetic resonance imaging (CMR) in a sample from the general population. Methods and results Subjects without history of cardiovascular disease and preserved LVEF but established diabetes, prediabetes, and controls from a population-based cohort underwent contrast-enhanced CMR. Obtained parameters included left ventricular (LV) function and morphology, late gadolinium enhancement as well as T1-mapping and derivation of extracellular volume fraction (ECV) by modified Look-Locker inversion recovery for diffuse fibrosis in a subset of patients. Fibrosis volume and cell volume were calculated and LV remodelling index was calculated by dividing the LV mass by its end-diastolic volume. Among 343 subjects (56.1 ± 9.2 years, 57% males), 47 subjects were classified as diabetes, 78 as prediabetes, and 218 as controls. Haematocrit values and thus ECV parameters were available in 251 subjects. LV remodelling index was significantly higher in participants with prediabetes and diabetes, independent of body mass index (BMI), hypertension, age, and sex. ECV was decreased in subjects with prediabetes and diabetes compared with healthy controls (23.1 ± 2.4% and 22.8 ± 3.0%, both P < 0.007). In contrast, cell volume was significantly higher in subjects with prediabetes and diabetes as compared with controls (109.1 ± 23.8 and 114.9 ± 32.3 mL vs. 96.5 ± 26.9 mL, both P < 0.03, respectively). However, differences in ECV and cell volume attenuated after the adjustment for cardiometabolic risk factors, including age, sex, BMI, and hypertension. Conclusion Subjects with prediabetes and diabetes but preserved LVEF had higher LV remodelling indices, suggesting early detectable changes in the disease process, while diffuse myocardial fibrosis appears to be less relevant at this stage.
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Affiliation(s)
- Corinna Storz
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Roberto Lorbeer
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Sophia D Heber
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Anina Schafnitzel
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Hanna Patscheider
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, Duesseldorf 40225, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistraße 15, Munich 81377, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Department of Cardiology, Charité, Experimental and Clinical Research Center and HELIOS-Clinics Berlin-Buch Schwanebecker Chaussee 50, 13125 Berlin, Germany.,Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University Munich, Norbert-Kerkel-Platz, Hausham 83734, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.,Institute for Cardiovascular Prevention, Ludwig-Maximilian-University-Hospital, Pettenkoferstraäe 9, Munich 80336, Germany.,German Center for Cardiovascular Disease Research (DZHK e.V.), Partnersite Munich, Biedersteiner Straße 29, Munich 80802, Germany
| | - Jeanette Schulz-Menger
- Department of Cardiology, Charité, Experimental and Clinical Research Center and HELIOS-Clinics Berlin-Buch Schwanebecker Chaussee 50, 13125 Berlin, Germany.,German Center for Cardiovascular Disease Research (DZHK e.V.), Partnersite Berlin, Oudenarder Straße 16, Berlin 13347, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
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21
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Frustaci A, Verardo R, Grande C, Galea N, Piselli P, Carbone I, Alfarano M, Russo MA, Chimenti C. Immune-Mediated Myocarditis in Fabry Disease Cardiomyopathy. J Am Heart Assoc 2018; 7:e009052. [PMID: 30371172 PMCID: PMC6201436 DOI: 10.1161/jaha.118.009052] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/25/2018] [Indexed: 12/21/2022]
Abstract
Background Glycosphingolipid accumulation in Fabry cells generates a proinflammatory response that may influence disease evolution and responsiveness to enzyme replacement therapy. This study evaluated incidence, mechanism, and impact of myocarditis in Fabry disease cardiomyopathy ( FDCM ). Methods and Results Myocarditis, defined as CD 3+ T lymphocytes >7/mm2 associated with necrosis of glycolipid-laden myocardiocytes, was retrospectively evaluated in endomyocardial biopsies from 78 patients with FDCM : 13 with maximal wall thickness (MWT) <11 mm (group 1), 17 with MWT 11 to 15 mm (group 2), 30 with MWT 16 to 20 mm (group 3), and 18 with MWT >20 mm (group 4). Myocarditis was investigated by polymerase chain reaction for cardiotropic viruses, by serum antiheart and antimyosin antibodies, and by cardiac magnetic resonance. Myocarditis was recognized at histology in 48 of 78 patients with FDCM (38% of group 1, 41% of group 2, 66% of group 3, and 72% of group 4). Myocarditis was characterized by positive antiheart and antimyosin antibodies and negative polymerase chain reaction for viral genomes. CD 3+ cells/mm2 correlated with myocyte necrosis, antimyosin autoantibody titer, and MWT ( P<0.001, r=0.79; P<0.001, r=0.84; P<0.001, r=0.61, respectively). Cardiac magnetic resonance showed myocardial edema in 24 of 78 patients (31%): 0% of group 1, 23% of group 2, 37% of group 3, and 50% of group 4. Conclusions Myocarditis is detectable at histology in up to 56% of patients with FDCM . It is immune mediated and correlates with disease severity. It can be disclosed by antiheart/antimyosin autoantibodies and in the advanced phase by cardiac magnetic resonance. It may contribute to progression of FDCM and resistance to enzyme replacement therapy.
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Affiliation(s)
- Andrea Frustaci
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
- Molecular and Cellular Cardiology LabIRCCS ‘L. Spallanzani’RomeItaly
| | - Romina Verardo
- Molecular and Cellular Cardiology LabIRCCS ‘L. Spallanzani’RomeItaly
| | - Claudia Grande
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological SciencesSapienza UniversityRomeItaly
| | - Pierluca Piselli
- Department of Epidemiology and Preclinical ResearchIRCCS ‘L. Spallanzani’RomeItaly
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological SciencesSapienza UniversityRomeItaly
| | - Maria Alfarano
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
| | | | - Cristina Chimenti
- Department of CardiovascularNephrologic, Anesthetic and Geriatric SciencesLa Sapienza University of RomeItaly
- Molecular and Cellular Cardiology LabIRCCS ‘L. Spallanzani’RomeItaly
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22
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Kim PK, Hong YJ, Sakuma H, Chawla A, Park JK, Park CH, Hong D, Han K, Lee JY, Hur J, Lee HJ, Kim YJ, Suh YJ, Choi BW. Myocardial Extracellular Volume Fraction and Change in Hematocrit Level: MR Evaluation by Using T1 Mapping in an Experimental Model of Anemia. Radiology 2018; 288:93-98. [DOI: 10.1148/radiol.2018171342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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Engblom H, Kanski M, Kopic S, Nordlund D, Xanthis CG, Jablonowski R, Heiberg E, Aletras AH, Carlsson M, Arheden H. Importance of standardizing timing of hematocrit measurement when using cardiovascular magnetic resonance to calculate myocardial extracellular volume (ECV) based on pre- and post-contrast T1 mapping. J Cardiovasc Magn Reson 2018; 20:46. [PMID: 29950178 PMCID: PMC6022290 DOI: 10.1186/s12968-018-0464-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/24/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) can be used to calculate myocardial extracellular volume fraction (ECV) by relating the longitudinal relaxation rate in blood and myocardium before and after contrast-injection to hematocrit (Hct) in blood. Hematocrit is known to vary with body posture, which could affect the calculations of ECV. The aim of this study was to test the hypothesis that there is a significant increase in calculated ECV values if the Hct is sampled after the CMR examination in supine position compared to when the patient arrives at the MR department. METHODS Forty-three consecutive patients including various pathologies as well as normal findings were included in the study. Venous blood samples were drawn upon arrival to the MR department and directly after the examination with the patient remaining in supine position. A Modified Look-Locker Inversion recovery (MOLLI) protocol was used to acquire mid-ventricular short-axis images before and after contrast injection from which motion-corrected T1 maps were derived and ECV was calculated. RESULTS Hematocrit decreased from 44.0 ± 3.7% before to 40.6 ± 4.0% after the CMR examination (p < 0.001). This resulted in a change in calculated ECV from 24.7 ± 3.8% before to 26.2 ± 4.2% after the CMR examination (p < 0.001). All patients decreased in Hct after the CMR examination compared to before except for two patients whose Hct remained the same. CONCLUSION Variability in CMR-derived myocardial ECV can be reduced by standardizing the timing of Hct measurement relative to the CMR examination. Thus, a standardized acquisition of blood sample for Hct after the CMR examination, when the patient is still in supine position, would increase the precision of ECV measurements.
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Affiliation(s)
- Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Sascha Kopic
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - David Nordlund
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Christos G. Xanthis
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Robert Jablonowski
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Anthony H. Aletras
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
- Laboratory of Computing, Medical Informatics and Biomedical – Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Getingevägen 3, 221 85 Lund, Sweden
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24
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Lee DC, Hinchcliff ME, Sarnari R, Stark MM, Lee J, Koloms K, Hoffmann A, Carns M, Thakrar A, Aren K, Varga J, Aquino A, Carr JC, Benefield BC, Shah SJ. Diffuse cardiac fibrosis quantification in early systemic sclerosis by magnetic resonance imaging and correlation with skin fibrosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:159-169. [PMID: 29808171 DOI: 10.1177/2397198318762888] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose To evaluate the utility of cardiac magnetic resonance (CMR) T1 mapping in early systemic sclerosis (SSc) and its association with skin score. Methods Twenty-four consecutive patients with early SSc referred for cardiovascular evaluation and 12 controls without SSc were evaluated. All patients underwent cine, T1 mapping, and late gadolinium enhanced (LGE) CMR imaging. T1 mapping indices were compared between SSc patients and controls (extracellular volume fraction [ECV], gadolinium partition coefficient [λ], pre-contrast T1, and post-contrast T1). The association between T1 mapping parameters and the modified Rodnan skin score (mRSS) was determined. Results There were no significant differences in cardiac structure/function between SSc patients and controls on cine imaging, and 8/24 (33%) SSc patients had evidence of LGE (i.e., focal myocardial fibrosis). Of the T1 mapping parameters (indices indicative of diffuse myocardial fibrosis), ECV differentiated SSc patients from controls the best, followed by λ, even when the eight SSc patients with LGE were excluded. ECV had a sensitivity and specificity of 75% and 75% for diffuse myocardial fibrosis (optimal abnormal cut-off value of >27% [area under ROC curve=0.85]). In the 16 patients without evidence of LGE, each of the 4 CMR T1 mapping parameters (ECV, λ, Pre-T1 and Post-T1) correlated with mRSS (R=0.51-0.65, P=0.007-0.043), indicating a correlation between SSc cardiac and skin fibrosis. Conclusions The four T1 mapping indices are significantly correlated with mRSS in patients with early SSc. Quantification of diffuse myocardial fibrosis using ECV should be considered as a marker for cardiac involvement in SSc clinical studies.
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Affiliation(s)
- Daniel C Lee
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611.,Division of Cardiology, Bluhm Cardiovascular Institute, 251 E Huron Street, Chicago, IL 60611
| | - Monique E Hinchcliff
- Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611.,Northwestern University Institute for Public Health and Medicine, 633 N St Clair Street, 18floor, Chicago, IL 60611
| | - Roberto Sarnari
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611
| | - Madeline M Stark
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611
| | - Jungwha Lee
- Northwestern University Institute for Public Health and Medicine, 633 N St Clair Street, 18floor, Chicago, IL 60611.,Department of Radiology, 676 N. St. Clair Street Suite 800, Chicago, Illinois, 60611
| | - Kimberly Koloms
- Northwestern University Institute for Public Health and Medicine, 633 N St Clair Street, 18floor, Chicago, IL 60611.,Department of Radiology, 676 N. St. Clair Street Suite 800, Chicago, Illinois, 60611
| | - Aileen Hoffmann
- Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611
| | - Mary Carns
- Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611
| | - Anjali Thakrar
- Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611
| | - Kathleen Aren
- Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611
| | - John Varga
- Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611
| | - Alejandro Aquino
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611
| | - James C Carr
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611.,Division of Cardiology, Bluhm Cardiovascular Institute, 251 E Huron Street, Chicago, IL 60611.,Division of Rheumatology 240 E. Huron Street M300, Chicago, IL 60611.,Northwestern University Institute for Public Health and Medicine, 633 N St Clair Street, 18floor, Chicago, IL 60611.,Department of Radiology, 676 N. St. Clair Street Suite 800, Chicago, Illinois, 60611
| | - Brandon C Benefield
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611
| | - Sanjiv J Shah
- Feinberg Cardiovascular Research Institute, 303 E. Chicago Avenue, Tarry 14-725, Chicago, IL 60611.,Division of Cardiology, Bluhm Cardiovascular Institute, 251 E Huron Street, Chicago, IL 60611
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25
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Levelt E, Gulsin G, Neubauer S, McCann GP. MECHANISMS IN ENDOCRINOLOGY: Diabetic cardiomyopathy: pathophysiology and potential metabolic interventions state of the art review. Eur J Endocrinol 2018; 178:R127-R139. [PMID: 29440374 PMCID: PMC5863473 DOI: 10.1530/eje-17-0724] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/12/2018] [Indexed: 12/22/2022]
Abstract
Heart failure is a major cause of morbidity and mortality in type 2 diabetes. Type 2 diabetes contributes to the development of heart failure through a variety of mechanisms, including disease-specific myocardial structural, functional and metabolic changes. This review will focus on the contemporary contributions of state of the art non-invasive technologies to our understanding of diabetic cardiomyopathy, including data on cardiac disease phenotype, cardiac energy metabolism and energetic deficiency, ectopic and visceral adiposity, diabetic liver disease, metabolic modulation strategies and cardiovascular outcomes with new classes of glucose-lowering therapies.
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Affiliation(s)
- Eylem Levelt
- British Heart Foundation Cardiovascular Research CentreUniversity of Leicester, Glenfield Hospital, Leicester, UK
- (E Levelt is now at Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK)
- Correspondenceshould be addressed to E Levelt;
| | - Gaurav Gulsin
- British Heart Foundation Cardiovascular Research CentreUniversity of Leicester, Glenfield Hospital, Leicester, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Gerry P McCann
- British Heart Foundation Cardiovascular Research CentreUniversity of Leicester, Glenfield Hospital, Leicester, UK
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26
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Lehmonen L, Vuorinen AM, Koivuniemi R, Leirisalo-Repo M, Holmström M, Kivistö S, Kaasalainen T. One-Year Follow-up Study Detects Myocardial Changes with Cardiovascular Magnetic Resonance Tagging in Active Rheumatoid Arthritis. Acad Radiol 2018; 25:476-485. [PMID: 29199058 DOI: 10.1016/j.acra.2017.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 02/02/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the effects of 1 year of medical treatment on myocardial function in active rheumatoid arthritis (RA). MATERIALS AND METHODS Thirty-nine female patients with RA without any known cardiovascular disease underwent a cardiovascular magnetic resonance (CMR) examination before and after 1 year of antirheumatic treatment. The population comprised untreated active early RA (ERA) and chronic RA patients, who were grouped accordingly. The CMR protocol included volumetric determinations, late gadolinium enhancement imaging, myocardial tagging, and native T1 mapping. DAS28-CRP disease activity scores were calculated before and after the treatment. RESULTS Results are reported as median (quartile 1-quartile 3). Time to peak diastolic filling rate improved in ERA (495 [443-561] ms vs 441 [340-518] ms, P = .018). Peak diastolic mean mid short-axis circumferential strain rate of all six segments was improved (82 [74-91] %/s vs 91 [77-100] %/s, P = .05), particularly in the anterior segment (82 [63-98] %/s vs 86 [77-109] %/s, P = .013). DAS28-CRP decreased in ERA (3.8 [3.2-4.1] vs 1.6 [1.4-2.2], P < .001). In chronic RA, no statistically significant improvement was detected. CONCLUSIONS Early treatment of active RA is important, as myocardial function detected with CMR tagging improved in ERA in parallel with decreasing inflammatory activity.
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27
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Abstract
Heart failure is a growing cardiovascular disease with significant epidemiological, clinical, and societal implications and represents a high unmet need. Strong efforts are currently underway by academic and industrial researchers to develop novel treatments for heart failure. Biomarkers play an important role in patient selection and monitoring in drug trials and in clinical management. The present review gives an overview of the role of available molecular, imaging, and device-derived digital biomarkers in heart failure drug development and highlights capabilities and limitations of biomarker use in this context.
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28
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Robison S, Karur GR, Wald RM, Thavendiranathan P, Crean AM, Hanneman K. Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation. J Cardiovasc Magn Reson 2018; 20:19. [PMID: 29544519 PMCID: PMC5856214 DOI: 10.1186/s12968-018-0443-1] [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: 09/12/2017] [Accepted: 03/05/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Calculation of cardiovascular magnetic resonance (CMR) extracellular volume (ECV) requires input of hematocrit, which may not be readily available. The purpose of this study was to evaluate the diagnostic accuracy of ECV calculated using various noninvasive measures of hematocrit compared to ECV calculated with input of laboratory hematocrit as the reference standard. METHODS One hundred twenty three subjects (47.7 ± 14.1 years; 42% male) were prospectively recruited for CMR T1 mapping between August 2016 and April 2017. Laboratory hematocrit was assessed by venipuncture. Noninvasive hematocrit was assessed with a point-of-care (POC) device (Pronto-7® Pulse CO-Oximeter®, Masimo Personal Health, Irvine, California, USA) and by synthetic derivation based on the relationship with blood pool T1 values. Left ventricular ECV was calculated with input of laboratory hematocrit (Lab-ECV), POC hematocrit (POC-ECV), and synthetic hematocrit (synthetic-ECV), respectively. Statistical analysis included Wilcoxon signed-rank test, Bland-Altman analysis, receiver-operating curve analysis and intra-class correlation (ICC). RESULTS There was no significant difference between Lab-ECV and POC-ECV (27.1 ± 4.7% vs. 27.3 ± 4.8%, p = 0.106), with minimal bias and modest precision (bias - 0.18%, 95%CI [- 2.85, 2.49]). There was no significant difference between Lab-ECV and synthetic-ECV (26.7 ± 4.4% vs. 26.5 ± 4.3%, p = 0.084) in subjects imaged at 1.5 T, although bias was slightly higher and limits of agreement were wider (bias 0.23%, 95%CI [- 2.82, 3.27]). For discrimination of abnormal Lab-ECV ≥30%, POC-ECV had good diagnostic performance (sensitivity 85%, specificity 96%, accuracy 94%, and AUC 0.902) and synthetic-ECV had moderate diagnostic performance (sensitivity 71%, specificity 98%, accuracy 93%, and AUC 0.849). POC-ECV had excellent test-retest (ICC 0.994, 95%CI[0.987, 0.997]) and inter-observer agreement (ICC 0.974, 95%CI[0.929, 0.991]). CONCLUSIONS Myocardial ECV can be accurately and reproducibly calculated with input of hematocrit measured using a noninvasive POC device, potentially overcoming an important barrier to implementation of ECV. Further evaluation of synthetic ECV is required prior to clinical implementation.
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Affiliation(s)
- Sean Robison
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Gauri Rani Karur
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Rachel M. Wald
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Andrew M. Crean
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
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29
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Aus dem Siepen F, Baumgärtner C, Müller-Henessen M, André F, Messroghli D, Ochs M, Riffel J, Giannitsis E, Katus HA, Friedrich MG, Buss SJ. Variability of cardiovascular magnetic resonance (CMR) T1 mapping parameters in healthy volunteers during long-term follow-up. Open Heart 2018. [PMID: 29531760 PMCID: PMC5845426 DOI: 10.1136/openhrt-2017-000717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Myocardial T1 and extracellular volume (ECV) derived from cardiovascular MRIs are more and more widely accepted as important markers for diagnosis, risk prediction and monitoring of cardiac disease. Yet data regarding long-term stability of myocardial T1 mapping are lacking. The aim of this study was to investigate the long-term stability of native and postcontrast T1 mapping values in healthy volunteers. Methods 18 strictly selected healthy volunteers (52±10 years, 12 men) were studied on a Philips Achieva 1.5 Tesla scanner. T1 relaxation times were measured before and 15 min after a bolus contrast injection of gadolinium diethylenetriamine penta-acetic acid (DTPA) (0.2 mmol/kg) using a single-breath-hold modified Look-Locker inversion recovery 3(3)3(3)5 sequence. ECV was calculated using native and postcontrast T1 times of myocardium and blood correcting for blood haematocrit. Exams were repeated 3.6±0.5 years later under the same conditions and using the same scan protocols. Results Cardiac biomarkers (high-sensitivity troponin T and N terminal pro-brain natriuretic peptide) remained unchanged, as well as left ventricular mass, and global and longitudinal function. No significant change occurred regarding native T1 times (1017±24 ms vs 1015±21 ms; P=0.6), postcontrast T1 times (426±38 ms vs 413±20 ms; P=0.13) or ECV (22%±2% vs 23%±2%; P=0.3). Native T1 time and ECV appeared to be better reproducible than postcontrast T1, resulting in lower coefficients of variation (ECV: 3.5%, native T1: 1.3%, postcontrast T1: 6.4%) and smaller limits of agreement (ECV: 2%/−2%, native T1: 39 ms/−35 ms, postcontrast T1: 85 ms/−59 ms). Conclusions During long-term follow-up, native T1 and ECV values are very robust markers, whereas postcontrast T1 results appear less stable.
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Affiliation(s)
- Fabian Aus dem Siepen
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Baumgärtner
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Müller-Henessen
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Messroghli
- Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin and Charité, University Medicine Berlin, Berlin, Germany
| | - Marco Ochs
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias G Friedrich
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Messroghli DR, Moon JC, Ferreira VM, Grosse-Wortmann L, He T, Kellman P, Mascherbauer J, Nezafat R, Salerno M, Schelbert EB, Taylor AJ, Thompson R, Ugander M, van Heeswijk RB, Friedrich MG. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson 2017; 19:75. [PMID: 28992817 PMCID: PMC5633041 DOI: 10.1186/s12968-017-0389-8] [Citation(s) in RCA: 959] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022] Open
Abstract
Parametric mapping techniques provide a non-invasive tool for quantifying tissue alterations in myocardial disease in those eligible for cardiovascular magnetic resonance (CMR). Parametric mapping with CMR now permits the routine spatial visualization and quantification of changes in myocardial composition based on changes in T1, T2, and T2*(star) relaxation times and extracellular volume (ECV). These changes include specific disease pathways related to mainly intracellular disturbances of the cardiomyocyte (e.g., iron overload, or glycosphingolipid accumulation in Anderson-Fabry disease); extracellular disturbances in the myocardial interstitium (e.g., myocardial fibrosis or cardiac amyloidosis from accumulation of collagen or amyloid proteins, respectively); or both (myocardial edema with increased intracellular and/or extracellular water). Parametric mapping promises improvements in patient care through advances in quantitative diagnostics, inter- and intra-patient comparability, and relatedly improvements in treatment. There is a multitude of technical approaches and potential applications. This document provides a summary of the existing evidence for the clinical value of parametric mapping in the heart as of mid 2017, and gives recommendations for practical use in different clinical scenarios for scientists, clinicians, and CMR manufacturers.
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Affiliation(s)
- Daniel R. Messroghli
- Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - James C. Moon
- University College London and Barts Heart Centre, London, UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Lars Grosse-Wortmann
- Division of Cardiology in the Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Taigang He
- Cardiovascular Science Research Centre, St George’s, University of London, London, UK
| | | | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Michael Salerno
- Departments of Medicine Cardiology Division, Radiology and Medical Imaging, and Biomedical Engineering, University of Virginia Health System, Charlottesville, VA USA
| | - Erik B. Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Andrew J. Taylor
- The Alfred Hospital, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Richard Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ruud B. van Heeswijk
- Department of Radiology, Lausanne University Hospital (CHUV) and Lausanne University (UNIL), Lausanne, Switzerland
| | - Matthias G. Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montréal, Québec Canada
- Department of Medicine, Heidelberg University, Heidelberg, Germany
- Département de radiologie, Université de Montréal, Montréal, Québec Canada
- Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
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Liu JM, Liu A, Leal J, McMillan F, Francis J, Greiser A, Rider OJ, Myerson S, Neubauer S, Ferreira VM, Piechnik SK. Measurement of myocardial native T1 in cardiovascular diseases and norm in 1291 subjects. J Cardiovasc Magn Reson 2017; 19:74. [PMID: 28954631 PMCID: PMC5618724 DOI: 10.1186/s12968-017-0386-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Native T1-mapping provides quantitative myocardial tissue characterization for cardiovascular diseases (CVD), without the need for gadolinium. However, its translation into clinical practice is hindered by differences between techniques and the lack of established reference values. We provide typical myocardial T1-ranges for 18 commonly encountered CVDs using a single T1-mapping technique - Shortened Look-Locker Inversion Recovery (ShMOLLI), also used in the large UK Biobank and Hypertrophic Cardiomyopathy Registry study. METHODS We analyzed 1291 subjects who underwent CMR (1.5-Tesla, MAGNETOM-Avanto, Siemens Healthcare, Erlangen, Germany) between 2009 and 2016, who had a single CVD diagnosis, with mid-ventricular T1-map assessment. A region of interest (ROI) was placed on native T1-maps in the "most-affected myocardium", characterized by the presence of late gadolinium enhancement (LGE), or regional wall motion abnormalities (RWMA) on cines. Another ROI was placed in the "reference myocardium" as far as possible from LGE/RWMA, and in the septum if no focal abnormality was present. To further define normality, we included native T1 of healthy subjects from an existing dataset after sub-endocardial pixel-erosions. RESULTS Native T1 of patients with normal CMR (938 ± 21 ms) was similar compared to healthy subjects (941 ± 23 ms). Across all patient groups (57 ± 19 yrs., 65% males), focally affected myocardium had significantly different T1 value compared to reference myocardium (all p < 0.001). In the affected myocardium, cardiac amyloidosis (1119 ± 61 ms) had the highest native T1 compared to normal and all other CVDs, while iron-overload (795 ± 58 ms) and Anderson-Fabry disease (863 ± 23 ms) had the lowest native reference T1 (all p < 0.001). Future studies designed to detect the large T1 differences between affected and reference myocardium are estimated to require small sample-sizes (n < 50). However, studies designed to detect the small T1 differences between reference myocardium in CVDs and healthy controls can require several thousand of subjects. CONCLUSIONS We provide typical T1-ranges for common clinical cardiac conditions in the largest cohort to-date, using ShMOLLI T1-mapping at 1.5 T. Sample-size calculations from this study may be useful for the design of future studies and trials that use T1-mapping as an endpoint.
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Affiliation(s)
- Joanna M. Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Joana Leal
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Fiona McMillan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Jane Francis
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | | | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Saul Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
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Raucci FJ, Parra DA, Christensen JT, Hernandez LE, Markham LW, Xu M, Slaughter JC, Soslow JH. Synthetic hematocrit derived from the longitudinal relaxation of blood can lead to clinically significant errors in measurement of extracellular volume fraction in pediatric and young adult patients. J Cardiovasc Magn Reson 2017; 19:58. [PMID: 28768519 PMCID: PMC5541652 DOI: 10.1186/s12968-017-0377-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/20/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Extracellular volume fraction (ECV) is altered in pathological cardiac remodeling and predicts death and arrhythmia. ECV can be quantified using cardiovascular magnetic resonance (CMR) T1 mapping but calculation requires a measured hematocrit (Hct). The longitudinal relaxation of blood has been used in adults to generate a synthetic Hct (estimate of true Hct) but has not been validated in pediatric populations. METHODS One hundred fourteen children and young adults underwent a total of 163 CMRs with T1 mapping. The majority of subjects had a measured Hct the same day (N = 146). Native and post-contrast T1 were determined in blood pool, septum, and free wall of mid-LV, avoiding areas of late gadolinium enhancement. Synthetic Hct and ECV were calculated and intraclass correlation coefficient (ICC) and linear regression were used to compare measured and synthetic values. RESULTS The mean age was 16.4 ± 6.4 years and mean left ventricular ejection fraction was 59% ± 9%. The mean measured Hct was 41.8 ± 3.0% compared to the mean synthetic Hct of 43.2% ± 2.9% (p < 0.001, ICC 0.46 [0.27, 0.52]) with the previously published model and 41.8% ± 1.4% (p < 0.001, ICC 0.28 [0.13, 0. 42]) with the locally-derived model. Mean measured mid-free wall ECV was 30.5% ± 4.8% and mean synthetic mid-free wall ECV of local model was 29.7% ± 4.6% (p < 0.001, ICC 0.93 [0.91, 0.95]). Correlations were not affected by heart rate and did not significantly differ in subpopulation analysis. While the ICC was strong, differences between measured and synthetic ECV ranged from -8.4% to 4.3% in the septum and -12.6% to 15.8% in the free wall. Using our laboratory's normal cut-off of 28.5%, 59 patients (37%) were miscategorized (53 false negatives, 6 false positives) with published model ECV. The local model had 37 miscategorizations (20 false negatives, 17 false positives), significantly fewer but still a substantial number (23%). CONCLUSIONS Our data suggest that use of synthetic Hct for the calculation of ECV results in miscategorization of individual patients. This difference may be less significant once synthetic ECV is calculated and averaged over a large research cohort, making it potentially useful as a research tool. However, we recommend formal measurement of Hct in children and young adults for clinical CMRs.
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Affiliation(s)
- Frank J Raucci
- Department of Pediatrics, Thomas P. Graham Jr, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, USA.
- Thomas P. Graham, Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA.
| | - David A Parra
- Department of Pediatrics, Thomas P. Graham Jr, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, USA
- Thomas P. Graham, Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Jason T Christensen
- Department of Pediatrics, Thomas P. Graham Jr, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, USA
- Thomas P. Graham, Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Lazaro E Hernandez
- Joe DiMaggio Children's Hospital, Pediatric and Congenital Cardiac MRI program, Los Angeles, CA, USA
| | - Larry W Markham
- Department of Pediatrics, Thomas P. Graham Jr, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, USA
- Thomas P. Graham, Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan H Soslow
- Department of Pediatrics, Thomas P. Graham Jr, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, USA
- Thomas P. Graham, Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Doctors' Office Tower, Nashville, TN, 37232-9119, USA
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Walter TC, Knobloch G, Canaan-Kuehl S, Greiser A, Sandek A, Blaschke D, Denecke T, Hamm B, Makowski MR. Segment-by-segment assessment of left ventricular myocardial affection in Anderson-Fabry disease by non-enhanced T1-mapping. Acta Radiol 2017; 58:914-921. [PMID: 27799574 DOI: 10.1177/0284185116675657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Anderson-Fabry disease (AFD) is an X-linked lysosomal enzyme disorder associated with an intracellular accumulation of sphingolipids, which shorten myocardial T1 relaxation times. Myocardial affection, however, varies between different segments. Purpose To evaluate the specific segmental distribution and degree of segmental affection in AFD patients. Material and Methods Twenty-five patients with AFD, 14 patients with hypertrophic cardiomyopathy (HCM), and 21 controls were included. A Modified Look-Locker Inversion Recovery sequence (MOLLI) was used for non-enhanced T1 mapping at 1.5 T in addition to standard cardiac imaging in 10-12 short axis views. T1 values were evaluated with a mixed model ANOVA and regression analysis to determine the best diagnostic cutoff values for T1 for each myocardial segment. Results Regression analysis showed the best diagnostic cutoff compared to controls in cardiac segments 1-4, 8-9, and 14. Mean differences between T1 for AFD versus HCM were greatest in segment 3, 4, and 9 (99 ms, 103 ms, 86 ms, respectively). Overall T1 times were 888 ± 70 ms and 903 ± 14 ms (AFD with and without LVH); 1014 ± 17 ms and 1001 ± 22 ms (HCM and controls, P < 0.05). Conclusion Myocardial segments are affected by a varying degree of T1 shortening in AFD patients. Segment-specific cutoff values allow the most specific detection and quantification of the extent of myocardial affection.
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Affiliation(s)
| | | | | | | | - Anja Sandek
- Department of Cardiology, University of Goettingen Medical School, Germany
| | | | | | - Bernd Hamm
- Department of Radiology, Charité, Germany
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Feingold B, Salgado CM, Reyes-Múgica M, Drant SE, Miller SA, Kennedy M, Kellman P, Schelbert EB, Wong TC. Diffuse myocardial fibrosis among healthy pediatric heart transplant recipients: Correlation of histology, cardiovascular magnetic resonance, and clinical phenotype. Pediatr Transplant 2017; 21. [PMID: 28574157 DOI: 10.1111/petr.12986] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
Fibrosis is commonly described in heart allografts lost late after transplantation. CMR-derived ECV is a validated measure of DMF in native adult hearts that may predict heart failure and mortality. We explored associations of ECV with histologic myocardial fibrosis and clinical features after pediatric heart transplantation. Twenty-five recipients (7.0±6.3 years at transplant and 10.7±6.5 years post-transplant) were prospectively recruited for CMR and BNP measurement at the time of surveillance biopsy. All had normal ejection fractions and lacked heart failure symptoms. Fibrosis was quantified on biopsy after picrosirius red staining as CVF. ECV was quantified using contemporaneous hematocrit on basal and mid-short-axis slices. ECV was moderately correlated with CVF (r=.47; P=.019). We found no associations of ECV with hemodynamics, ischemic time, time since transplantation, or number of prior biopsies or acute rejections. Compared to healthy non-transplant controls, there was no significant difference in ECV (25.1±3.0 vs 23.7±2.0%, P=.09). Log-transformed BNP was correlated with ECV (recipients: r=.46, P=.02; recipients and controls: r=.45, P=.006). These findings suggest ECV quantifies DMF and relates to biological indicators of cardiac function after pediatric heart transplantation.
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Affiliation(s)
- Brian Feingold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cláudia M Salgado
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stacey E Drant
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan A Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Kennedy
- Cardiovascular Magnetic Resonance Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA
| | - Peter Kellman
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erik B Schelbert
- Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Cardiovascular Magnetic Resonance Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Timothy C Wong
- Cardiovascular Magnetic Resonance Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Marty B, Coppa B, Carlier PG. Fast, precise, and accurate myocardial T 1 mapping using a radial MOLLI sequence with FLASH readout. Magn Reson Med 2017; 79:1387-1398. [PMID: 28671304 DOI: 10.1002/mrm.26795] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Quantitative cardiac MRI, and more particularly T1 mapping, has become a most important modality to characterize myocardial tissue. In this work, the value of a radial variant of the conventional modified Look-Locker inversion recovery sequence (raMOLLI) is demonstrated. METHODS The raMOLLI acquisition scheme consisted of five radial echo trains of 80 spokes acquired using either a fast low-angle shot (FLASH) or a true fast imaging with steady-state-precession (TrueFISP) readout at different time points after a single magnetization inversion. View sharing combined with a compressed sensing algorithm allowed the reconstruction of 50 images along the T1 relaxation recovery curve, to which a dictionary-fitting approach was applied to estimate T1 . The sequence was validated on a nine-vial phantom, on 19 healthy subjects, and one patient suffering from dilated cardiomyopathy. RESULTS The raMOLLI sequence allowed a significant decrease of myocardial T1 map acquisition time down to five heartbeats, while exhibiting a higher degree of accuracy and a comparable precision on T1 value estimation than the conventional modified Look-Locker inversion recovery sequence. The FLASH readout demonstrated a better robustness to B0 inhomogeneities than TrueFISP, and was therefore preferred for in vivo acquisitions. CONCLUSIONS This sequence represents a good candidate for ultrafast acquisition of myocardial T1 maps. Magn Reson Med 79:1387-1398, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- B Marty
- Institute of Myology, NMR Laboratory, Paris, France.,CEA, DRF, IBFJ, MIRCen, NMR Laboratory, Paris, France
| | - B Coppa
- Institute of Myology, NMR Laboratory, Paris, France.,CEA, DRF, IBFJ, MIRCen, NMR Laboratory, Paris, France
| | - P G Carlier
- Institute of Myology, NMR Laboratory, Paris, France.,CEA, DRF, IBFJ, MIRCen, NMR Laboratory, Paris, France
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Schelbert EB, Sabbah HN, Butler J, Gheorghiade M. Employing Extracellular Volume Cardiovascular Magnetic Resonance Measures of Myocardial Fibrosis to Foster Novel Therapeutics. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005619. [PMID: 28512159 DOI: 10.1161/circimaging.116.005619] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Quantifying myocardial fibrosis (MF) with myocardial extracellular volume measures acquired during cardiovascular magnetic resonance promises to transform clinical care by advancing pathophysiologic understanding and fostering novel therapeutics. Extracellular volume quantifies MF by measuring the extracellular compartment depicted by the myocardial uptake of contrast relative to plasma. MF is a key domain of dysfunctional but viable myocardium among others (eg, microvascular dysfunction and cardiomyocyte/mitochondrial dysfunction). Although anatomically distinct, these domains may functionally interact. MF represents pathological remodeling in the heart associated with cardiac dysfunction and adverse outcomes likely mediated by interactions with the microvasculature and the cardiomyocyte. Reversal of MF improves key measures of cardiac dysfunction, so reversal of MF represents a likely mechanism for improved outcomes. Instead of characterizing the myocardium as homogenous tissue and using important yet still generic descriptors, such as thickness (hypertrophy) and function (diastolic or systolic), which lack mechanistic specificity, paradigms of cardiac disease have evolved to conceptualize myocardial disease and patient vulnerability based on the extent of disease involving its various compartments. Specifying myocardial compartmental involvement may then implicate cellular/molecular disease pathways for treatment and targeted pharmaceutical development and above all highlight the role of the cardiac-specific pathology in heart failure among myriad other changes in the heart and beyond. The cardiology community now requires phase 2 and 3 clinical trials to examine strategies for the regression/prevention of MF and eventually biomarkers to identify MF without reliance on cardiovascular magnetic resonance. It seems likely that efficacious antifibrotic therapy will improve outcomes, but definitive data are needed.
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Affiliation(s)
- Erik B Schelbert
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.).
| | - Hani N Sabbah
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Javed Butler
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)
| | - Mihai Gheorghiade
- From the Department of Medicine, University of Pittsburgh School of Medicine, PA (E.B.S.); UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA (E.B.S.); Clinical and Translational Science Institute, University of Pittsburgh, PA (E.B.S.); Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health System, Detroit, MI (H.N.S.); Cardiology Division, Department of Medicine, Stony Brook University, NY (J.B.); and Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (M.G.)
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Saeed M, Liu H, Liang CH, Wilson MW. Magnetic resonance imaging for characterizing myocardial diseases. Int J Cardiovasc Imaging 2017; 33:1395-1414. [PMID: 28364177 DOI: 10.1007/s10554-017-1127-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/23/2017] [Indexed: 12/21/2022]
Abstract
The National Institute of Health defined cardiomyopathy as diseases of the heart muscle. These myocardial diseases have different etiology, structure and treatment. This review highlights the key imaging features of different myocardial diseases. It provides information on myocardial structure/orientation, perfusion, function and viability in diseases related to cardiomyopathy. The standard cardiac magnetic resonance imaging (MRI) sequences can reveal insight on left ventricular (LV) mass, volumes and regional contractile function in all types of cardiomyopathy diseases. Contrast enhanced MRI sequences allow visualization of different infarct patterns and sizes. Enhancement of myocardial inflammation and infarct (location, transmurality and pattern) on contrast enhanced MRI have been used to highlight the key differences in myocardial diseases, predict recovery of function and healing. The common feature in many forms of cardiomyopathy is the presence of diffuse-fibrosis. Currently, imaging sequences generating the most interest in cardiomyopathy include myocardial strain analysis, tissue mapping (T1, T2, T2*) and extracellular volume (ECV) estimation techniques. MRI sequences have the potential to decode the etiology by showing various patterns of infarct and diffuse fibrosis in myocarditis, amyloidosis, sarcoidosis, hypertrophic cardiomyopathy due to aortic stenosis, restrictive cardiomyopathy, arrythmogenic right ventricular dysplasia and hypertension. Integrated PET/MRI system may add in the future more information for the diagnosis and progression of cardiomyopathy diseases. With the promise of high spatial/temporal resolution and 3D coverage, MRI will be an indispensible tool in diagnosis and monitoring the benefits of new therapies designed to treat myocardial diseases.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA, 94107-5705, USA.
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Chang-Hong Liang
- Department of Radiology, Guangdong General Hospital, Guangzhou, China
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA, 94107-5705, USA
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Graham-Brown MPM, Rutherford E, Levelt E, March DS, Churchward DR, Stensel DJ, McComb C, Mangion K, Cockburn S, Berry C, Moon JC, Mark PB, Burton JO, McCann GP. Native T1 mapping: inter-study, inter-observer and inter-center reproducibility in hemodialysis patients. J Cardiovasc Magn Reson 2017; 19:21. [PMID: 28238284 PMCID: PMC5327541 DOI: 10.1186/s12968-017-0337-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Native T1 mapping is a cardiovascular magnetic resonance (CMR) technique that associates with markers of fibrosis and strain in hemodialysis patients. The reproducibility of T1 mapping in hemodialysis patients, prone to changes in fluid status, is unknown. Accurate quantification of myocardial fibrosis in this population has prognostic potential. METHODS Using 3 Tesla CMR, we report the results of 1) the inter-study, inter-observer and intra-observer reproducibility of native T1 mapping in 10 hemodialysis patients; 2) inter-study reproducibility of left ventricular (LV) structure and function in 10 hemodialysis patients; 3) the agreement of native T1 map and native T1 phantom analyses between two centres in 20 hemodialysis patients; 4) the effect of changes in markers of fluid status on native T1 values in 10 hemodialysis patients. RESULTS Inter-study, inter-observer and intra-observer variability of native T1 mapping were excellent with co-efficients of variation (CoV) of 0.7, 0.3 and 0.4% respectively. Inter-study CoV for LV structure and function were: LV mass = 1%; ejection fraction = 1.1%; LV end-diastolic volume = 5.2%; LV end-systolic volume = 5.6%. Inter-centre variability of analysis techniques were excellent with CoV for basal and mid-native T1 slices between 0.8-1.2%. Phantom analyses showed comparable native T1 times between centres, despite different scanners and acquisition sequences (centre 1: 1192.7 ± 7.5 ms, centre 2: 1205.5 ± 5 ms). For the 10 patients who underwent inter-study testing, change in body weight (Δweight) between scans correlated with change in LV end-diastolic volume (ΔLVEDV) (r = 0.682;P = 0.03) representing altered fluid status between scans. There were no correlations between change in native T1 between scans (ΔT1) and ΔLVEDV or Δweight (P > 0.6). Linear regression confirmed ΔT1 was unaffected by ΔLVEDV or Δweight (P > 0.59). CONCLUSIONS Myocardial native T1 is reproducible in HD patients and unaffected by changes in fluid status at the levels we observed. Native T1 mapping is a potential imaging biomarker for myocardial fibrosis in patients with end-stage renal disease.
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Affiliation(s)
- Matthew P M Graham-Brown
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK.
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK.
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Elaine Rutherford
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, UK
| | - E Levelt
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - Daniel S March
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - Darren R Churchward
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Christie McComb
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Kenneth Mangion
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Samantha Cockburn
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
| | - Colin Berry
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - James C Moon
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Patrick B Mark
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, UK
- The Glasgow Renal & Transplant Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, UK
| | - James O Burton
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
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Chong CR, Clarke K, Levelt E. Metabolic Remodeling in Diabetic Cardiomyopathy. Cardiovasc Res 2017; 113:422-430. [PMID: 28177068 PMCID: PMC5412022 DOI: 10.1093/cvr/cvx018] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/02/2017] [Indexed: 02/07/2023] Open
Abstract
Diabetes is a risk factor for heart failure and cardiovascular mortality with specific changes to myocardial metabolism, energetics, structure, and function. The gradual impairment of insulin production and signalling in diabetes is associated with elevated plasma fatty acids and increased myocardial free fatty acid uptake and activation of the transcription factor PPARα. The increased free fatty acid uptake results in accumulation of toxic metabolites, such as ceramide and diacylglycerol, activation of protein kinase C, and elevation of uncoupling protein-3. Insulin signalling and glucose uptake/oxidation become further impaired, and mitochondrial function and ATP production become compromised. Increased oxidative stress also impairs mitochondrial function and disrupts metabolic pathways. The diabetic heart relies on free fatty acids (FFA) as the major substrate for oxidative phosphorylation and is unable to increase glucose oxidation during ischaemia or hypoxia, thereby increasing myocardial injury, especially in ageing female diabetic animals. Pharmacological activation of PPARγ in adipose tissue may lower plasma FFA and improve recovery from myocardial ischaemic injury in diabetes. Not only is the diabetic heart energetically-impaired, it also has early diastolic dysfunction and concentric remodelling. The contractile function of the diabetic myocardium negatively correlates with epicardial adipose tissue, which secretes proinflammatory cytokines, resulting in interstitial fibrosis. Novel pharmacological strategies targeting oxidative stress seem promising in preventing progression of diabetic cardiomyopathy, although clinical evidence is lacking. Metabolic agents that lower plasma FFA or glucose, including PPARγ agonism and SGLT2 inhibition, may therefore be promising options.
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Affiliation(s)
- Cher-Rin Chong
- 1 Department of Physiology, Anatomy and Genetics, University of Oxford
| | - Kieran Clarke
- 1 Department of Physiology, Anatomy and Genetics, University of Oxford
| | - Eylem Levelt
- 2 Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital
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Hashimura H, Kimura F, Ishibashi-Ueda H, Morita Y, Higashi M, Nakano S, Iguchi A, Uotani K, Sugimura K, Naito H. Radiologic-Pathologic Correlation of Primary and Secondary Cardiomyopathies: MR Imaging and Histopathologic Findings in Hearts from Autopsy and Transplantation. Radiographics 2017; 37:719-736. [PMID: 28129067 DOI: 10.1148/rg.2017160082] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
RSNA, 2017.
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Affiliation(s)
- Hiromi Hashimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Fumiko Kimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Hatsue Ishibashi-Ueda
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Yoshiaki Morita
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Masahiro Higashi
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Shintaro Nakano
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Atsushi Iguchi
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Kensuke Uotani
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Kazuro Sugimura
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
| | - Hiroaki Naito
- From the Departments of Radiology (H.H., Y.M., M.H., H.N.) and Pathology (H.H., H.I.U.), National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan; Departments of Diagnostic Radiology (F.K.), Cardiology (S.N.), and Cardiovascular Surgery (A.I.), Saitama Medical University International Medical Center, Hidaka, Japan; Department of Radiology, Tenri Hospital, Tenri, Japan (K.U.); and Department of Radiology, Kobe University, Kobe, Japan (K.S.)
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Wong C, Chen S, Iyngkaran P. Cardiac Imaging in Heart Failure with Comorbidities. Curr Cardiol Rev 2017; 13:63-75. [PMID: 27492227 PMCID: PMC5324322 DOI: 10.2174/1573403x12666160803100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.
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Affiliation(s)
- Chiew Wong
- Flinders University, NT Medical School, Darwin Australia
| | - Sylvia Chen
- Flinders University, NT Medical School, Darwin Australia
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42
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Automatic Measurement of the Myocardial Interstitium: Synthetic Extracellular Volume Quantification Without Hematocrit Sampling. JACC Cardiovasc Imaging 2016; 9:54-63. [PMID: 26762875 DOI: 10.1016/j.jcmg.2015.11.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The authors sought to generate a synthetic extracellular volume fraction (ECV) from the relationship between hematocrit and longitudinal relaxation rate of blood. BACKGROUND ECV quantification by cardiac magnetic resonance (CMR) measures diagnostically and prognostically relevant changes in the extracellular space. Current methodologies require blood hematocrit (Hct) measurement-a complication to easy clinical application. We hypothesized that the relationship between Hct and longitudinal relaxation rate of blood (R1 = 1/T1blood) could be calibrated and used to generate a synthetic ECV without Hct that was valid, user-friendly, and prognostic. METHODS Proof-of-concept: 427 subjects with a wide range of health and disease were divided into derivation (n = 214) and validation (n = 213) cohorts. Histology cohort: 18 patients with severe aortic stenosis with histology obtained during valve replacement. Outcome cohort: For comparison with external outcome data, we applied synthetic ECV to 1,172 consecutive patients (median follow-up 1.7 years; 74 deaths). All underwent CMR scanning at 1.5-T with ECV calculation from pre- and post-contrast T1 (blood and myocardium) and venous Hct. RESULTS Proof-of-concept: In the derivation cohort, native R1blood and Hct showed a linear relationship (R(2) = 0.51; p < 0.001), which was used to create synthetic Hct and ECV. Synthetic ECV correlated well with conventional ECV (R(2) = 0.97; p < 0.001) without bias. These results were maintained in the validation cohort. Histology cohort: Synthetic and conventional ECV both correlated well with collagen volume fraction measured from histology (R(2) = 0.61 and 0.69, both p < 0.001) with no statistical difference (p = 0.70). Outcome cohort: Synthetic ECV related to all-cause mortality (hazard ratio 1.90; 95% confidence interval 1.55 to 2.31; for every 5% increase in ECV). Finally, we engineered a synthetic ECV tool, generating automatic ECV maps during image acquisition. CONCLUSIONS Synthetic ECV provides validated noninvasive quantification of the myocardial extracellular space without blood sampling and is associated with cardiovascular outcomes.
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Mapeo miocárdico con resonancia magnética cardiaca: valor diagnóstico de las nuevas secuencias. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Blaszczyk E, Töpper A, Schmacht L, Wanke F, Greiser A, Schulz-Menger J, von Knobelsdorff-Brenkenhoff F. Influence of spatial resolution and contrast agent dosage on myocardial T1 relaxation times. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 30:85-91. [PMID: 27544271 DOI: 10.1007/s10334-016-0581-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Our aim was to study the influence of small variations in spatial resolution and contrast agent dosage on myocardial T1 relaxation time. MATERIALS AND METHODS Twenty-nine healthy volunteers underwent cardiovascular magnetic resonance at 3T twice, including a modified look-locker inversion recovery (MOLLI) technique-3(3)3(3)5-for T1 mapping. Native T1 was assessed in three spatial resolutions (voxel size 1.4 × 1.4 × 6, 1.6 × 1.6 × 6, 1.7 × 1.7 × 6 mm3), and postcontrast T1 after 0.1 and 0.2 mmol/kg gadobutrol. Partition coefficient was calculated based on myocardial and blood T1. T1 analysis was done per segment, per slice, and for the whole heart. RESULTS Native T1 values did not differ with varying spatial resolution per segment (p = 0.116-0.980), per slice (basal: p = 0.772; middle: p = 0.639; apex: p = 0.276), and globally (p = 0.191). Postcontrast T1 values were significantly lower with higher contrast agent dosage (p < 0.001). The global partition coefficient was 0.43 ± 0.3 for 0.2 and 0.1 mmol gadobutrol (p = 0.079). CONCLUSION Related to the tested MOLLI technique at 3T, very small variations in spatial resolution (voxel sizes between 1.4 × 1.4 × 6 and 1.7 × 1.7 × 6 mm3) remained without effect on the native T1 relaxation times. Postcontrast T1 values were naturally shorter with higher contrast agent dosage while the partition coefficient remained constant. Further studies are necessary to test whether these conclusions hold true for larger matrix sizes and in larger cohorts.
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Affiliation(s)
- Edyta Blaszczyk
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Agnieszka Töpper
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Luisa Schmacht
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Felix Wanke
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | | | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany. .,Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany.
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Sanz J, LaRocca G, Mirelis JG. Myocardial Mapping With Cardiac Magnetic Resonance: The Diagnostic Value of Novel Sequences. ACTA ACUST UNITED AC 2016; 69:849-61. [PMID: 27450946 DOI: 10.1016/j.rec.2016.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/18/2016] [Indexed: 01/05/2023]
Abstract
Cardiac magnetic resonance has evolved into a crucial modality for the evaluation of cardiomyopathy due to its ability to characterize myocardial structure and function. In the last few years, interest has increased in the potential of "mapping" techniques that provide direct and objective quantification of myocardial properties such as T1, T2, and T2* times. These approaches enable the detection of abnormalities that affect the myocardium in a diffuse fashion and/or may be too subtle for visual recognition. This article reviews the current state of myocardial T1 and T2-mapping in both health and disease.
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Affiliation(s)
- Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, United States; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Gina LaRocca
- The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, United States
| | - Jesús G Mirelis
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Roux C, Kachenoura N, Raissuni Z, Mousseaux E, Young J, Graves MJ, Jublanc C, Cluzel P, Chanson P, Kamenický P, Redheuil A. Effects of cortisol on the heart: characterization of myocardial involvement in cushing's disease by longitudinal cardiac MRI T1 mapping. J Magn Reson Imaging 2016; 45:147-156. [PMID: 27393826 DOI: 10.1002/jmri.25374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Cushing's disease (CD) is associated with alterations in cardiac geometry and function, shown to be reversible after treatment. Our aim was to study cortisol-related changes in myocardial content in CD at baseline and after treatment using MR myocardial T1 times. MATERIALS AND METHODS This is a longitudinal study performed in 10 patients with active CD matched with 10 hypertensive and 10 healthy controls. All subjects had MR after CD diagnosis and 6 months after cortisol normalization. The 1.5 Tesla MR protocol included left ventricular geometry and function assessment and MOLLI sequences before and after contrast injection as well as late gadolinium enhancement. RESULTS At baseline, native myocardial T1 was significantly higher in CD patients compared with controls and the hypertensive group (1056 ± 139 ms versus 929 ± 80 ms, P = 0.023; 1056 ± 139 ms versus 952 ± 51, P = 0.049). After treatment, native and postcontrast myocardial T1 decreased in CD patients versus controls (1056 ± 139 ms versus 832 ± 78, P = 0.006 and 483 ± 69 ms versus 395 ± 39 ms, P = 0.010) reaching values even lower than found in controls (P = 0.038 and P = 0.001, respectively). CONCLUSION Native myocardial T1 is increased in Cushing's disease independently from hypertension and notably decreases after effective treatment, highlighting its potential to detect subclinical diffuse myocardial involvement in this condition. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:147-156.
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Affiliation(s)
- Charles Roux
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France
| | - Nadjia Kachenoura
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France
| | | | - Elie Mousseaux
- Université Paris Descartes, INSERM UMR 970, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Européen George Pompidou, Service de Radiologie Cardiovasculaire, Paris, France
| | - Jacques Young
- Institut National de la Santé et de la Recherche Médicale (INSERM) U693, F-94276, Le Kremlin Bicêtre, France.,Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94276, Le Kremlin Bicêtre, France.,Université Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S 693, F-94276, Le Kremlin Bicêtre, France
| | - Martin J Graves
- Radiology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Christel Jublanc
- Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, service d'endocrinologie, IE3M, Paris, France
| | - Philippe Cluzel
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département d'Imagerie Cardiovasculaire, Paris, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94276, Le Kremlin Bicêtre, France.,Université Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S 693, F-94276, Le Kremlin Bicêtre, France.,Radiology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Peter Kamenický
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, F-94276, Le Kremlin Bicêtre, France.,Université Paris-Sud, Faculté de Médecine Paris-Sud, UMR-S 693, F-94276, Le Kremlin Bicêtre, France.,Radiology, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Alban Redheuil
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 7371, UMR_S 1146, Laboratoire d'Imagerie Biomédicale, ICAN Imaging Core Lab, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département d'Imagerie Cardiovasculaire, Paris, France
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Perea Palazón R, Ortiz Pérez J, Prat González S, de Caralt Robira T, Cibeira López M, Solé Arqués M. Parametric techniques for characterizing myocardial tissue through magnetic resonance imaging (Part 1): T1 mapping. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baxa J, Ferda J, Hromádka M. T1 mapping of the ischemic myocardium: Review of potential clinical use. Eur J Radiol 2016; 85:1922-1928. [PMID: 27105590 DOI: 10.1016/j.ejrad.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/26/2016] [Accepted: 04/13/2016] [Indexed: 12/25/2022]
Abstract
Cardiac magnetic resonance imaging (CMR) is an indispensable part of the diagnostic algorithm in cardiology. CMR has become a gold standard in various disorders; moreover, it is well established also as a surrogate end-point in experimental and clinical studies. Particularly, the ability to directly display myocardial injury is a unique feature in comparison with other methods. The mapping of magnetic relaxation properties (T1, T2 and T2* relaxation times) are still relatively new techniques, but promising to improve the robustness of CMR and add new appropriate indications. The high potential of T1 mapping in the diagnostic of myocardial ischemic involvement has been highlighted in several experimental and clinical studies, but the use in clinical routine was limited due to the shortcomings in scanning and image evaluation. However, the quantitative technique of T1 mapping is now commercially available and its simple use, good reproducibility and limited subjectivity allow its incorporation into routine CMR protocols. This review article is aimed to summarise existing results and clinical experience with T1 mapping in patients with ischemic cardiac disease.
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Affiliation(s)
- Jan Baxa
- Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University in Prague and University Hospital Pilsen, Czech Republic.
| | - Jiří Ferda
- Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University in Prague and University Hospital Pilsen, Czech Republic
| | - Milan Hromádka
- Department of Cardiology, University Hospital Pilsen, Czech Republic
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49
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Perea Palazón RJ, Ortiz Pérez JT, Prat González S, de Caralt Robira TM, Cibeira López MT, Solé Arqués M. Parametric techniques for characterizing myocardial tissue by magnetic resonance imaging (part 1): T1 mapping. RADIOLOGIA 2016; 58:164-77. [PMID: 26944850 DOI: 10.1016/j.rx.2015.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 11/16/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations.
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Affiliation(s)
- R J Perea Palazón
- Servicio de Radiodiagnóstico, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - J T Ortiz Pérez
- Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - S Prat González
- Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - T M de Caralt Robira
- Servicio de Radiodiagnóstico, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M T Cibeira López
- Servicio de Hematología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M Solé Arqués
- Servicio de Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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50
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Schelbert EB, Messroghli DR. State of the Art: Clinical Applications of Cardiac T1 Mapping. Radiology 2016; 278:658-76. [DOI: 10.1148/radiol.2016141802] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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