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Tyler A, Huang L, Kunze K, Neji R, Mooiweer R, Rogers C, Masci PG, Roujol S. Characterization of quantitative susceptibility mapping in the left ventricular myocardium. J Cardiovasc Magn Reson 2024; 26:101000. [PMID: 38237902 PMCID: PMC11129096 DOI: 10.1016/j.jocmr.2024.101000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Myocardial quantitative susceptibility mapping (QSM) may offer better specificity to iron than conventional T2* imaging in the assessment of cardiac diseases, including intra-myocardial hemorrhage. However, the precision and repeatability of cardiac QSM have not yet been characterized. The aim of this study is to characterize these key metrics in a healthy volunteer cohort and show the feasibility of the method in patients. METHODS Free breathing respiratory-navigated multi-echo 3D gradient echo images were acquired, from which QSM maps were reconstructed using the Morphology Enhanced Dipole Inversion toolbox. This technique was first evaluated in a susceptibility phantom containing tubes with known concentrations of gadolinium. In vivo characterization of myocardial QSM was then performed in a cohort of 10 healthy volunteers where each subject was scanned twice. Mean segment susceptibility, precision (standard deviation of voxel magnetic susceptibilities within one segment), and repeatability (absolute difference in segment mean susceptibility between repeats) of QSM were calculated for each American Heart Association (AHA) myocardial segment. Finally, the feasibility of the method was shown in 10 patients, including four with hemorrhagic infarcts. RESULTS The phantom experiment showed a strong linear relationship between measured and predicted susceptibility shifts (R2 > 0.99). For the healthy volunteer cohort, AHA segment analysis showed the mean segment susceptibility was 0.00 ± 0.02 ppm, the mean precision was 0.05 ± 0.04 ppm, and the mean repeatability was 0.02 ± 0.02 ppm. Cardiac QSM was successfully performed in all patients. Focal iron deposits were successfully visualized in the patients with hemorrhagic myocardial infarctions. CONCLUSION The precision and repeatability of cardiac QSM were successfully characterized in phantom and in vivo experiments. The feasibility of the technique was also successfully demonstrated in patients. While challenges still remain, further clinical evaluation of the technique is now warranted. TRIAL REGISTRATION This work does not report on a health care intervention.
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Affiliation(s)
- Andrew Tyler
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Li Huang
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Karl Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom; MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Ronald Mooiweer
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom; MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Charlotte Rogers
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom.
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Brendel JM, Kratzenstein A, Berger J, Hagen F, Nikolaou K, Gawaz M, Greulich S, Krumm P. T2* map at cardiac MRI reveals incidental hepatic and cardiac iron overload. Diagn Interv Imaging 2023; 104:552-559. [PMID: 37550171 DOI: 10.1016/j.diii.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of this study was to assess the diagnostic capabilities of cardiac magnetic resonance (CMR) T2* mapping in detecting incidental hepatic and cardiac iron overload. MATERIALS AND METHODS Patients with various clinical indications for CMR examination were consecutively included at a single center from January 2019 to April 2023. All patients underwent T2* mapping at 1.5 T in a single mid-ventricular short-axis as part of a comprehensive routine CMR protocol. T2* measurements were performed of the heart (using a region-of-interest in the interventricular septum) and the liver, categorized according to the severity of iron overload. The degree of cardiac iron overload was categorized as mild (15 ms < T2* < 20 ms), moderate (10 ms < T2* < 15 ms) and severe (T2* < 10 ms). The degree of hepatic iron overload was categorized as mild (4 ms < T2* < 8 ms), moderate (2 ms < T2* < 4 ms), severe (T2* < 2 ms). Image quality and inter-reader agreement were assessed using intraclass correlation coefficient (ICC). RESULTS CMR examinations from 614 patients (374 men, 240 women) with a mean age of 50 ± 18 (standard deviation) years were fully evaluable. A total of 24/614 patients (3.9%) demonstrated incidental hepatic iron overload; of these, 22/614 patients (3.6%) had mild hepatic iron overload, and 2/614 patients (0.3%) had moderate hepatic iron overload. Seven out of 614 patients (1.1%) had incidental cardiac iron overload; of these, 5/614 patients (0.8%) had mild iron overload, 1/614 patients (0.2%) had moderate iron overload, and 1/614 patients (0.2%) had severe iron overload. Good to excellent inter-reader agreement was observed for the assessment of T2* values (ICC, 0.90 for heart [95% confidence interval: 0.88-0.91]; ICC, 0.91 for liver [95% confidence interval: 0.89-0.92]). CONCLUSION Analysis of standard CMR T2* maps detects incidental cardiac and hepatic iron overload in 1.1% and 3.9% of patients, respectively, which may have implications for further patient management. Therefore, despite an overall low number of incidental abnormal findings, T2* imaging may be included in a standardized comprehensive CMR protocol.
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Affiliation(s)
- Jan M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Alina Kratzenstein
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Josephine Berger
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, 72076 Germany.
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, 72076 Germany
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Kottam A, Hanneman K, Schenone A, Daubert MA, Sidhu GD, Gropler RJ, Garcia MJ. State-of-the-Art Imaging of Infiltrative Cardiomyopathies: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2023; 16:e000081. [PMID: 37916407 DOI: 10.1161/hci.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Infiltrative cardiomyopathies comprise a broad spectrum of inherited or acquired conditions caused by deposition of abnormal substances within the myocardium. Increased wall thickness, inflammation, microvascular dysfunction, and fibrosis are the common pathological processes that lead to abnormal myocardial filling, chamber dilation, and disruption of conduction system. Advanced disease presents as heart failure and cardiac arrhythmias conferring poor prognosis. Infiltrative cardiomyopathies are often diagnosed late or misclassified as other more common conditions, such as hypertrophic cardiomyopathy, hypertensive heart disease, ischemic or other forms of nonischemic cardiomyopathies. Accurate diagnosis is also critical because clinical features, testing methodologies, and approach to treatment vary significantly even within the different types of infiltrative cardiomyopathies on the basis of the type of substance deposited. Substantial advances in noninvasive cardiac imaging have enabled accurate and early diagnosis. thereby eliminating the need for endomyocardial biopsy in most cases. This scientific statement discusses the role of contemporary multimodality imaging of infiltrative cardiomyopathies, including echocardiography, nuclear and cardiac magnetic resonance imaging in the diagnosis, prognostication, and assessment of response to treatment.
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Baron T, Gerovasileiou S, Flachskampf FA. The role of imaging in the selection of patients for HFpEF therapy. Eur Heart J Cardiovasc Imaging 2023; 24:1343-1351. [PMID: 37399510 PMCID: PMC10531123 DOI: 10.1093/ehjci/jead137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) traditionally has been characterized as a form of heart failure without therapeutic options, in particular with a lack of response to the established therapies of heart failure with reduced ejection fraction (HFrEF). However, this is no longer true. Besides physical exercise, risk factor modification, aldosterone blocking agents, and sodium-glucose cotransporter 2 inhibitors, specific therapies are emerging for specific HFpEF etiologies, such as hypertrophic cardiomyopathy or cardiac amyloidosis. This development justifies increased efforts to arrive at specific diagnoses within the umbrella of HFpEF. Cardiac imaging plays by far the largest role in this effort and is discussed in the following review.
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Affiliation(s)
- Tomasz Baron
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, 751 85 Uppsala, Sweden
- Uppsala Clinical Research, 751 85 Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, 751 85 Uppsala, Sweden
- VO Medicin, Lasarettet i Enköping, all 785 81 Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, 751 85 Uppsala, Sweden
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Reinhold J, Burra V, Corballis N, Tsampasian V, Matthews G, Papadopoulou C, Vassiliou VS. Effects of Intravenous Iron Replacement Therapy on Cardiovascular Outcomes in Patients with Heart Failure: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2023; 10:116. [PMID: 36975880 PMCID: PMC10057806 DOI: 10.3390/jcdd10030116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
(1) Background: Iron deficiency (ID) is an important adverse prognostic marker in patients with heart failure (HF); however, it is unclear whether intravenous iron replacement reduces cardiovascular mortality in this patient group. Here, we estimate the effect of intravenous iron replacement therapy on hard clinical outcomes following the publication of IRONMAN, the largest trial in this field. (2) Methods: In this systematic review and meta-analysis, prospectively registered with PROSPERO and reported according to PRISMA guidelines, we searched PubMed and Embase for randomized controlled trials investigating intravenous iron replacement in patients with HF and co-existing ID. The primary outcome was cardiovascular mortality and secondary outcomes were all-cause mortality, hospitalizations for HF and a combination of the primary outcome and hospitalizations for HF. (3) Results: A total of 1671 items were identified and after removal of duplicates we screened titles and abstracts of 1202 records. Some 31 studies were identified for full-text review and 12 studies were included in the final review. The odds ratio (OR) for cardiovascular death using a random effects model was 0.85 (95% CI 0.69 to 1.04) and for all-cause mortality it was 0.83 (95% CI 0.59 to 1.15). There was a significant reduction in hospitalizations for HF (OR 0.49, 95% CI 0.35 to 0.69) and the combination of hospitalizations for HF and cardiovascular death (OR 0.65, 95% CI 0.5 to 0.85). (4) Conclusions: This review supports the use of IV iron replacement reducing hospitalization rates for HF, however more research is required to determine the effect on cardiovascular mortality and to identify the patient population most likely to benefit.
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Affiliation(s)
- Johannes Reinhold
- Norwich Medical School, University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Vyas Burra
- Medical School, King’s College London, Strand, London WC2R 2LS, UK
| | - Natasha Corballis
- Norwich Medical School, University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Gareth Matthews
- Norwich Medical School, University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Charikleia Papadopoulou
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
- Royal Papworth Hospital, Papworth Rd, Trumpington, Cambridge CB2 0AY, UK
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
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Aimo A, Huang L, Tyler A, Barison A, Martini N, Saccaro LF, Roujol S, Masci PG. Quantitative susceptibility mapping (QSM) of the cardiovascular system: challenges and perspectives. J Cardiovasc Magn Reson 2022; 24:48. [PMID: 35978351 PMCID: PMC9387036 DOI: 10.1186/s12968-022-00883-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) is a powerful, non-invasive, magnetic resonance imaging (MRI) technique that relies on measurement of magnetic susceptibility. So far, QSM has been employed mostly to study neurological disorders characterized by iron accumulation, such as Parkinson's and Alzheimer's diseases. Nonetheless, QSM allows mapping key indicators of cardiac disease such as blood oxygenation and myocardial iron content. For this reason, the application of QSM offers an unprecedented opportunity to gain a better understanding of the pathophysiological changes associated with cardiovascular disease and to monitor their evolution and response to treatment. Recent studies on cardiovascular QSM have shown the feasibility of a non-invasive assessment of blood oxygenation, myocardial iron content and myocardial fibre orientation, as well as carotid plaque composition. Significant technical challenges remain, the most evident of which are related to cardiac and respiratory motion, blood flow, chemical shift effects and susceptibility artefacts. Significant work is ongoing to overcome these challenges and integrate the QSM technique into clinical practice in the cardiovascular field.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Li Huang
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andrew Tyler
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andrea Barison
- Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, St Thomas' Hospital, 4th Floor Lambeth Wing, London, SE1 7EH, UK.
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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See WS, So EKF, Hwang GYY, Chin L, Ip L, Lam WWM, Ha SY, Cheung YF. Native cardiac magnetic resonance T1 mapping and cardiac mechanics as assessed by speckle tracking echocardiography in patients with beta-thalassaemia major. IJC HEART & VASCULATURE 2022; 38:100947. [PMID: 35024432 PMCID: PMC8733147 DOI: 10.1016/j.ijcha.2021.100947] [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: 07/29/2021] [Revised: 11/14/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND We hypothesize that cardiac magnetic resonance (CMR) native T1 is associated with myocardial deformation in thalassaemia patients. The present study aimed to compare CMR native T1 values to conventional T2* values in patients with beta-thalassaemia and to explore relationships between these CMR parameters of myocardial iron overload and left ventricular (LV) and left atrial (LA) myocardial deformation. METHODS Thirty-four (16 males) patients aged 35.5 ± 9.2 years were studied. Myocardial T2* and T1 mapping were performed to assess the cardiac iron overload, while two-dimensional speckle-tracking echocardiography was performed in determine LV and LA myocardial deformation. RESULTS T2* was 36.4 ± 8.7 ms with 3 patients having myocardial iron load (T2*<20 ms). The native T1 was 947.1 ± 84.8 ms, which was significantly lower than the reported normal values in the literature. There was a significant correlation between T1 and T2* values (r = 0.68, p < 0.001). There were no significant correlations between T1 and T2* values and conventional and tissue Doppler parameters of left ventricular systolic and diastolic function. On the other hand, T1, but not T2*, values were found to correlate negatively with maximum LA area indexed by body surface area (r = -0.34, p = 0.047) and positively with LA strain rate at atrial contraction (r = 0.36, p = 0.04). There were no associations between either of these CMR parameters with indices of ventricular deformation. CONCLUSIONS In patients with beta-thalassaemia major, native T1 values are decreased, associated with T2* values, and correlated with maximum LA area and LA strain rate at atrial contraction.
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Affiliation(s)
- Wing-Shan See
- Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Edwina Kam-fung So
- Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Gloria Yu-Yan Hwang
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Leanne Chin
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - Lawrence Ip
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | | | - Shau-yin Ha
- Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Yiu-fai Cheung
- Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Alonso-Fernández-Gatta M, Martín-García A, Díez-Campelo M, Martín-García AC, López-Cadenas F, Sánchez PL. Utilidad del mapeo miocárdico T1 y T2 mediante resonancia magnética cardiaca en pacientes transfundidos con síndrome mielodisplásico de bajo riesgo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Alonso-Fernández-Gatta M, Martín-García A, Díez-Campelo M, Martín-García AC, López-Cadenas F, Sánchez PL. Usefulness of myocardial T 1 and T 2 mapping with magnetic resonance in transfusion-dependent patients with low-risk myelodysplastic syndrome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:630-633. [PMID: 33531293 DOI: 10.1016/j.rec.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Marta Alonso-Fernández-Gatta
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Ana Martín-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - María Díez-Campelo
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Sapin
| | - Agustín C Martín-García
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Félix López-Cadenas
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Sapin
| | - Pedro L Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Alonso-Fernandez-Gatta M, Martin-Garcia A, Martin-Garcia AC, Lopez-Cadenas F, Diaz-Pelaez E, Jimenez-Solas T, Gonzalez-Martinez T, Sanchez-Pablo C, Diez-Campelo M, Sanchez PL. Predictors of cardiovascular events and all-cause of death in patients with transfusion-dependent myelodysplastic syndrome. Br J Haematol 2021; 195:536-541. [PMID: 34180544 DOI: 10.1111/bjh.17652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) involves the second cause of death in low-risk myelodysplastic syndrome (MDS) population. Prospective study to characterise the CVD and to identify predictors for the combined event (CE) cardiovascular event and/or all-cause mortality in transfusion dependent low-risk MDS patients. Thirty-one patients underwent a cardiac assessment including biomarkers and cardiac magnetic resonance (cMR) with parametric sequences (T1, T2 and T2* mapping) and myocardial deformation by feature tracking (FT) and were analysed for clonal hematopoiesis of indeterminate potential mutations. Cardiac assessment revealed high prevalence of unknown structural heart disease (51% cMR pathological findings). After 2·2 [0·44] years follow-up, 35·5% of patients suffered the CE: 16% death, 29% cardiovascular event. At multivariate analysis elevated NT-proBNP ≥ 486pg/ml (HR 96·7; 95%-CI 1·135-8243; P = 0·044), reduced native T1 time < 983ms (HR 44·8; 95%-CI 1·235-1623; P = 0·038) and higher left ventricular global longitudinal strain (LV-GLS) (HR 0·4; 95%-CI 0·196-0·973; P = 0·043) showed an independent prognostic value. These variables, together with the myocardial T2* time < 20ms, showed an additive prognostic value (Log Rank: 12·4; P = 0·001). In conclusion, low-risk MDS patients frequently suffer CVD. NT-proBNP value, native T1 relaxation time and longitudinal strain by FT are independent predictors of poor cardiovascular prognosis, thus, their determination would identify high-risk patients who could benefit from a cardiac treatment and follow-up.
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Affiliation(s)
| | - Ana Martin-Garcia
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV (ISCiii), Salamanca, Spain
| | - Agustin C Martin-Garcia
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV (ISCiii), Salamanca, Spain
| | - Felix Lopez-Cadenas
- Hematology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Elena Diaz-Pelaez
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV (ISCiii), Salamanca, Spain
| | - Tamara Jimenez-Solas
- Hematology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | | | - Clara Sanchez-Pablo
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV (ISCiii), Salamanca, Spain
| | - Maria Diez-Campelo
- Hematology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Pedro L Sanchez
- Cardiology Department, University Hospital of Salamanca, IBSAL, CIBER-CV (ISCiii), Salamanca, Spain
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Affiliation(s)
- Moises Vasquez
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
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Menacho K, Abdel-Gadir A, Moon JC, Fernandes JL. T2* Mapping Techniques: Iron Overload Assessment and Other Potential Clinical Applications. Magn Reson Imaging Clin N Am 2020; 27:439-451. [PMID: 31279448 DOI: 10.1016/j.mric.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
T2* mapping techniques has evolved significantly since their introduction in the early 2000s and a significant amount of evidence has been gathered to support their clinical routine use for iron overload assessment. This article focuses on the most important aspects of how to perform T2* imaging, from acquisition, to postprocessing, to analyzing the data with clinical concentration. Newer techniques have made T2* mapping more robust and accurate, allowing a broader use of this technique for noncontrast ischemia imaging based on blood oxygen levels, in addition to evaluation of intramyocardial hemorrhage and microvascular obstruction.
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Affiliation(s)
- Katia Menacho
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, Institute of Cardiovascular Science, University College London, St Bartholomew's Hospital, 2nd Floor, King George V Block, West Smithfiled, London EC1A 7BE, UK
| | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E6BT, UK; Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Block, London EC1A 7BE, UK
| | - James C Moon
- The Cardiovascular Magnetic Resonance Imaging Unit, The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Block, West Smithfield, London EC1A 7BE, UK
| | - Juliano Lara Fernandes
- Jose Michel Kalaf Research Institute, Radiologia Clinica de Campinas, Av Jose de Souza Campos 840, Campinas, São Paulo 13092-100, Brazil.
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Baggiano A, Boldrini M, Martinez-Naharro A, Kotecha T, Petrie A, Rezk T, Gritti M, Quarta C, Knight DS, Wechalekar AD, Lachmann HJ, Perlini S, Pontone G, Moon JC, Kellman P, Gillmore JD, Hawkins PN, Fontana M. Noncontrast Magnetic Resonance for the Diagnosis of Cardiac Amyloidosis. JACC Cardiovasc Imaging 2020; 13:69-80. [DOI: 10.1016/j.jcmg.2019.03.026] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 11/16/2022]
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Triadyaksa P, Oudkerk M, Sijens PE. Cardiac T 2 * mapping: Techniques and clinical applications. J Magn Reson Imaging 2019; 52:1340-1351. [PMID: 31837078 PMCID: PMC7687175 DOI: 10.1002/jmri.27023] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiac T2* mapping is a noninvasive MRI method that is used to identify myocardial iron accumulation in several iron storage diseases such as hereditary hemochromatosis, sickle cell disease, and β‐thalassemia major. The method has improved over the years in terms of MR acquisition, focus on relative artifact‐free myocardium regions, and T2* quantification. Several improvement factors involved include blood pool signal suppression, the reproducibility of T2* measurement as affected by scanner hardware, and acquisition software. Regarding the T2* quantification, improvement factors include the applied curve‐fitting method with or without truncation of the signals acquired at longer echo times and whether or not T2* measurement focuses on multiple segmental regions or the midventricular septum only. Although already widely applied in clinical practice, data processing still differs between centers, contributing to measurement outcome variations. State of the art T2* measurement involves pixelwise quantification providing better spatial iron loading information than region of interest‐based quantification. Improvements have been proposed, such as on MR acquisition for free‐breathing mapping, the generation of fast mapping, noise reduction, automatic myocardial contour delineation, and different T2* quantification methods. This review deals with the pro and cons of different methods used to quantify T2* and generate T2* maps. The purpose is to recommend a combination of MR acquisition and T2* mapping quantification techniques for reliable outcomes in measuring and follow‐up of myocardial iron overload. The clinical application of cardiac T2* mapping for iron overload's early detection, monitoring, and treatment is addressed. The prospects of T2* mapping combined with different MR acquisition methods, such as cardiac T1 mapping, are also described. Level of Evidence: 4 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
- Pandji Triadyaksa
- University of Groningen, Groningen, The Netherlands.,Universitas Diponegoro, Department of Physics, Faculty of Science and Mathematics, Semarang, Indonesia
| | - Matthijs Oudkerk
- University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Paul E Sijens
- University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
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15
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Halliday BP, Prasad SK. The Interstitium in the Hypertrophied Heart. JACC Cardiovasc Imaging 2019; 12:2357-2368. [DOI: 10.1016/j.jcmg.2019.05.033] [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: 12/17/2018] [Revised: 04/06/2019] [Accepted: 05/07/2019] [Indexed: 12/17/2022]
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16
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Abstract
MRI is a key tool in the current management of patients with thalassemia. Given its capability of assessing iron overload in different organs noninvasively and without contrast, it has significant advantages over other metrics, including serum ferritin. Liver iron concentration can be measured either with relaxometry methods T2*/T2 or signal intensity ratio techniques. Myocardial iron can be assessed in the same examination through T2* imaging. In this review, we focus on showing how MRI evaluates iron in both organs and the clinical applications as well as practical approaches to using this tool by clinicians taking care of patients with thalassemia.
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17
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Reiter U, Reiter C, Kräuter C, Fuchsjäger M, Reiter G. Cardiac magnetic resonance T1 mapping. Part 2: Diagnostic potential and applications. Eur J Radiol 2018; 109:235-247. [PMID: 30539759 DOI: 10.1016/j.ejrad.2018.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/07/2018] [Accepted: 10/15/2018] [Indexed: 02/07/2023]
Abstract
Non-invasive identification and differentiation of myocardial diseases represents the primary objectives of cardiac magnetic resonance (CMR) longitudinal relaxation time (T1) and extracellular volume (ECV) mapping. Given the fact that myocardial T1 and ECV values overlap throughout and within left ventricular phenotypes, a central issue to be addressed is whether and to what extent myocardial T1 and ECV mapping provides additional or superior diagnostic information to standard CMR imaging, and whether native T1 mapping could be employed as a non-contrast alternative to late gadolinium enhancement (LE) imaging. The present review aims to summarize physiological and pathophysiological alterations in native T1 and ECV values and summarized myocardial T1 and ECV alterations associated with cardiac diseases to support the translation of research findings into routine CMR imaging.
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Affiliation(s)
- Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 19/P, 8036 Graz, Austria.
| | - Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 19/P, 8036 Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 19/P, 8036 Graz, Austria; Institute of Medical Engineering, Graz University of Technology, Stremayrgasse 16/III, 8010 Graz, Austria.
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 19/P, 8036 Graz, Austria.
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 19/P, 8036 Graz, Austria; Research & Development, Siemens Healthcare Diagnostics GmbH, Strassgangerstrasse 315, 8054 Graz, Austria.
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18
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Myocardial Imaging with CMR Parametric Mapping: Clinical Applications. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Shaw JL, Nelson MD, Wei J, Motwani M, Landes S, Mehta PK, Thomson LEJ, Berman DS, Li D, Bairey Merz CN, Sharif B. Inverse association of MRI-derived native myocardial T1 and perfusion reserve index in women with evidence of ischemia and no obstructive CAD: A pilot study. Int J Cardiol 2018; 270:48-53. [PMID: 30041981 DOI: 10.1016/j.ijcard.2018.06.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND It has recently been shown that magnetic resonance (MR) "native T1" mapping is capable of characterizing abnormal microcirculation in patients with obstructive coronary artery disease (CAD). In studies involving women with signs and symptoms of ischemia and no obstructive CAD (INOCA), however, the potential role of native T1 as an imaging marker and its association with indices of diastolic function or vasodilator-induced myocardial ischemia have not been explored. We investigated whether native T1 in INOCA is associated with reduced myocardial perfusion reserve index (MPRI) or with diastolic dysfunction. METHODS Twenty-two female patients with INOCA and twelve female reference controls with matching age and body-mass index were studied. The patients had evidence of vasodilator-induced ischemia without obstructive CAD or any prior infarction. All 34 subjects underwent stress/rest MR including native T1 mapping (MOLLI 5(3)3) at 1.5-Tesla. RESULTS Compared with controls, patients had similar morphology/function. As expected, MPRI was significantly reduced in patients compared to controls (1.78 ± 0.39 vs. 2.49 ± 0.41, p < 0.0001). Native T1 was significantly elevated in patients (1040.1 ± 29.3 ms vs. 1003.8 ± 18.5 ms, p < 0.001) and the increased T1 showed a significant inverse correlation with MPRI (r = -0.481, p = 0.004), but was not correlated with reduced diastolic strain rate. CONCLUSIONS Symptomatic women with INOCA have elevated native T1 compared to matched reference controls and there is a significant association between elevated native T1 and impaired MPRI, considered a surrogate measure of ischemia severity in this cohort. Future studies in a larger cohort are needed to elucidate the mechanism underlying this inverse relationship.
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Affiliation(s)
- Jaime L Shaw
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, CA, United States
| | - Michael D Nelson
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Janet Wei
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Manish Motwani
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Sofy Landes
- Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Puja K Mehta
- Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Louise E J Thomson
- Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States
| | - C Noel Bairey Merz
- Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Bioengineering, University of California Los Angeles, CA, United States; David Geffen School of Medicine, University of California Los Angeles, CA, United States.
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20
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Chen BH, Wu R, An DA, Shi RY, Yao QY, Lu Q, Hu J, Jiang M, Deen J, Chandra A, Xu JR, Wu LM. Oxygenation-sensitive cardiovascular magnetic resonance in hypertensive heart disease with left ventricular myocardial hypertrophy and non-left ventricular myocardial hypertrophy: Insight from altered mechanics and cardiac BOLD imaging. J Magn Reson Imaging 2018; 48:1297-1306. [PMID: 29734491 DOI: 10.1002/jmri.26055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/02/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND BOLD (blood oxygen level dependent) MRI can detect regional condition of myocardial oxygen supply and demand by means of paramagnetic properties. PURPOSE Noninvasive assessment of myocardial oxygenation by BOLD MRI in hypertensive patients with hypertension (HTN) left ventricular myocardial hypertrophy (LVMH) and HTN non-LVMH and its correlation with myocardial mechanics were performed. STUDY TYPE Prospective. POPULATION Twenty patients with HTN LVMH, 21 patients with HTN non-LVMH, and 23 normotensive controls were enrolled. FIELD STRENGTH/SEQUENCE Cine imaging, T2* and T1 mapping sequences were achieved at 3.0T. ASSESSMENT Dedicated T1 mapping, T2*, and cine imaging analysis were performed by two radiologists using cvi42. STATISTICAL TESTS One-way analysis of variance, Kruskal-Wallis test, Bland-Altman analysis, Pearson's correlation coefficient, Spearman's rank correlation. RESULTS T2* values of HTN LVMH group were significantly lower versus the controls (23.78 ± 3.09 versus 30.77 ± 2.71; P < 0.001) and HTN non-LVMH group (23.78 ± 3.09 versus 28.64 ± 4.23; P < 0.001). Left ventricular peak circumferential strain were reduced in HTN LVMH patients compared with other two groups (-11.32 [-15.64, -10.3], -16.78 [-19.35, -15.34], and -19.73 [-20.57, -18.73]; P < 0.05); and longitudinal strain of HTN LVMH patients were lower than other two groups (-11.31 ± 2.91, -15.1 ± 3.06, and -18.85 ± 1.85; P < 0.05); radial strain of HTN LVMH patients were also lower than other two groups (25.03 ± 16, 40.95 ± 17.5 and 47.9 ± 10.23; P < 0.05). Extracellular volume correlated with peak circumferential, longitudinal, and radial strain (spearman rho = 0.6, 0.64, and -0.69; P < 0.05), respectively; T2* negatively correlated with peak circumferential and longitudinal strain (spearman rho = -0.43 and -0.49; P < 0.05), respectively. Patients with lower T2* values had significant decreases in myocardial mechanics (P < 0.05). DATA CONCLUSION HTN LVMH patients have both impaired myocardial mechanics and decreased T2* values compared with HTN non-LVMH and normotensive groups. BOLD MRI could provide a feasible assessment modality for detecting altered T2* due to the change of de-oxygenated hemoglobin and hence to the change of signal intensity in oxygenation-sensitive images. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1297-1306.
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Affiliation(s)
- Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruo-Yang Shi
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiu-Ying Yao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, USA
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - James Deen
- Department of Radiology, Wayne State University, Detroit, Michigan, USA
| | - Ankush Chandra
- Department of Radiology, Wayne State University, Detroit, Michigan, USA
| | - Jian-Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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21
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Torlasco C, Cassinerio E, Roghi A, Faini A, Capecchi M, Abdel-Gadir A, Giannattasio C, Parati G, Moon JC, Cappellini MD, Pedrotti P. Role of T1 mapping as a complementary tool to T2* for non-invasive cardiac iron overload assessment. PLoS One 2018; 13:e0192890. [PMID: 29466447 PMCID: PMC5821344 DOI: 10.1371/journal.pone.0192890] [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] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/08/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Iron overload-related heart failure is the principal cause of death in transfusion dependent patients, including those with Thalassemia Major. Linking cardiac siderosis measured by T2* to therapy improves outcomes. T1 mapping can also measure iron; preliminary data suggests it may have higher sensitivity for iron, particularly for early overload (the conventional cut-point for no iron by T2* is 20ms, but this is believed insensitive). We compared T1 mapping to T2* in cardiac iron overload. METHODS In a prospectively large single centre study of 138 Thalassemia Major patients and 32 healthy controls, we compared T1 mapping to dark blood and bright blood T2* acquired at 1.5T. Linear regression analysis was used to assess the association of T2* and T1. A "moving window" approach was taken to understand the strength of the association at different levels of iron overload. RESULTS The relationship between T2* (here dark blood) and T1 is described by a log-log linear regression, which can be split in three different slopes: 1) T2* low, <20ms, r2 = 0.92; 2) T2* = 20-30ms, r2 = 0.48; 3) T2*>30ms, weak relationship. All subjects with T2*<20ms had low T1; among those with T2*>20ms, 38% had low T1 with most of the subjects in the T2* range 20-30ms having a low T1. CONCLUSIONS In established cardiac iron overload, T1 and T2* are concordant. However, in the 20-30ms T2* range, T1 mapping appears to detect iron. These data support previous suggestions that T1 detects missed iron in 1 out of 3 subjects with normal T2*, and that T1 mapping is complementary to T2*. The clinical significance of a low T1 with normal T2* should be further investigated.
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Affiliation(s)
- Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Elena Cassinerio
- Rare Diseases Centre, Department of Medicine and Medical Specialities, “Ca’ Granda” Foundation IRCCS, Milan, Italy
| | - Alberto Roghi
- Cardiology 4, Department of Cardiology and Cardiovascular Surgery, Niguarda Hospital, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Marco Capecchi
- Rare Diseases Centre, Department of Medicine and Medical Specialities, “Ca’ Granda” Foundation IRCCS, Milan, Italy
| | - Amna Abdel-Gadir
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Cristina Giannattasio
- Cardiology 4, Department of Cardiology and Cardiovascular Surgery, Niguarda Hospital, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - James C. Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Maria D. Cappellini
- Rare Diseases Centre, Department of Medicine and Medical Specialities, “Ca’ Granda” Foundation IRCCS, Milan, Italy
| | - Patrizia Pedrotti
- Cardiology 4, Department of Cardiology and Cardiovascular Surgery, Niguarda Hospital, Milan, Italy
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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23
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Krittayaphong R, Zhang S, Saiviroonporn P, Viprakasit V, Tanapibunpon P, Komoltri C, Wangworatrakul W. Detection of cardiac iron overload with native magnetic resonance T1 and T2 mapping in patients with thalassemia. Int J Cardiol 2017; 248:421-426. [DOI: 10.1016/j.ijcard.2017.06.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/08/2017] [Accepted: 06/26/2017] [Indexed: 12/15/2022]
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van den Boomen M, Slart RHJA, Hulleman EV, Dierckx RAJO, Velthuis BK, van der Harst P, Sosnovik DE, Borra RJH, Prakken NHJ. Native T 1 reference values for nonischemic cardiomyopathies and populations with increased cardiovascular risk: A systematic review and meta-analysis. J Magn Reson Imaging 2017; 47:891-912. [PMID: 29131444 PMCID: PMC5873388 DOI: 10.1002/jmri.25885] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/17/2017] [Indexed: 12/12/2022] Open
Abstract
Background Although cardiac MR and T1 mapping are increasingly used to diagnose diffuse fibrosis based cardiac diseases, studies reporting T1 values in healthy and diseased myocardium, particular in nonischemic cardiomyopathies (NICM) and populations with increased cardiovascular risk, seem contradictory. Purpose To determine the range of native myocardial T1 value ranges in patients with NICM and populations with increased cardiovascular risk. Study Type Systemic review and meta‐analysis. Population Patients with NICM, including hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), and patients with myocarditis (MC), iron overload, amyloidosis, Fabry disease, and populations with hypertension (HT), diabetes mellitus (DM), and obesity. Field Strength/Sequence (Shortened) modified Look–Locker inversion‐recovery MR sequence at 1.5 or 3T. Assessment PubMed and Embase were searched following the PRISMA guidelines. Statistical Tests The summary of standard mean difference (SMD) between the diseased and a healthy control populations was generated using a random‐effects model in combination with meta‐regression analysis. Results The SMD for HCM, DCM, and MC patients were significantly increased (1.41, 1.48, and 1.96, respectively, P < 0.01) compared with healthy controls. The SMD for HT patients with and without left‐ventricle hypertrophy (LVH) together was significantly increased (0.19, P = 0.04), while for HT patients without LVH the SMD was zero (0.03, P = 0.52). The number of studies on amyloidosis, iron overload, Fabry disease, and HT patients with LVH did not meet the requirement to perform a meta‐analysis. However, most studies reported a significantly increased T1 for amyloidosis and HT patients with LVH and a significant decreased T1 for iron overload and Fabry disease patients. Data Conclusions Native T1 mapping by using an (Sh)MOLLI sequence can potentially assess myocardial changes in HCM, DCM, MC, iron overload, amyloidosis, and Fabry disease compared to controls. In addition, it can help to diagnose left‐ventricular remodeling in HT patients. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:891–912.
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Affiliation(s)
- Maaike van den Boomen
- Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard-MIT Health Science and Technology, USA
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands; Department of Biomedical Photonic Imaging, University of Twente, the Netherlands
| | - Enzo V Hulleman
- Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University of Utrecht, University Medical Center Utrecht, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - David E Sosnovik
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard-MIT Health Science and Technology, USA
| | - Ronald J H Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Netherlands; Medical Imaging Centre of Southwest Finland, Turku University Hospital, Finland
| | - Niek H J Prakken
- Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands
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25
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Abstract
Quantitative myocardial and blood T1 have recently achieved clinical utility in numerous pathologies, as they provide non-invasive tissue characterization with the potential to replace invasive biopsy. Native T1 time (no contrast agent), changes with myocardial extracellular water (edema, focal or diffuse fibrosis), fat, iron, and amyloid protein content. After contrast, the extracellular volume fraction (ECV) estimates the size of the extracellular space and identifies interstitial disease. Spatially resolved quantification of these biomarkers (so-called T1 mapping and ECV mapping) are steadily becoming diagnostic and prognostically useful tests for several heart muscle diseases, influencing clinical decision-making with a pending second consensus statement due mid-2017. This review outlines the physics involved in estimating T1 times and summarizes the disease-specific clinical and research impacts of T1 and ECV to date. We conclude by highlighting some of the remaining challenges such as their community-wide delivery, quality control, and standardization for clinical practice.
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Affiliation(s)
- Dina Radenkovic
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK
- University College London Medical School, Bloomsbury Campus, Gower Street, London, UK
| | - Sebastian Weingärtner
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany
- Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Lewis Ricketts
- University College London Medical School, Bloomsbury Campus, Gower Street, London, UK
| | - James C Moon
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK
- NIHR University College London Hospitals Biomedical Research Center, Tottenham Court Road, London, UK
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, UK.
- NIHR University College London Hospitals Biomedical Research Center, Tottenham Court Road, London, UK.
- UCL Institute of Cardiovascular Science, University College London, London, UK.
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26
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Shah R, Nucifora G, Perry R, Selvanayagam JB. Noninvasive imaging in cardiac deposition diseases. J Magn Reson Imaging 2017; 47:44-59. [DOI: 10.1002/jmri.25720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/16/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ranjit Shah
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park Adelaide Australia
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
| | - Gaetano Nucifora
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
- School of Medicine; Flinders University; Bedford Park Adelaide Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park Adelaide Australia
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
- School of Medicine; Flinders University; Bedford Park Adelaide Australia
| | - Joseph B. Selvanayagam
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park Adelaide Australia
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
- School of Medicine; Flinders University; Bedford Park Adelaide Australia
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27
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Adam RD, Shambrook J, Flett AS. The Prognostic Role of Tissue Characterisation using Cardiovascular Magnetic Resonance in Heart Failure. Card Fail Rev 2017; 3:86-96. [PMID: 29387459 DOI: 10.15420/cfr.2017:19:1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite significant advances in heart failure diagnostics and therapy, the prognosis remains poor, with one in three dying within a year of hospital admission. This is at least in part due to the difficulties in risk stratification and personalisation of therapy. The use of left ventricular systolic function as the main arbiter for entrance into clinical trials for drugs and advanced therapy, such as implantable defibrillators, grossly simplifies the complex heterogeneous nature of the syndrome. Cardiovascular magnetic resonance offers a wealth of data to aid in diagnosis and prognostication. The advent of novel cardiovascular magnetic resonance mapping techniques allows us to glimpse some of the pathophysiological mechanisms underpinning heart failure. We review the growing prognostic evidence base using these techniques.
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Affiliation(s)
- Robert D Adam
- Department of Cardiology, University Hospital Southampton,Southampton, UK
| | - James Shambrook
- Department of Cardiology, University Hospital Southampton,Southampton, UK
| | - Andrew S Flett
- Department of Cardiology, University Hospital Southampton,Southampton, UK
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28
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Pennell DJ, Baksi AJ, Prasad SK, Mohiaddin RH, Alpendurada F, Babu-Narayan SV, Schneider JE, Firmin DN. Review of Journal of Cardiovascular Magnetic Resonance 2015. J Cardiovasc Magn Reson 2016; 18:86. [PMID: 27846914 PMCID: PMC5111217 DOI: 10.1186/s12968-016-0305-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022] Open
Abstract
There were 116 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2015, which is a 14 % increase on the 102 articles published in 2014. The quality of the submissions continues to increase. The 2015 JCMR Impact Factor (which is published in June 2016) rose to 5.75 from 4.72 for 2014 (as published in June 2015), which is the highest impact factor ever recorded for JCMR. The 2015 impact factor means that the JCMR papers that were published in 2013 and 2014 were cited on average 5.75 times in 2015. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.
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Affiliation(s)
- D. J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - A. J. Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - S. K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - R. H. Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - F. Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - S. V. Babu-Narayan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - J. E. Schneider
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - D. N. Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
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29
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Vassiliou VS, Heng EL, Gatehouse PD, Donovan J, Raphael CE, Giri S, Babu-Narayan SV, Gatzoulis MA, Pennell DJ, Prasad SK, Firmin DN. Magnetic resonance imaging phantoms for quality-control of myocardial T1 and ECV mapping: specific formulation, long-term stability and variation with heart rate and temperature. J Cardiovasc Magn Reson 2016; 18:62. [PMID: 27659737 PMCID: PMC5034463 DOI: 10.1186/s12968-016-0275-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) phantoms are routinely used for quality assurance in MRI centres; however their long term stability for verification of myocardial T1/ extracellular volume fraction (ECV) mapping has never been investigated. METHODS Nickel-chloride agarose gel phantoms were formulated in a reproducible laboratory procedure to mimic blood and myocardial T1 and T2 values, native and late after Gadolinium administration as used in T1/ECV mapping. The phantoms were imaged weekly with an 11 heart beat MOLLI sequence for T1 and long TR spin-echo sequences for T2, in a carefully controlled reproducible manner for 12 months. RESULTS There were only small relative changes seen in all the native and post gadolinium T1 values (up to 9.0 % maximal relative change in T1 values) or phantom ECV (up to 8.3 % maximal relative change of ECV, up to 2.2 % maximal absolute change in ECV) during this period. All native and post gadolinium T2 values remained stable over time with <2 % change. Temperature sensitivity testing showed MOLLI T1 values in the long T1 phantoms increasing by 23.9 ms per degree increase and short T1 phantoms increasing by 0.3 ms per degree increase. There was a small absolute increase in ECV of 0.069 % (~0.22 % relative increase in ECV) per degree increase. Variation in heart rate testing showed a 0.13 % absolute increase in ECV (~0.45 % relative increase in ECV) per 10 heart rate increase. CONCLUSIONS These are the first phantoms reported in the literature modeling T1 and T2 values for blood and myocardium specifically for the T1mapping/ECV mapping application, with stability tested rigorously over a 12 month period. This work has significant implications for the utility of such phantoms in improving the accuracy of serial scans for myocardial tissue characterisation by T1 mapping methods and in multicentre work.
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Affiliation(s)
- Vassilios S. Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Ee Ling Heng
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Peter D. Gatehouse
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Jacqueline Donovan
- Department of Biochemistry, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
| | - Claire E. Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | | | - Sonya V. Babu-Narayan
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Michael A. Gatzoulis
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Dudley J. Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - Sanjay K. Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
| | - David N. Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
- Imperial College, National Heart and Lung Institute, London, UK
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30
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A randomized trial of amlodipine in addition to standard chelation therapy in patients with thalassemia major. Blood 2016; 128:1555-61. [DOI: 10.1182/blood-2016-06-721183] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Key Points
In thalassemia patients with cardiac siderosis, amlodipine combined with iron chelation resulted in more effective reduction of cardiac iron. The combined treatment did not have any effect on serum ferritin and left ventricular ejection fraction.
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31
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Alam MH, Auger D, McGill LA, Smith GC, He T, Izgi C, Baksi AJ, Wage R, Drivas P, Firmin DN, Pennell DJ. Comparison of 3 T and 1.5 T for T2* magnetic resonance of tissue iron. J Cardiovasc Magn Reson 2016; 18:40. [PMID: 27391316 PMCID: PMC4938967 DOI: 10.1186/s12968-016-0259-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND T2* magnetic resonance of tissue iron concentration has improved the outcome of transfusion dependant anaemia patients. Clinical evaluation is performed at 1.5 T but scanners operating at 3 T are increasing in numbers. There is a paucity of data on the relative merits of iron quantification at 3 T vs 1.5 T. METHODS A total of 104 transfusion dependent anaemia patients and 20 normal volunteers were prospectively recruited to undergo cardiac and liver T2* assessment at both 1.5 T and 3 T. Intra-observer, inter-observer and inter-study reproducibility analysis were performed on 20 randomly selected patients for cardiac and liver T2*. RESULTS Association between heart and liver T2* at 1.5 T and 3 T was non-linear with good fit (R (2) = 0.954, p < 0.001 for heart white-blood (WB) imaging; R (2) = 0.931, p < 0.001 for heart black-blood (BB) imaging; R (2) = 0.993, p < 0.001 for liver imaging). R2* approximately doubled between 1.5 T and 3 T with linear fits for both heart and liver (94, 94 and 105 % respectively). Coefficients of variation for intra- and inter-observer reproducibility, as well as inter-study reproducibility trended to be less good at 3 T (3.5 to 6.5 %) than at 1.5 T (1.4 to 5.7 %) for both heart and liver T2*. Artefact scores for the heart were significantly worse with the 3 T BB sequence (median 4, IQR 2-5) compared with the 1.5 T BB sequence (4 [3-5], p = 0.007). CONCLUSION Heart and liver T2* and R2* at 3 T show close association with 1.5 T values, but there were more artefacts at 3 T and trends to lower reproducibility causing difficulty in quantifying low T2* values with high tissue iron. Therefore T2* imaging at 1.5 T remains the gold standard for clinical practice. However, in centres where only 3 T is available, equivalent values at 1.5 T may be approximated by halving the 3 T tissue R2* with subsequent conversion to T2*.
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Affiliation(s)
- Mohammed H. Alam
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- />Imperial College, London, UK
| | - Dominique Auger
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Laura-Ann McGill
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- />Imperial College, London, UK
| | - Gillian C. Smith
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- />Imperial College, London, UK
| | | | - Cemil Izgi
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A. John Baksi
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rick Wage
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Peter Drivas
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - David N. Firmin
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- />Imperial College, London, UK
| | - Dudley J. Pennell
- />NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- />Imperial College, London, UK
- />Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
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32
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Abstract
The myocardium is particularly susceptible to complications from iron loading in thalassemia major. In the first years of life, severe anemia leads to high-output cardiac failure and death if not treated. The necessary supportive blood transfusions create loading of iron that cannot be naturally excreted, and this iron accumulates within tissues, including the heart. Free unbound iron catalyzes the formation of toxic hydroxyl radicals, which damage cells and cause cardiac dysfunction. Significant cardiac siderosis may present by the age of 10 and may lead to acute clinical heart failure, which must be treated urgently. Atrial fibrillation is the most frequently encountered iron-related arrhythmia. Iron chelation is effective at removing iron from the myocardium, at the expense of side effects that hamper compliance to therapy. Monitoring of myocardial iron content is mandatory for clinical management of cardiac risk. T2* cardiac magnetic resonance measures myocardial iron and is the strongest biomarker for prediction of heart failure and arrhythmic events. It has been calibrated to human myocardial tissue iron concentration and is highly reproducible across all magnetic resonance scanner vendors. As survival and patient age increases, endothelial dysfunction and diabetes may become new factors in the cardiovascular health of thalassemia patients. Promising new imaging technology and therapies could ameliorate the long-term prognosis.
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Affiliation(s)
- Dominique Auger
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,Imperial College London, London, United Kingdom
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,Imperial College London, London, United Kingdom
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