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Goldberg JF, Spinner JA, Soslow JH. Myocarditis in children 2024, new themes and continued questions. Curr Opin Cardiol 2024; 39:315-322. [PMID: 38661130 DOI: 10.1097/hco.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW While pediatric myocarditis incidence has increased since the coronavirus disease 2019 (COVID-19) pandemic, there remain questions regarding diagnosis, risk stratification, and optimal therapy. This review highlights recent publications and continued unanswered questions related to myocarditis in children. RECENT FINDINGS Emergence from the COVID-19 era has allowed more accurate description of the incidence and prognosis of myocarditis adjacent to COVID-19 infection and vaccine administration as well that of multi-system inflammatory disease in children (MIS-C). As cardiac magnetic resonance technology has shown increased availability and evidence in pediatric myocarditis, it is important to understand conclusions from adult imaging studies and define the use of this imaging biomarker in children. Precision medicine has begun to allow real-time molecular evaluations to help diagnose and risk-stratify cardiovascular diseases, with emerging evidence of these modalities in myocarditis. SUMMARY Recent information regarding COVID-19 associated myocarditis, cardiac magnetic resonance, and molecular biomarkers may help clinicians caring for children with myocarditis and identify needs for future investigations.
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Bramlet M, Mohamadi S, Srinivas J, Dassanayaka T, Okammor T, Shadden M, Sutton BP. Automating aortic cross-sectional measurement of 3D aorta models. J Med Imaging (Bellingham) 2024; 11:034503. [PMID: 38817710 PMCID: PMC11135202 DOI: 10.1117/1.jmi.11.3.034503] [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: 09/01/2023] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Aortic dissection carries a mortality as high as 50%, but surgical palliation is also fraught with morbidity risks of stroke or paralysis. As such, a significant focus of medical decision making is on longitudinal aortic diameters. We hypothesize that three-dimensional (3D) modeling affords a more efficient methodology toward automated longitudinal aortic measurement. The first step is to automate the measurement of manually segmented 3D models of the aorta. We developed and validated an algorithm to analyze a 3D segmented aorta and output the maximum dimension of minimum cross-sectional areas in a stepwise progression from the diaphragm to the aortic root. Accordingly, the goal is to assess the diagnostic validity of the 3D modeling measurement as a substitute for existing 2D measurements. Approach From January 2021 to June 2022, 66 3D non-contrast steady-state free precession magnetic resonance images of aortic pathology with clinical aortic measurements were identified; 3D aorta models were manually segmented. A novel mathematical algorithm was applied to each model to generate maximal aortic diameters from the diaphragm to the root, which were then correlated to clinical measurements. Results With a 76% success rate, we analyzed the resulting 50 3D aortic models utilizing the automated measurement tool. There was an excellent correlation between the automated measurement and the clinical measurement. The intra-class correlation coefficient and p -value for each of the nine measured locations of the aorta were as follows: sinus of valsalva, 0.99, < 0.001 ; sino-tubular junction, 0.89, < 0.001 ; ascending aorta, 0.97, < 0.001 ; brachiocephalic artery, 0.96, < 0.001 ; transverse segment 1, 0.89, < 0.001 ; transverse segment 2, 0.93, < 0.001 ; isthmus region, 0.92, < 0.001 ; descending aorta, 0.96, < 0.001 ; and aorta at diaphragm, 0.3, < 0.001 . Conclusions Automating diagnostic measurements that appease clinical confidence is a critical first step in a fully automated process. This tool demonstrates excellent correlation between measurements derived from manually segmented 3D models and the clinical measurements, laying the foundation for transitioning analytic methodologies from 2D to 3D.
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Affiliation(s)
- Matthew Bramlet
- University of Illinois College of Medicine at Peoria, Pediatric Cardiology, Peoria, Illinois, United States
| | - Salman Mohamadi
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
| | - Jayishnu Srinivas
- University of Illinois College of Medicine Peoria, Peoria, Illinois, United States
| | - Tehan Dassanayaka
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
| | - Tafara Okammor
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
| | | | - Bradley P. Sutton
- University of Illinois Urbana Champaign, Bioengineering, Champaign, Illinois, United States
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Jahnke C, Darma A, Lindemann F, Oebel S, Hilbert S, Bode K, Stehning C, Smink J, Paetsch I. Electrophysiological cardiovascular MR: procedure-ready mesh model generation for interventional guidance based on non-selective excitation compressed sensing whole heart imaging. Sci Rep 2024; 14:8974. [PMID: 38637577 PMCID: PMC11026457 DOI: 10.1038/s41598-024-59230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Fully CMR-guided electrophysiological interventions (EP-CMR) have recently been introduced but data on the optimal CMR imaging protocol are scarce. This study determined the clinical utility of 3D non-selective whole heart steady-state free precession imaging using compressed SENSE (nsWHcs) for automatic segmentation of cardiac cavities as the basis for targeted catheter navigation during EP-CMR cavo-tricuspid isthmus ablation. Fourty-two consecutive patients with isthmus-dependent right atrial flutter underwent EP-CMR radiofrequency ablations. nsWHcs succeeded in all patients (nominal scan duration, 98 ± 10 s); automatic segmentation/generation of surface meshes of right-sided cavities exhibited short computation times (16 ± 3 s) with correct delineation of right atrium, right ventricle, tricuspid annulus and coronary sinus ostium in 100%, 100%, 100% and 95%, respectively. Point-by-point ablation adhered to the predefined isthmus line in 62% of patients (26/42); activation mapping confirmed complete bidirectional isthmus block (conduction time difference, 136 ± 28 ms). nsWHcs ensured automatic and reliable 3D segmentation of targeted endoluminal cavities, multiplanar reformatting and image fusion (e.g. activation time measurements) and represented the basis for precise real-time active catheter navigation during EP-CMR ablations of isthmus-dependent right atrial flutter. Hence, nsWHcs can be considered a key component in order to advance EP-CMR towards the ultimate goal of targeted substrate-based ablation procedures.
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Affiliation(s)
- Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Frank Lindemann
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Kerstin Bode
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | | | - Jouke Smink
- Philips Research Laboratories, Best, The Netherlands
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
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Inserra MC, Cannizzaro MT, Passaniti G, Celona A, Secinaro A, Curione D, D'Angelo T, Garretto O, Romeo P. MR imaging of primary benign cardiac tumors in the pediatric population. Heliyon 2023; 9:e19932. [PMID: 37809686 PMCID: PMC10559362 DOI: 10.1016/j.heliyon.2023.e19932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Primary cardiac tumors are rare in all ages, especially in children, with a reported prevalence range of 0.0017-0.28% in autopsy series. Due to their rarity, the diagnostic and therapeutic pathways reserved to them are usually described by single case reports, leading to the point where a common diagnostic protocol is imperative to obtain a differential diagnosis. The first diagnostic approach is done with transthoracic echocardiogram (TTE), due to its wide availability, low cost, absence of ionizing radiations and non-invasiveness. Several tumors are discovered incidentally and, in many cases, TTE is helpful to determine location, size and anatomical features, playing a key role in the differential diagnosis. In the last few years, cardiac magnetic resonance imaging (CMR) has had an increased role in the diagnostic pathway of pediatric cardiac masses, due to its high accuracy in characterizing mass tissue properties (especially for soft tissue), and in detecting tumor size, extent, pericardial/pleural effusion, leading to the correct diagnosis, treatment and follow-up. Therefore, nowadays, several consensus statements consider CMR as a leading imaging technique, thanks to its non-invasive tissue characterization, without the use of ionizing radiation, in an unrestricted field of view. As suggested by the most recent literature, the pediatric protocol is not so different from the adult one, adapted to the size and cardiac frequency of the patient, sometimes requiring special conditions such as free-breathing sequences and/or sedation or general anesthesia in non-cooperating patients.
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Affiliation(s)
| | | | - Giulia Passaniti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Antonio Celona
- UOC Radiodiagnostica, San Vincenzo Hospital, Provincial Health Agency of Messina, Taormina, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Davide Curione
- Advanced Cardiothoracic Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, Messina Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Orazio Garretto
- UOSD Radiologia 2 CAST, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
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Shi B, Han Z, Zhang W, Li W. The clinical value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34211. [PMID: 37443473 PMCID: PMC10344501 DOI: 10.1097/md.0000000000034211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to investigate the diagnostic value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester in China. METHODS A literature search was conducted to evaluate the clinical value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester using English and Chinese databases. Numerical values for sensitivity and specificity were obtained from false-negative, false-positive, true-negative, and true-positive rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals. Summary receiver operating characteristic (SROC) curves were applied to assess the performance of the diagnostic tests. Data were processed using Review Manager 5.3. RESULTS Four studies (151 patients with fetal cardiovascular abnormalities and 3397 undiagnosed controls) met our evaluation criteria. The sensitivity was 0.91 and 0.96, respectively, and the specificity was 1.00. The Area Under the Curve (AUC) from the SROC curves was >90%; therefore, it was classified as excellent. Furthermore, there were 6 types of fetal cardiovascular abnormalities, and the pooled screening rate of atrioventricular septal defects was the highest. CONCLUSION Our meta-analysis showed that the use of color ultrasound during the second trimester can be an excellent diagnostic tool for fetal cardiovascular abnormalities.
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Affiliation(s)
- Bingye Shi
- Color Ultrasound Room, Affiliated Hospital of Hebei University, Baoding, China
| | - Zhe Han
- Department of Cardiac Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Wei Zhang
- Medical Engineering Center, Affiliated Hospital of Hebei University, Baoding, China
| | - Wenxiu Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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DiLorenzo MP, Grosse-Wortmann L. Myocardial Fibrosis in Congenital Heart Disease and the Role of MRI. Radiol Cardiothorac Imaging 2023; 5:e220255. [PMID: 37404787 PMCID: PMC10316299 DOI: 10.1148/ryct.220255] [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: 10/27/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
Progress in the field of congenital heart surgery over the last century can only be described as revolutionary. Recent improvements in patient outcomes have been achieved through refinements in perioperative care. In the current and future eras, the preservation and restoration of myocardial health, beginning with the monitoring of tissue remodeling, will be central to improving cardiac outcomes. Visualization and quantification of fibrotic myocardial remodeling is one of the greatest assets that cardiac MRI brings to the field of cardiology, and its clinical use within the field of congenital heart disease (CHD) has been an area of particular interest in the last few decades. This review summarizes the physical underpinnings of myocardial tissue characterization in CHD, with an emphasis on T1 parametric mapping and late gadolinium enhancement. It describes methods and suggestions for obtaining images, extracting quantitative and qualitative data, and interpreting the results for children and adults with CHD. The tissue characterization observed in different lesions is used to examine the causes and pathomechanisms of fibrotic remodeling in this population. Similarly, the clinical consequences of elevated imaging biomarkers of fibrosis on patient health and outcomes are explored. Keywords: Pediatrics, MR Imaging, Cardiac, Heart, Congenital, Tissue Characterization, Congenital Heart Disease, Cardiac MRI, Parametric Mapping, Fibrosis, Late Gadolinium Enhancement © RSNA, 2023.
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Nyktari E, Drakopoulou M, Rozos P, Loukopoulou S, Vrachliotis T, Kourtidou S, Toutouzas K. Marfan Syndrome beyond Aortic Root-Phenotyping Using Cardiovascular Magnetic Resonance Imaging and Clinical Implications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050942. [PMID: 37241174 DOI: 10.3390/medicina59050942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Marfan syndrome (MFS) is an inherited autosomal-dominant connective tissue disorder with multiorgan involvement including musculoskeletal, respiratory, cardiovascular, ocular, and skin manifestations. Life expectancy in patients with MFS is primarily determined by the degree of cardiovascular involvement. Aortic disease is the major cardiovascular manifestation of MFS. However, non-aortic cardiac diseases, such as impaired myocardial function and arrhythmia, have been increasingly acknowledged as additional causes of morbidity and mortality. We present two cases demonstrating the phenotypical variation in patients with MFS and how CMR (Cardiovascular Magnetic Resonance) could serve as a "one stop shop" to retrieveS all the necessary information regarding aortic/vascular pathology as well as any potential underlying arrhythmogenic substrate or cardiomyopathic process.
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Affiliation(s)
| | - Maria Drakopoulou
- Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Sofia Loukopoulou
- Paediatric Cardiology Clinic, 'Agia Sofia' General Paediatric Hospital, 11527 Athina, Greece
| | | | | | - Konstantinos Toutouzas
- Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Real C, Párraga R, Pizarro G, García-Lunar I, González-Calvo E, Martínez-Gómez J, Sánchez-González J, Sampedro P, Sanmamed I, De Miguel M, De Cos-Gandoy A, Bodega P, Ibanez B, Santos-Beneit G, Fuster V, Fernández-Jiménez R. Magnetic resonance imaging reference values for cardiac morphology, function and tissue composition in adolescents. EClinicalMedicine 2023; 57:101885. [PMID: 37064511 PMCID: PMC10102894 DOI: 10.1016/j.eclinm.2023.101885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Background Cardiovascular magnetic resonance (CMR) is a precise tool for the assessment of cardiac anatomy, function, and tissue composition. However, studies providing CMR reference values in adolescence are scarce. We aim to provide sex-specific CMR reference values for biventricular and atrial dimensions and function and myocardial relaxation times in this population. Methods Adolescents aged 15-18 years with no known cardiovascular disease underwent a non-contrast 3-T CMR scan between March 2021 and October 2021. The imaging protocol included a cine steady-state free-precession sequence for the analysis of chamber size and function, as well as T2-GraSE and native MOLLI T1-mapping for the characterization of myocardial tissue. Findings CMR scans were performed in 123 adolescents (mean age 16 ± 0.5 years, 52% girls). Mean left and right ventricular end-diastolic indexed volumes were higher in boys than in girls (91.7 ± 11.6 vs 78.1 ± 8.3 ml/m2, p < 0.001; and 101.3 ± 14.1 vs 84.1 ± 10.5 ml/m2, p < 0.001), as was the indexed left ventricular mass (48.5 ± 9.6 vs 36.6 ± 6.0 g/m2, p < 0.001). Left ventricular ejection fraction showed no significant difference by sex (62.2 ± 4.1 vs 62.8 ± 4.2%, p = 0.412), whereas right ventricular ejection fraction trended slightly lower in boys (55.4 ± 4.7 vs. 56.8 ± 4.4%, p = 0.085). Indexed atrial size and function parameters did not differ significantly between sexes. Global myocardial native T1 relaxation time was lower in boys than in girls (1215 ± 23 vs 1252 ± 28 ms, p < 0.001), whereas global myocardial T2 relaxation time did not differ by sex (44.4 ± 2.0 vs 44.1 ± 2.4 ms, p = 0.384). Sex-stratified comprehensive percentile tables are provided for most relevant cardiac parameters. Interpretation This cross-sectional study provides overall and sex-stratified CMR reference values for cardiac dimensions and function, and myocardial tissue properties, in adolescents. This information is useful for clinical practice and may help in the differential diagnosis of cardiac diseases, such as cardiomyopathies and myocarditis, in this population. Funding Instituto de Salud Carlos III (PI19/01704).
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Affiliation(s)
- Carlos Real
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rocío Párraga
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Ruber Juan Bravo Quironsalud UEM, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
- Cardiology Department, University Hospital La Moraleja, Madrid, Spain
| | - Ernesto González-Calvo
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | - Irene Sanmamed
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Mercedes De Miguel
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Amaya De Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
- Corresponding author. Centro Nacional de Investigaciones Cardiovasculares (CNIC). Calle Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
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Umer M, Kalra DK. Cardiac MRI in Fabry disease. Front Cardiovasc Med 2023; 9:1075639. [PMID: 36818911 PMCID: PMC9931723 DOI: 10.3389/fcvm.2022.1075639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Fabry disease is a rare, progressive X-linked inherited disorder of glycosphingolipid metabolism due to a deficiency of α-galactosidase A enzyme. It leads to the accumulation of globotriaosylceramide within lysosomes of multiple organs, predominantly the vascular, renal, cardiac, and nervous systems. Fabry cardiomyopathy is characterized by increased left ventricular wall thickness/mass, functional abnormalities, valvular heart disease, arrhythmias, and heart failure. Early diagnosis and treatment are critical to avoid cardiac or renal complications that can significantly reduce life expectancy in untreated FD. This review will focus on the role of cardiovascular magnetic resonance imaging in the diagnosis, clinical decision-making, and monitoring of treatment efficacy.
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The Use of Stress Cardiovascular Imaging in Pediatric Population. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020218. [PMID: 36832347 PMCID: PMC9954485 DOI: 10.3390/children10020218] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Although not frequent in the pediatric population, ischemia could occur in children due to several congenital and acquired disease. Stress imaging is key for the non-invasive evaluation of myocardial abnormalities and perfusion defect in this clinical setting. Moreover, beyond ischemia assessment, it can provide complementary diagnostic and prognostic information in valvular heart disease and cardiomyopathies. When performed using cardiovascular magnetic resonance, it could detect, in addition, myocardial fibrosis and infarction, increasing the diagnostic yield. Several imaging modalities are currently available for the evaluation of stress myocardial perfusion. Advances in technologies have also increased the feasibility, safety and availability of these modalities in the pediatric age group. However, despite the established role of stress imaging and its increasing use in daily clinical practice, there are currently no specific guidelines, and little data are available in the literature on this topic. The aim of this review is to summarize the most recent evidence on pediatric stress imaging and its clinical application with a focus on the advantages and limitations of each imaging modality currently available.
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Beer M, Schönnagel B, Herrmann J, Klömpken S, Schaal M, Kaestner M, Apitz C, Brunner H. Non-invasive pediatric cardiac imaging-current status and further perspectives. Mol Cell Pediatr 2022; 9:21. [PMID: 36575291 PMCID: PMC9794482 DOI: 10.1186/s40348-022-00153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Non-invasive cardiac imaging has a growing role in diagnosis, differential diagnosis, therapy planning, and follow-up in children and adolescents with congenital and acquired cardiac diseases. This review is based on a systematic analysis of international peer-reviewed articles and additionally presents own clinical experiences. It provides an overview of technical advances, emerging clinical applications, and the aspect of artificial intelligence. MAIN BODY The main imaging modalities are echocardiography, CT, and MRI. For echocardiography, strain imaging allows a novel non-invasive assessment of tissue integrity, 3D imaging rapid holistic overviews of anatomy. Fast cardiac CT imaging new techniques-especially for coronary assessment as the main clinical indication-have significantly improved spatial and temporal resolution in adjunct with a major reduction in ionizing dose. For cardiac MRI, assessment of tissue integrity even without contrast agent application by mapping sequences is a major technical breakthrough. Fetal cardiac MRI is an emerging technology, which allows structural and functional assessment of fetal hearts including even 4D flow analyses. Last but not least, artificial intelligence will play an important role for improvements of data acquisition and interpretation in the near future. CONCLUSION Non-invasive cardiac imaging plays an integral part in the workup of children with heart disease. In recent years, its main application congenital heart disease has been widened for acquired cardiac diseases.
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Affiliation(s)
- Meinrad Beer
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Björn Schönnagel
- grid.13648.380000 0001 2180 3484Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- grid.13648.380000 0001 2180 3484Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Klömpken
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Matthias Schaal
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Michael Kaestner
- grid.410712.10000 0004 0473 882XDivision of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Christian Apitz
- grid.410712.10000 0004 0473 882XDivision of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Horst Brunner
- grid.410712.10000 0004 0473 882XDepartment of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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12
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Fu H, Hu Q, Guo Y. Characterizing a rare cardiac desmoid fibromatosis with multi-modality imaging techniques in a child. Eur Heart J Case Rep 2022; 7:ytac450. [PMID: 36685096 PMCID: PMC9847556 DOI: 10.1093/ehjcr/ytac450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/26/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hang Fu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan 610041, China
| | - Qianrong Hu
- Department of Pathology, West China School of Medicine, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
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Ferumoxytol-Enhanced Cardiac Magnetic Resonance Angiography and 4D Flow: Safety and Utility in Pediatric and Adult Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121810. [PMID: 36553257 PMCID: PMC9777095 DOI: 10.3390/children9121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
Cardiac magnetic resonance imaging and angiography have a crucial role in the diagnostic evaluation and follow up of pediatric and adult patients with congenital heart disease. Although much of the information required of advanced imaging studies can be provided by standard gadolinium-enhanced magnetic resonance imaging, the limitations of precise bolus timing, long scan duration, complex imaging protocols, and the need to image small structures limit more widespread use of this modality. Recent experience with off-label diagnostic use of ferumoxytol has helped to mitigate some of these barriers. Approved by the U.S. FDA for intravenous treatment of anemia, ferumoxytol is an ultrasmall superparamagnetic iron oxide nanoparticle that has a long blood pool residence time and high relaxivity. Once metabolized by macrophages, the iron core is incorporated into the reticuloendothelial system. In this work, we aim to summarize the evolution of ferumoxytol-enhanced cardiovascular magnetic resonance imaging and angiography and highlight its many applications for congenital heart disease.
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Umer M, Motwani M, Jefferies JL, Kalra DK. Cardiac involvement in Fabry Disease and the Role of Multimodality Imaging in Diagnosis and Disease Monitoring. Curr Probl Cardiol 2022; 48:101439. [DOI: 10.1016/j.cpcardiol.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
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