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Yarahmadi P, Forouzannia SM, Forouzannia SA, Malik SB, Yousefifard M, Nguyen PK. Prognostic Value of Qualitative and Quantitative Stress CMR in Patients With Known or Suspected CAD. JACC Cardiovasc Imaging 2024; 17:248-265. [PMID: 37632499 DOI: 10.1016/j.jcmg.2023.05.025] [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: 05/04/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Recent studies suggest that quantitative cardiac magnetic resonance (CMR) may have more accuracy than qualitative CMR in coronary artery disease (CAD) diagnosis. However, the prognostic value of quantitative and qualitative CMR has not been compared systematically. OBJECTIVES The objective was to conduct a systematic review and meta-analysis assessing the utility of qualitative and quantitative stress CMR in the prognosis of patients with known or suspected CAD. METHODS A comprehensive search was performed through Embase, Scopus, Web of Science, and Medline. Studies that used qualitative vasodilator CMR or quantitative CMR assessments to compare the prognosis of patients with positive and negative CMR results were extracted. A meta-analysis was then performed to assess: 1) major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction (MI), unstable angina, and coronary revascularization; and 2) cardiac hard events defined as the composite of cardiac death and nonfatal MI. RESULTS Forty-one studies with 38,030 patients were included in this systematic review. MACE occurred significantly more in patients with positive qualitative (HR: 3.86; 95% CI: 3.28-4.54) and quantitative (HR: 4.60; 95% CI: 1.60-13.21) CMR assessments. There was no significant difference between qualitative and quantitative CMR assessments in predicting MACE (P = 0.75). In studies with qualitative CMR assessment, cardiac hard events (OR: 7.21; 95% CI: 4.99-10.41), cardiac death (OR: 5.63; 95% CI: 2.46-12.92), nonfatal MI (OR: 7.46; 95% CI: 3.49-15.96), coronary revascularization (OR: 6.34; 95% CI: 3.42-1.75), and all-cause mortality (HR: 1.66; 95% CI: 1.12-2.47) were higher in patients with positive CMR. CONCLUSIONS The presence of myocardial ischemia on CMR is associated with worse clinical outcomes in patients with known or suspected CAD. Both qualitative and quantitative stress CMR assessments are helpful tools for predicting clinical outcomes.
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Affiliation(s)
- Pourya Yarahmadi
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA
| | | | - Seyed Ali Forouzannia
- Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sachin B Malik
- Department of Radiology, Division of Cardiovascular Imaging, Stanford University, Stanford, California, USA
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Patricia K Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford, California, USA.
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Kim C, Park CH, Kim DY, Cha J, Lee BY, Park CH, Kang EJ, Koo HJ, Kitagawa K, Cha MJ, Krittayaphong R, Choi SI, Viswamitra S, Ko SM, Kim SM, Hwang SH, Trang NN, Lee W, Kim YJ, Lee J, Yang DH. Semi-Quantitative Scoring of Late Gadolinium Enhancement of the Left Ventricle in Patients with Ischemic Cardiomyopathy: Improving Interobserver Reliability and Agreement Using Consensus Guidance from the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) 2020. Korean J Radiol 2022; 23:298-307. [PMID: 35213094 PMCID: PMC8876655 DOI: 10.3348/kjr.2021.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. Materials and Methods A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50–61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via web-based review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss’ kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). Results Interobserver reliability (Fleiss’ kappa) in each segment ranged 0.242–0.662 before the consensus and increased to 0.301–0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728–0.805 and 0.849–0.884; vascular territory, 0.756–0.902 and 0.852–0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. Conclusion The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.
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Affiliation(s)
- Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yeon Kim
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Jaehyung Cha
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sang Il Choi
- Department of Radiology, Seoul University Bundang Hospital, Seongnam, Korea
| | - Sanjaya Viswamitra
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Karnataka, India
| | - Sung Min Ko
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | - Nguyen Ngoc Trang
- Radiology Center, Bach Mai University Hospital, Hanoi, Vietnam , Korea
| | - Whal Lee
- Department of Radiology, Seoul University Hospital, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dettori R, Frick M, Burgmaier K, Lubberich RK, Hellmich M, Marx N, Reith S, Burgmaier M, Milzi A. Quantitative Flow Ratio Is Associated with Extent and Severity of Ischemia in Non-Culprit Lesions of Patients with Myocardial Infarction. J Clin Med 2021; 10:jcm10194535. [PMID: 34640551 PMCID: PMC8509261 DOI: 10.3390/jcm10194535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Quantitative flow ratio (QFR) is a novel method to assess the relevance of coronary stenoses based only on angiographic projections. We could previously show that QFR is able to predict the hemodynamic relevance of non-culprit lesions in patients with myocardial infarction. However, it is still unclear whether QFR is also associated with the extent and severity of ischemia, which can effectively be assessed with imaging modalities such as cardiac magnetic resonance (CMR). Thus, our aim was to evaluate the associations of QFR with both extent and severity of ischemia. We retrospectively determined QFR in 182 non-culprit coronary lesions from 145 patients with previous myocardial infarction, and compared it with parameters assessing extent and severity of myocardial ischemia in staged CMR. Whereas ischemic burden in lesions with QFR > 0.80 was low (1.3 ± 5.5% in lesions with QFR ≥ 0.90; 1.8 ± 7.3% in lesions with QFR 0.81–0.89), there was a significant increase in ischemic burden in lesions with QFR ≤ 0.80 (16.6 ± 15.6%; p < 0.001 for QFR ≥ 0.90 vs. QFR ≤ 0.80). These data could be confirmed by other parameters assessing extent of ischemia. In addition, QFR was also associated with severity of ischemia, assessed by the relative signal intensity of ischemic areas. Finally, QFR predicts a clinically relevant ischemic burden ≥ 10% with good diagnostic accuracy (AUC 0.779, 95%-CI: 0.666–0.892, p < 0.001). QFR may be a feasible tool to identify not only the presence, but also extent and severity of myocardial ischemia in non-culprit lesions of patients with myocardial infarction.
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Affiliation(s)
- Rosalia Dettori
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
| | - Michael Frick
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne, D-50937 Cologne, Germany;
| | - Richard Karl Lubberich
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany;
| | - Nikolaus Marx
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
| | - Sebastian Reith
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
| | - Mathias Burgmaier
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
| | - Andrea Milzi
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52070 Aachen, Germany; (R.D.); (M.F.); (R.K.L.); (N.M.); (S.R.); (M.B.)
- Correspondence:
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Cardiac Magnetic Resonance Feature Tracking: A Novel Method to Assess Left Ventricular Three-Dimensional Strain Mechanics After Chronic Myocardial Infarction. Acad Radiol 2021; 28:619-627. [PMID: 32340915 DOI: 10.1016/j.acra.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 01/22/2023]
Abstract
RATIONALE AND OBJECTIVES This study was designed to assess left ventricular deformation after chronic myocardial infarction (CMI) using cardiac magnetic resonance feature tracking (CMR-FT) technology, and analyze its relationship with left ventricular ejection fraction (LVEF) and infarcted transmurality. MATERIALS AND METHODS Ninety-six patients with CMI and 72 controls underwent 3.0 T CMR scanning. Strain parameters were measured by dedicated software, including global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), global peak radial strain (GPRS), segmental peak longitudinal strain (PLS), peak circumferential strain (PCS), and peak radial strain (PRS). All enhanced myocardium segments were divided into subendocardial infarction (SI) and transmural infarction (TI) group. Pearson, intraclass correlation coefficient and receiver operating characteristic analysis were performed to compare the parameters' mean values between SI and TI groups. RESULTS GPLS, GPRS, and GPCS in CMI group were significantly decreased comparing with control group. PRS and PCS in TI group were significantly lower than those in SI group, whereas no statistical difference was observed in PLS. In Pearson correlation analysis, LVEF was strongly correlated with GPLS, GPRS, and GPCS in CMI patients. Additionally, excellent reproducibility of all strain parameters was observed. In receiver operating characteristic analysis, segmental PRS and PCS might differentiate SI from TI with higher diagnostic efficiency (p < 0.05), while PLS was less valuable (p > 0.05). CONCLUSION CMR-FT could noninvasively and quantitatively assess global and regional myocardial strain in CMI patients with excellent reproducibility and strong correlation with LVEF. Additionally, segmental myocardial strain parameters indicate potential clinical value in differentiating myocardial infarction subtype.
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Ghannam M, Siontis KC, Kim HM, Cochet H, Jais P, Eng MJ, Attili A, Sharaf-Dabbagh G, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Factors predictive for delayed enhancement in cardiac resonance imaging in patients undergoing catheter ablation of premature ventricular complexes. Heart Rhythm O2 2020; 2:64-72. [PMID: 34113906 PMCID: PMC8183950 DOI: 10.1016/j.hroo.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Patients undergoing ablation of premature ventricular complexes (PVCs) can have cardiac scar. Risk factors for the presence of scar are not well defined. Objectives To determine the prevalence of scarring detected by delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in patients undergoing ablation of PVCs, to create a risk score predictive of scar, and to explore correlations between the scoring system and long-term outcomes. Methods DE-CMR imaging was performed in consecutive patients with frequent PVCs referred for ablation. The full sample was used to develop a prediction model for cardiac scar based on demographic and clinical characteristics, and internal validation of the prediction model was done using bootstrap samples. Results The study consisted of 333 patients (52% male, aged 53.2 ± 14.5 years, preablation ejection fraction 50.9% ± 12.2%, PVC burden 20.7 ± 13.14), of whom 112 (34%) had DE-CMR scarring. Multiple logistic regression analysis showed age (odds ratio [OR] 1.02 [1.01–1.04]/year, P = .019) and preablation ejection fraction (OR 0.92 [0.89–0.94]/%, P < .001) to be predictive of scar. A weighted risk score incorporating age and ejection fraction was used to stratify patients into low-, medium-, and high-risk groups. Scar prevalence was around 86% in the high-risk group and 12% in the low-risk group; high-risk patients had worse survival free of arrhythmia. Conclusions Cardiac scar was present in one-third of patients referred for PVC ablation. A weighted risk score based simply on patient age and preprocedural ejection fraction can help discriminate between patients at high and low risk for the presence of cardiac scar and worse arrhythmia outcomes.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | | | - Hyungjin Myra Kim
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Hubert Cochet
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Mehdi Juhoor Eng
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Anil Attili
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ghaith Sharaf-Dabbagh
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
- Address reprint requests and correspondence: Dr Frank Bogun, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5853.
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Nishiwaki A, Kobayashi H, Ikumi N, Kobayashi Y, Yokoe I, Sugiyama K, Matsukawa Y, Takei M, Kitamura N. Salivary Gland Focus Score Is Associated With Myocardial Fibrosis in Primary Sjögren Syndrome Assessed by a Cardiac Magnetic Resonance Approach. J Rheumatol 2020; 48:859-866. [DOI: 10.3899/jrheum.200352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
Objective.The risk of clinically manifested major cardiovascular (CV) events in primary Sjögren syndrome (pSS) remains unclear. This study aimed to assess myocardial fibrosis in pSS and investigate the associated disease characteristics by cardiac magnetic resonance imaging (cMRI).Methods.We performed a cross-sectional study of patients with pSS without cardiac symptoms. Labial gland biopsy was documented in 44 patients (85%). Patients without CV risk factors underwent contrast-enhanced cMRI. Late gadolinium enhancement (LGE) was used to assess myocardial fibrosis. Myocardial edema was assessed using T2-weighted imaging (T2WI). We compared the left ventricular (LV) geometry and function between the groups with and without LGE. Further, we explored the associations of cMRI abnormalities with pSS characteristics.Results.Fifty-two women with pSS (median age 55, IQR 47.0–65.7 yrs) were enrolled in the study. LGE was observed in 10 patients (19%), two of whom showed high intensity on T2WI. High intensity on T2WI was observed in 3 patients (5.8%). LV mass index and LV mass/end-diastolic volume tended to be higher in the LGE-positive group than in the LGE-negative group (P = 0.078 and 0.093, respectively). Salivary gland focus score (FS) ≥ 3 was independently associated with LGE-positive in the multivariable analysis (OR 11.21, 95% CI 1.18–106.80).Conclusion.Subclinical myocardial fibrosis, as detected by cMRI, was frequent in patients with pSS without cardiac symptoms. Abnormal cMRI findings were associated with salivary gland FS ≥ 3.
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Marcos-Garces V, Gavara J, Monmeneu JV, Lopez-Lereu MP, Perez N, Rios-Navarro C, De Dios E, Moratal D, Miñana G, Nuñez J, Chorro FJ, Bodi V. A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome. J Clin Med 2020; 9:E1957. [PMID: 32585832 PMCID: PMC7356983 DOI: 10.3390/jcm9061957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023] Open
Abstract
Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.
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Affiliation(s)
- Victor Marcos-Garces
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
| | - Jose Gavara
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), 46015 Valencia, Spain; (J.VM.); (M.PL.-L.)
| | - Maria P Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, Exploraciones Radiologicas Especiales (ERESA), 46015 Valencia, Spain; (J.VM.); (M.PL.-L.)
| | - Nerea Perez
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
| | - Cesar Rios-Navarro
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
| | - Elena De Dios
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| | - Gema Miñana
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain; (V.M.-G.); (G.M.); (J.N.); (F.JC.)
- Instituto de Investigacion Sanitaria INCLIVA, 46010 Valencia, Spain; (J.G.); (N.P.); (C.R.-N.)
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain;
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
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Beitzke D, Rasul S, Lassen ML, Pichler V, Senn D, Stelzmüller ME, Nolz R, Loewe C, Hacker M. Assessment of Myocardial Viability in Ischemic Heart Disease by PET/MRI: Comparison of Left Ventricular Perfusion, Hibernation, and Scar Burden. Acad Radiol 2020; 27:188-197. [PMID: 31053482 DOI: 10.1016/j.acra.2019.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/08/2019] [Accepted: 03/24/2019] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES Hybrid positron emission tomography-magnetic resonance (PET-MR) is a novel imaging technology that enables a comprehensive assessment of myocardial viability. The aim of this study was to intra-individually compare simultaneously acquired viability parameters from MRI and PET to determine complementary and redundant information. MATERIALS AND METHODS Thirty-nine patients with ischemic heart disease (IHD) underwent cardiac PET-MR for myocardial viability assessment. Cardiac magnetic resonance (CMR), including late gadolinium enhancement (LGE), and PET, including a dynamic dual-tracer acquisition of [13N]ammonia ([13N]NH3)/[18F]fluorodeoxyglucose ([18F]FDG), were performed simultaneously. Allocation, extent, and transmural degree of left ventricular (LV) scars were measured from LGE. Perfusion, viability, and hibernation were assessed by PET. RESULTS A comparison of scar location revealed six more areas of infarction on MR than on PET. Mean LV scarring by CMR was 14% (range, 2% to 42%) and 14% (range, 1% to 46%) by PET (CMR vs. PET: p = 0.9). An intra-individual comparison of scarring showed a good inter-method correlation (r = 0.7), which was also evident in the subgroup with low ejection fraction (EF) (r = 0.6). Hibernation and transmural degree of scars showed a moderate to weak correlation (r = 0.4), which was even worse in the low EF group (r = 0.1). CONCLUSIONS In patients with IHD, there was a good correlation between PET and CMR for the LV scar extent using hybrid cardiac PET-MR. The degree of transmural scarring by CMR showed no correlation to PET hibernation. Therefore, cardiac PET-MR might be a suitable tool for a comprehensive assessment of myocardial viability if used to predict response to cardiac reperfusion strategies.
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Affiliation(s)
- Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Lyngby Lassen
- QIMP Group, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Verena Pichler
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Daniela Senn
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | | | - Richard Nolz
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria.
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Buckert D, Witzel S, Steinacker JM, Rottbauer W, Bernhardt P. Comparing Cardiac Magnetic Resonance-Guided Versus Angiography-Guided Treatment of Patients With Stable Coronary Artery Disease: Results From a Prospective Randomized Controlled Trial. JACC Cardiovasc Imaging 2019; 11:987-996. [PMID: 29976305 DOI: 10.1016/j.jcmg.2018.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The purpose of this study was the prospective and randomized evaluation of cardiovascular endpoints and quality of life in patients with stable coronary artery disease comparing a cardiac magnetic resonance (CMR)-based management strategy with a coronary angiography-based approach. BACKGROUND Evidence from trials prospectively evaluating the role of CMR in clinical pathways and decision processes is limited. METHODS Patients with symptomatic CAD were randomized to diagnostic coronary angiography (group 1) or adenosine stress CMR (group 2). The primary endpoint was the composite of cardiac death and nonfatal myocardial infarction. Quality of life was assessed using the Seattle Angina Questionnaire at baseline and during follow-up. RESULTS Two hundred patients were enrolled. In group 1, 45 revascularizations (45.9%) were performed. In group 2, 27 patients (28.1%) were referred to revascularization because of ischemia on CMR. At 12-month follow-up, 7 primary events occurred: 3 in group 1 (event rate 3.1%) and 4 in group 2 (event rate 4.2%), with no statistically significant difference (p = 0.72). Within the next 2 years, 6 additional events could be observed, giving 4 events in group 1 and 9 events in group 2 (event rate 4.1% vs. 9.4%; p = 0.25). Group 2 showed significant quality-of-life improvement after 1 year in comparison to group 1. CONCLUSIONS A CMR-based management strategy for patients with stable coronary artery disease was safe, reduced revascularization procedures, and resulted in better quality of life at 12-month follow-up, though noninferiority could not be proved. Optimal timing for reassessment remains to be investigated. (Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary Intervention [MAGnet]; NCT02580851).
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Affiliation(s)
- Dominik Buckert
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.
| | - Simon Witzel
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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10
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Sugiyama K, Kobayashi H, Kobayashi Y, Yokoe I, Takei M, Kitamura N. Association of cardiac magnetic resonance-detected myocardial abnormalities with disease characteristics and brain natriuretic peptide levels in systemic sclerosis without cardiac symptoms. Int J Rheum Dis 2019; 22:1016-1022. [PMID: 30924296 DOI: 10.1111/1756-185x.13540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to evaluate the association between myocardial abnormalities and left ventricular (LV) geometry as assessed using cardiac magnetic resonance imaging (CMRI) in systemic sclerosis (SSc) patients without cardiac symptoms. METHODS SSc patients without cardiac symptoms or cardiovascular risk factors underwent contrast CMRI. CMRI were assessed for structural and functional LV parameters and myocardial fibrosis based on myocardial late gadolinium enhancement (LGE). The correlation between brain natriuretic peptide (BNP) levels and LGE status was evaluated. RESULTS Among 49 patients, 27 (55%) showed LGE positivity. The most common identified LGE pattern was a linear pattern. LGE was not consistent with coronary artery distribution. There was no difference in ejection fraction between those with and without LGE. LV morphological changes were observed in 29% of SSc patients. An abnormal LV structure was detected in 44% and 14% of patients in the LGE+ and LGE- groups, respectively. The BNP levels were higher by 57% in the LGE+ group than in the LGE-group. Receiver operating characteristic analysis showed that BNP levels reliably detected myocardial abnormalities (area under the curve, 0.72; 95% confidence interval 0.58-0.88). CONCLUSIONS Myocardial abnormalities were common in SSc patients without cardiac symptoms. We suggest that LV morphological changes may have resulted from myocardial abnormalities. BNP may be useful as a screening tool for the detection of myocardial abnormalities in SSc patients.
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Affiliation(s)
- Kaita Sugiyama
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hitomi Kobayashi
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuyuki Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Isamu Yokoe
- Division of Internal Medicine, Kyoundo Hospital, Tokyo, Japan
| | - Masami Takei
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noboru Kitamura
- Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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