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Romano S, Farzaneh-Far A. Advancing CMR Feature-Tracking Strain: Toward Standardization and Clinical Adoption. JACC Cardiovasc Imaging 2024; 17:380-381. [PMID: 37589607 DOI: 10.1016/j.jcmg.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Simone Romano
- Department of Internal Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy.
| | - Afshin Farzaneh-Far
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina, USA
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Islam S, Heydari B, Ge Y, Antiochos P, Steel KE, Bingham SE, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner J, Shenoy C, Leung S, Gonzalez JA, Raman SV, Ferrari VA, Schulz-Menger J, Simonetti OP, Stuber M, Kwong RY. PROGNOSTIC IMPLICATIONS OF VARIOUS MYOCARDIAL PATTERNS OF ISCHEMIA AND INFARCTION FROM 4,537 CONTRAST-ENHANCED STRESS CMR STUDIES IN PATIENTS WITH STABLE CHEST PAIN SYNDROMES: ANALYSIS OF THE MULTICENTER SPINS REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01825-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Qazi S, Ge Y, Patel K, Antiochos P, Islam S, Longmore RB, Heydari B, Bingham SE, Mikolich JR, Arai AE, Bandettini WP, Shanbhag SM, Patel AR, Farzaneh-Far A, Heitner J, Shenoy C, Leung S, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. STRESS CARDIOVASCULAR MAGNETIC RESONANCE IMAGING IS AN EFFECTIVE PROGNOSTIC TOOL IN PATIENTS WITH SUSPECTED ISCHEMIC CARDIOMYOPATHY REGARDLESS OF AGE, SEX, RACE, OBESITY, HYPERTENSION, DIABETES, AND LV DILATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Heydari B, Ge Y, Antiochos P, Islam S, Steel K, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Raman SV, Ferrari VA, Shah DJ, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry. JACC Cardiovasc Imaging 2023:S1936-878X(22)00752-5. [PMID: 36764892 DOI: 10.1016/j.jcmg.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations. OBJECTIVES In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD. METHODS Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting. RESULTS SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (ICA; 3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality. CONCLUSIONS Stress CMR demonstrated excellent prognostic performance with lower rates of ICA referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891).
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Yin Ge
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Panagiotis Antiochos
- Cardiology Division, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sabeeh Islam
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Steel
- St Joseph Medical Center, Bellingham, Washington, USA
| | | | - Shuaib Abdullah
- VA North Texas Medical Center and University of Texas-Southwestern Medical School, Dallas, Texas, USA
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA
| | - Andrew E Arai
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - W Patricia Bandettini
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Amit R Patel
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sujata M Shanbhag
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - John F Heitner
- Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA
| | - Subha V Raman
- Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, Indiana, USA
| | - Victor A Ferrari
- Hospital of the University of Pennsylvania and Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA
| | - Dipan J Shah
- Weill Cornell Medical College, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeanette Schulz-Menger
- Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, Germany; Helios Clinics, Cardiology, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Kochav JD, Kim J, Judd R, Tak KA, Janjua E, Maciejewski AJ, Kim HW, Klem I, Heitner J, Shah D, Zoghbi WA, Shenoy C, Farzaneh-Far A, Polsani V, Villar-Calle P, Parker M, Judd KM, Khalique OK, Leon MB, Devereux RB, Levine RA, Kim RJ, Weinsaft JW. Myocardial Contractile Mechanics in Ischemic Mitral Regurgitation: Multicenter Data Using Stress Perfusion Cardiovascular Magnetic Resonance. JACC Cardiovasc Imaging 2022; 15:1212-1226. [PMID: 35798397 PMCID: PMC9273017 DOI: 10.1016/j.jcmg.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Left ventricular (LV) ischemia has been variably associated with functional mitral regurgitation (FMR). Determinants of FMR in patients with ischemia are poorly understood. OBJECTIVES This study sought to test whether contractile mechanics in ischemic myocardium underlying the mitral valve have an impact on likelihood of FMR. METHODS Vasodilator stress perfusion cardiac magnetic resonance was performed in patients with coronary artery disease (CAD) at multiple centers. FMR severity was confirmed quantitatively via core lab analysis. To test relationship of contractile mechanics with ischemic FMR, regional wall motion and strain were assessed in patients with inducible ischemia and minimal (≤5% LV myocardium, nontransmural) infarction. RESULTS A total of 2,647 patients with CAD were studied; 34% had FMR (7% moderate or greater). FMR severity increased with presence (P < 0.001) and extent (P = 0.01) of subpapillary ischemia: patients with moderate or greater FMR had more subpapillary ischemia (odds ratio [OR]: 1.13 per 10% LV; 95% CI: 1.05-1.21; P = 0.001) independent of ischemia in remote regions (P = NS); moderate or greater FMR prevalence increased stepwise with extent of ischemia and infarction in subpapillary myocardium (P < 0.001); stronger associations between FMR and infarction paralleled greater wall motion scores in infarct-affected territories. Among patients with inducible ischemia and minimal infarction (n = 532), wall motion and radial strain analysis showed impaired subpapillary contractile mechanics to associate with moderate or greater FMR (P < 0.05) independent of remote regions (P = NS). Conversely, subpapillary ischemia without contractile dysfunction did not augment FMR likelihood. Mitral and interpapillary dimensions increased with subpapillary radial strain impairment; each remodeling parameter associated with impaired subpapillary strain (P < 0.05) independent of remote strain (P = NS). Subpapillary radial strain (OR: 1.13 per 5% [95% CI: 1.02-1.25]; P = 0.02) and mitral tenting area (OR: 1.05 per 10 mm2 [95% CI: 1.00-1.10]; P = 0.04) were associated with moderate or greater FMR controlling for global remodeling represented by LV end-systolic volume (P = NS): when substituting sphericity for LV volume, moderate or greater FMR remained independently associated with subpapillary radial strain impairment (OR: 1.22 per 5% [95% CI: 1.02-1.47]; P = 0.03). CONCLUSIONS Among patients with CAD and ischemia, FMR severity and adverse mitral apparatus remodeling increase in proportion to contractile dysfunction underlying the mitral valve.
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Affiliation(s)
- Jonathan D Kochav
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Katherine A Tak
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Emmad Janjua
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - John Heitner
- Division of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Dipan Shah
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chetan Shenoy
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | - Michele Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin M Judd
- Heart Imaging Technologies, Durham, North Carolina, USA
| | - Omar K Khalique
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Robert A Levine
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
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Bevilacqua M, De Togni P, Cattazzo F, Dell'Atti D, Dalbeni A, Mazzaferri F, Tacconelli E, Farzaneh-Far A, Fava C, Minuz P, Romano S. Global Longitudinal Strain to Predict Respiratory Failure and Death in Patients Admitted for COVID-19-Related Disease. Am J Cardiol 2022; 165:109-115. [PMID: 34895871 PMCID: PMC8658404 DOI: 10.1016/j.amjcard.2021.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022]
Abstract
Evidence of the involvement of the cardiovascular system in patients with COVID-19 is increasing. The evaluation of the subclinical cardiac involvement is crucial for risk stratification at admission, and left ventricular global longitudinal strain (LVGLS) may be useful for this purpose. A total of 87 consecutive patients admitted to the COVID Center were enrolled from December 2020 to April 2021. A complete echocardiography examination was performed within 72 hours from admission. The main outcome was the need for mechanical ventilation by way of orotracheal intubation (OTI) and mortality, and the secondary outcome was the worsening of the respiratory function during hospitalization, interpreted as a decrease of the ratio between the partial pressure of oxygen and the fraction of inspired oxygen (P/F) <100. Of 87 patients, 14 had severe disease leading to OTI or death, whereas 24 had a P/F <100. LVGLS was significantly impaired in patients with severe disease. After adjustment for risk factors, by considering LVGLS as continuous variable, the latter remained significantly associated with severe acute respiratory distress syndrome (P/F <100) (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.18 to 1.88, p = 0.001) and OTI/death (HR 1.63, 95% CI 1.13 to 2.38, p = 0.012). When using an LVGLS cutoff of −16.1%, LVGLS ≥ −16.1% was independently associated with a higher risk of severe acute respiratory distress syndrome (HR 4.0, 95% CI 1.4 to 11.1, p= 0.008) and OTI/death (HR 7.3, 95% CI 1.6 to 34.1, p = 0.024). LVGLS can detect high-risk patients at the admission, which can help to guide in starting early treatment of the admitted patients.
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Affiliation(s)
- Michele Bevilacqua
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Paolo De Togni
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Filippo Cattazzo
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Davide Dell'Atti
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Andrea Dalbeni
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Fulvia Mazzaferri
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Cristiano Fava
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Pietro Minuz
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy
| | - Simone Romano
- Department of Internal Medicine, Internal Medicine Section C, University Hospital of Verona, Verona, Italy.
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Hooks M, Okasha O, Velangi PS, Nijjar PS, Farzaneh-Far A, Shenoy C. Left ventricular thrombus on cardiovascular magnetic resonance imaging in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 22:1425-1433. [PMID: 33026088 PMCID: PMC11004928 DOI: 10.1093/ehjci/jeaa244] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Case reports have described left ventricular (LV) thrombus in patients with non-ischaemic cardiomyopathy (NICM). We aimed to systematically study the characteristics, predictors, and outcomes of LV thrombus in NICM. METHODS AND RESULTS Forty-eight patients with LV thrombus detected on late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE CMR) in NICM were compared with 124 patients with LV thrombus in ischaemic cardiomyopathy (ICM), and 144 matched patients with no LV thrombus in NICM. The performance of echocardiography for the detection of LV thrombus was compared between NICM and ICM. The 12-month incidence of embolism was compared between the three study groups. Independent predictors of LV thrombus in NICM were LV ejection fraction (LVEF) [hazard ratio (HR) 1.36 per 5% decrease; P = 0.002], LGE presence (HR 6.30; P < 0.001), and LGE extent (HR 1.33 per 5% increase; P = 0.001). Compared with patients with LV thrombus in ICM, those with LV thrombus in NICM had a 10-fold higher prevalence of thrombi in other cardiac chambers. The performance of echocardiography for the detection of LV thrombus was not different between NICM and ICM. The 12-month incidence of embolism associated with LV thrombus was not different between NICM and ICM (8.7% vs. 6.8%; P = 0.69) but both were higher compared with no LV thrombus in NICM (1.5%). CONCLUSION Independent predictors of LV thrombus in NICM were lower LVEF, LGE presence, and greater LGE extent. The 12-month incidence of embolism associated with LV thrombus in NICM was not different compared with LV thrombus in ICM.
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Affiliation(s)
- Matthew Hooks
- Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Pratik S Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
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Antiochos P, Ge Y, Heydari B, Steel K, Bingham S, Abdullah SM, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Prognostic Value of Stress Cardiac Magnetic Resonance in Patients With Known Coronary Artery Disease. JACC Cardiovasc Imaging 2021; 15:60-71. [PMID: 34419400 DOI: 10.1016/j.jcmg.2021.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study sought to determine whether stress cardiac magnetic resonance (CMR) provides clinically relevant risk reclassification in patients with known coronary artery disease (CAD) in a multicenter setting in the United States. BACKGROUND Despite improvements in medical therapy and coronary revascularization, patients with previous CAD account for a disproportionately large portion of CV events and pose a challenge for noninvasive stress testing. METHODS From the Stress Perfusion Imaging in the United States (SPINS) registry, we identified consecutive patients with documented CAD who were referred to stress CMR for evaluation of myocardial ischemia. The primary outcome was nonfatal myocardial infarction (MI) or cardiovascular (CV) death. Major adverse CV events (MACE) included MI/CV death, hospitalization for heart failure or unstable angina, and late unplanned coronary artery bypass graft. The prognostic association and net reclassification improvement by ischemia for MI/CV death were determined. RESULTS Out of 755 patients (age 64 ± 11 years, 64% male), we observed 97 MI/CV deaths and 210 MACE over a median follow-up of 5.3 years. Presence of ischemia demonstrated a significant association with MI/CV death (HR: 2.30; 95% CI: 1.54-3.44; P < 0.001) and MACE (HR: 2.24 ([95% CI: 1.69-2.95; P < 0.001). In a multivariate model adjusted for CV risk factors, ischemia maintained strong association with MI/CV death (HR: 1.84; 95% CI: 1.17-2.88; P = 0.008) and MACE (HR: 1.77; 95% CI: 1.31-2.40; P < 0.001) and reclassified 95% of patients at intermediate pretest risk (62% to low risk, 33% to high risk) with corresponding changes in the observed event rates of 1.4% and 5.3% per year for low and high post-test risk, respectively. CONCLUSIONS In a multicenter cohort of patients with known CAD, CMR-assessed ischemia was strongly associated with MI/CV death and reclassified patient risk beyond CV risk factors, especially in those considered to be at intermediate risk. Absence of ischemia was associated with a <2% annual rate of MI/CV death. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891).
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Affiliation(s)
- Panagiotis Antiochos
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bobak Heydari
- Stephenson Cardiac Imaging Center, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Shuaib M Abdullah
- Veteran Affairs, North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany; Helios Clinics, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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9
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Ge Y, Steel K, Antiochos P, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Shanbhag SM, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Nawaz H, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Stress CMR in patients with obesity: insights from the Stress CMR Perfusion Imaging in the United States (SPINS) registry. Eur Heart J Cardiovasc Imaging 2021; 22:518-527. [PMID: 33166994 DOI: 10.1093/ehjci/jeaa281] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Non-invasive assessment and risk stratification of coronary artery disease in patients with large body habitus is challenging. We aim to examine whether body mass index (BMI) modifies the prognostic value and diagnostic utility of stress cardiac magnetic resonance imaging (CMR) in a multicentre registry. METHODS AND RESULTS The SPINS Registry enrolled consecutive intermediate-risk patients who presented with a clinical indication for stress CMR in the USA between 2008 and 2013. Baseline demographic data including BMI, CMR indices, and ratings of study quality were collected. Primary outcome was defined by a composite of cardiovascular death and non-fatal myocardial infarction. Of the 2345 patients with available BMI included in the SPINS cohort, 1177 (50%) met criteria for obesity (BMI ≥ 30) with 531 (23%) at or above Class 2 obesity (BMI ≥ 35). In all BMI categories, >95% of studies were of diagnostic quality for cine, perfusion, and late gadolinium enhancement (LGE) sequences. At a median follow-up of 5.4 years, those without ischaemia and LGE experienced a low annual rate of hard events (<1%), across all BMI strata. In patients with obesity, both ischaemia [hazard ratio (HR): 2.14; 95% confidence interval (CI): 1.30-3.50; P = 0.003] and LGE (HR: 3.09; 95% CI: 1.83-5.22; P < 0.001) maintained strong adjusted association with the primary outcome in a multivariable Cox regression model. Downstream referral rates to coronary angiography, revascularization, and cost of care spent on ischaemia testing did not significantly differ within the BMI categories. CONCLUSION In this large multicentre registry, elevated BMI did not negatively impact the diagnostic quality and the effectiveness of risk stratification of patients referred for stress CMR.
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Affiliation(s)
- Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, TX 78234, USA
| | - Panagiotis Antiochos
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | - Shuaib Abdullah
- Veteran Administration North Texas Healthcare System, UT Southwestern Medical Center, Dallas, TX 75216, USA
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, PA 16148, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health (NHLBI/NIH), Bethesda, MD 20814, USA
| | - W Patricia Bandettini
- National Heart, Lung and Blood Institute, National Institutes of Health (NHLBI/NIH), Bethesda, MD 20814, USA
| | - Sujata M Shanbhag
- National Heart, Lung and Blood Institute, National Institutes of Health (NHLBI/NIH), Bethesda, MD 20814, USA
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY 40536, USA
| | - Jorge A Gonzalez
- Division of Cardiology & Radiology, Scripps Clinic, La Jolla, CA 92037, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Haseeb Nawaz
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin 13125, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital (CHUV), University of Lausanne (UNIL), Lausanne 1011, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
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10
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Farzaneh-Far A, Wong J. Stressed enough? Hyperaemic thresholds during quantitative cardiovascular magnetic resonance perfusion mapping. Eur Heart J Cardiovasc Imaging 2021; 22:282-284. [PMID: 33338199 DOI: 10.1093/ehjci/jeaa268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL 60612, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Joyce Wong
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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11
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Romano S, Dell'atti D, Judd RM, Kim RJ, Weinsaft JW, Kim J, Heitner JF, Hahn RT, Farzaneh-Far A. Prognostic Value of Feature-Tracking Right Ventricular Longitudinal Strain in Severe Functional Tricuspid Regurgitation: A Multicenter Study. JACC Cardiovasc Imaging 2021; 14:1561-1568. [PMID: 33865769 PMCID: PMC8349765 DOI: 10.1016/j.jcmg.2021.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to evaluate the prognostic value of cardiac magnetic resonance (CMR) feature-tracking-derived right ventricular (RV) free wall longitudinal strain (RVFWLS) in a large multicenter population of patients with severe functional tricuspid regurgitation. BACKGROUND Tricuspid regurgitation imposes a volume overload on the RV that can lead to progressive RV dilation and dysfunction. Overt RV dysfunction is associated with poor prognosis and increased operative risk. Abnormalities of myocardial strain may provide the earliest evidence of ventricular dysfunction. CMR feature-tracking techniques now allow assessment of strain from routine cine images, without specialized pulse sequences. Whether abnormalities of RV strain measured using CMR feature tracking have prognostic value in patients with tricuspid regurgitation is unknown. METHODS Consecutive patients with severe functional tricuspid regurgitation undergoing CMR at 4 U.S. medical centers were included in this study. Feature-tracking RVFWLS was calculated from 4-chamber cine views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between RVFWLS and death. The incremental prognostic value of RVFWLS was assessed in nested models. RESULTS Of the 544 patients in this study, 128 died during a median follow-up of 6 years. By Kaplan-Meier analysis, patients with RVFWLS ≥median (-16%) had significantly reduced event-free survival compared with those with RVFWLS CONCLUSIONS CMR feature-tracking-derived RVFWLS is an independent predictor of mortality in patients with severe functional tricuspid regurgitation, incremental to common clinical and imaging risk factors.
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Affiliation(s)
- Simone Romano
- Department of Internal Medicine, University of Verona, Verona, Italy
| | - Davide Dell'atti
- Department of Internal Medicine, University of Verona, Verona, Italy
| | - Robert M Judd
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Raymond J Kim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jonathan W Weinsaft
- Division of Cardiology, Weill Cornell Medical College, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medical College, New York, New York, USA
| | - John F Heitner
- Department of Cardiology, New York Methodist Hospital, New York, New York, USA
| | - Rebecca T Hahn
- Structural Heart and Valve Center, Columbia University, New York, New York, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA.
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12
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Kochav JD, Kim J, Judd R, Kim HW, Klem I, Heitner J, Shah D, Shenoy C, Farzaneh-Far A, Polsani V, Kalil R, Villar-Calle P, Nambiar L, Sultana R, Parker M, Cargile P, Khalique OK, Leon MB, Karmpaliotis D, Ratcliffe M, Levine R, Zoghbi WA, Devereux RB, Moskowitz CS, Kim R, Weinsaft JW. Ischemia-Mediated Dysfunction in Subpapillary Myocardium as a Marker of Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2021; 14:826-839. [PMID: 33744130 PMCID: PMC8086776 DOI: 10.1016/j.jcmg.2021.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The goal of this study was to test whether ischemia-mediated contractile dysfunction underlying the mitral valve affects functional mitral regurgitation (FMR) and the prognostic impact of FMR. BACKGROUND FMR results from left ventricular (LV) remodeling, which can stem from myocardial tissue alterations. Stress cardiac magnetic resonance can assess ischemia and infarction in the left ventricle and papillary muscles; relative impact on FMR is uncertain. METHODS Vasodilator stress cardiac magnetic resonance was performed in patients with known or suspected coronary artery disease at 7 sites. Images were centrally analyzed for MR etiology/severity, mitral apparatus remodeling, and papillary ischemia. RESULTS A total of 8,631 patients (mean age 60.0 ± 14.1 years; 55% male) were studied. FMR was present in 27%, among whom 16% (n = 372) had advanced (moderate or severe) FMR. Patients with ischemia localized to subpapillary regions were more likely to have advanced FMR (p = 0.003); those with ischemia localized to other areas were not (p = 0.17). Ischemic/dysfunctional subpapillary myocardium (odds ratio: 1.24/10% subpapillary myocardium; confidence interval: 1.17 to 1.31; p < 0.001) was associated with advanced FMR controlling for infarction. Among a subgroup with (n = 372) and without (n = 744) advanced FMR matched (1:2) on infarct size/distribution, patients with advanced FMR had increased adverse mitral apparatus remodeling, paralleled by greater ischemic/dysfunctional subpapillary myocardium (p < 0.001). Although posteromedial papillary ischemia was more common with advanced FMR (p = 0.006), subpapillary ischemia with dysfunction remained associated (p < 0.001), adjusting for posteromedial papillary ischemia (p = 0.074). During follow-up (median 5.1 years), 1,473 deaths occurred in the overall cohort; advanced FMR conferred increased mortality risk (hazard ratio: 1.52; 95% confidence interval: 1.25 to 1.86; p < 0.001) controlling for left ventricular ejection fraction, infarction, and ischemia. CONCLUSIONS Ischemic and dysfunctional subpapillary myocardium provides a substrate for FMR, which predicts mortality independent of key mechanistic substrates.
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Affiliation(s)
- Jonathan D Kochav
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | - John Heitner
- Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Dipan Shah
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chetan Shenoy
- Division of Cardiology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Ramsey Kalil
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Lakshmi Nambiar
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Razia Sultana
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Michele Parker
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Omar K Khalique
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dimitrios Karmpaliotis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Ratcliffe
- Division of Cardiac Surgery, University of California, San Francisco, California, USA
| | - Robert Levine
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William A Zoghbi
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Chaya S Moskowitz
- Department of Epidemiology and Biostatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raymond Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina, USA
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13
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Zhong Z, Sun K, Dan G, Luo Q, Farzaneh-Far A, Karaman MM, Zhou XJ. Visualization of Human Aortic Valve Dynamics Using Magnetic Resonance Imaging with Sub-Millisecond Temporal Resolution. J Magn Reson Imaging 2021; 54:1246-1254. [PMID: 33761166 DOI: 10.1002/jmri.27603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Visualization of aortic valve dynamics is important in diagnosing valvular diseases but is challenging to perform with magnetic resonance imaging (MRI) due to the limited temporal resolution. PURPOSE To develop an MRI technique with sub-millisecond temporal resolution and demonstrate its application in visualizing rapid aortic valve opening and closing in human subjects in comparison with echocardiography and conventional MRI techniques. STUDY TYPE Prospective. POPULATION Twelve healthy subjects. FIELD STRENGTH/SEQUENCE 3 T; gradient-echo-train-based sub-millisecond periodic event encoded imaging (get-SPEEDI) and balanced steady-state free precession (bSSFP). ASSESSMENT Images were acquired using get-SPEEDI with a temporal resolution of 0.6 msec. get-SPEEDI was triggered by an electrocardiogram so that each echo in the gradient echo train corresponded to an image at a specific time point, providing a time-resolved characterization of aortic valve dynamics. For comparison, bSSFP was also employed with 12 msec and 24 msec temporal resolutions, respectively. The durations of the aortic valve rapid opening (Tro ), rapid closing (Trc ), and the maximal aortic valve area (AVA) normalized to height were measured with all three temporal resolutions. M-mode echocardiograms with a temporal resolution of 0.8 msec were obtained for further comparison. STATISTICAL TEST Parameters were compared between the three sequences, together with the echocardiography results, with a Mann-Whitney U test. RESULTS Significantly shorter Tro (mean ± SD: 27.5 ± 6.7 msec) and Trc (43.8 ± 11.6 msec) and larger maximal AVA/height (2.01 ± 0.29 cm2 /m) were measured with get-SPEEDI compared to either bSSFP sequence (Tro of 56.3 ± 18.8 and 63.8 ± 20.2 msec; Trc of 68.2 ± 16.6 and 72.8 ± 18.2 msec; maximal AVA/height of 1.63 ± 0.28 and 1.65 ± 0.32 cm2 /m for 12 msec and 24 msec temporal resolutions, respectively, P < 0.05). In addition, the get-SPEEDI results were more consistent with those measured using echocardiography, especially for Tro (29.0 ± 4.1 msec, P = 0.79) and Trc (41.6 ± 4.3 msec, P = 0.16). DATA CONCLUSION: get-SPEEDI allows for visualization of human aortic valve dynamics and provided values closer to those measured using echocardiography than the bSSFP sequences. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Zheng Zhong
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kaibao Sun
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Guangyu Dan
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Qingfei Luo
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Afshin Farzaneh-Far
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Meryem Muge Karaman
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xiaohong Joe Zhou
- Center for Magnetic Resonance Research, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
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14
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Antiochos P, Ge Y, Steel K, Chen YY, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Murthy VL, Kwong RY. Evaluation of Stress Cardiac Magnetic Resonance Imaging in Risk Reclassification of Patients With Suspected Coronary Artery Disease. JAMA Cardiol 2020; 5:1401-1409. [PMID: 32745166 DOI: 10.1001/jamacardio.2020.2834] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance The role of stress cardiac magnetic resonance (CMR) imaging in clinical decision-making by reclassification of risk across American College of Cardiology/American Heart Association guideline-recommended categories has not been established. Objective To examine the utility of stress CMR imaging for risk reclassification in patients without a history of coronary artery disease (CAD) who presented with suspected myocardial ischemia. Design, Setting, and Participants A retrospective, multicenter cohort study with median follow-up of 5.4 years (interquartile range, 4.6-6.9) was conducted at 13 centers across 11 US states. Participants included 1698 consecutive patients aged 35 to 85 years with 2 or more coronary risk factors but no history of CAD who presented with suspected myocardial ischemia to undergo stress CMR imaging. The study was conducted from February 18, 2019, to March 1, 2020. Main Outcomes and Measures Cardiovascular (CV) death and nonfatal myocardial infarction (MI). Major adverse CV events (MACE) including CV death, nonfatal MI, hospitalization for heart failure or unstable angina, and late, unplanned coronary artery bypass graft surgery. Results Of the 1698 patients, 873 were men (51.4%); mean (SD) age was 62 (11) years, accounting for 67 CV death/nonfatal MIs and 190 MACE. Clinical models of pretest risk were constructed and patients were categorized using guideline-based categories of low (<1% per year), intermediate (1%-3% per year), and high (>3% year) risk. Stress CMR imaging provided risk reclassification across all baseline models. For CV death/nonfatal MI, adding stress CMR-assessed left ventricular ejection fraction, presence of ischemia, and late gadolinium enhancement to a model incorporating the validated CAD Consortium score, hypertension, smoking, and diabetes provided significant net reclassification improvement of 0.266 (95% CI, 0.091-0.441) and C statistic improvement of 0.086 (95% CI, 0.022-0.149). Stress CMR imaging reclassified 60.3% of patients in the intermediate pretest risk category (52.4% reclassified as low risk and 7.9% as high risk) with corresponding changes in the observed event rates of 0.6% per year for low posttest risk and 4.9% per year for high posttest risk. For MACE, stress CMR imaging further provided significant net reclassification improvement (0.361; 95% CI, 0.255-0.468) and C statistic improvement (0.092; 95% CI, 0.054-0.131), and reclassified 59.9% of patients in the intermediate pretest risk group (48.7% reclassified as low risk and 11.2% as high risk). Conclusions and Relevance In this multicenter cohort of patients with no history of CAD presenting with suspected myocardial ischemia, stress CMR imaging reclassified patient risk across guideline-based risk categories, beyond clinical risk factors. The findings of this study support the value of stress CMR imaging for clinical decision-making, especially in patients at intermediate risk for CV death and nonfatal MI.
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Affiliation(s)
- Panagiotis Antiochos
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Cardiology Division, University Hospital of Lausanne, Lausanne, Switzerland
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, Texas
| | - Yi-Yun Chen
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Shuaib Abdullah
- Veteran Administration North Texas Healthcare System, UT Southwestern Medical Center, Dallas
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit R Patel
- Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington
| | - Jorge A Gonzalez
- Division of Cardiology & Radiology, Scripps Clinic, La Jolla, California
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Victor A Ferrari
- Perelman School of Medicine, Division of Cardiovascular, Hospital of the University of Pennsylvania, Philadelphia
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine and Frankel Cardiovascular Center, University of Michigan, Ann Arbor
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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15
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Romano S, Dell'atti D, Judd R, Kim R, Weinsaft J, Kim J, Heitner J, Farzaneh-Far A. Right ventricular longitudinal strain measured using feature-tracking cardiac magnetic resonance is an independent predictor of all cause mortality in patients with severe tricuspid regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Tricuspid regurgitation imposes a volume overload on the right ventricle (RV) that can lead to progressive RV dilation and dysfunction. Overt RV dysfunction is associated with poor prognosis and increased operative risk. Abnormalities of myocardial strain may provide the earliest evidence of ventricular dysfunction. CMR feature-tracking techniques now allow assessment of strain from routine cine-images, without specialized pulse sequences. Whether abnormalities of RV strain measured using CMR feature-tracking have prognostic value in patients with tricuspid regurgitation is unknown
Purpose
To evaluate the prognostic value of CMR feature-tracking derived RV free wall longitudinal strain (RVFWLS) in a large multicenter population of patients with severe tricuspid regurgitation.
Methods
Consecutive patients with severe tricuspid regurgitation undergoing CMR at four US medical centers were included in this study. Feature-tracking RVFWLS was calculated from 4 chamber cine-views (Figure-left panel). The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between RVFWLS and death. The incremental prognostic value of RVFWLS was assessed in nested models.
Results
Of the 406 patients in this study,115 died during a median follow-up of 8.8 years. By Kaplan-Meier-analysis, patients with RVFWLS ≥median (−16%) had significantly reduced event free survival compared to those with RVFWLS < median (log-rank p<0.001) (Figure-right panel). By Cox multivariable regression modeling, each 1% worsening in RVFWLS was associated with a 13% increased risk-of-death after adjustement for clinical and imaging risk factors (HR=1.13 per %; p<0.001). Addition of RVFWLS in this model resulted in significant-improvement in the global-chi-square (26 to 65; p<0.0001).
Conclusions
CMR feature-tracking derived RVFWLS is an independent predictor of mortality in patients with severe tricuspid regurgitation, incremental to common clinical and imaging risk factors.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Romano
- University of Verona, Verona, Italy
| | | | - R Judd
- Duke University, Division of cardiology, Department of Medicine, Durham, United States of America
| | - R Kim
- Duke University, Division of cardiology, Department of Medicine, Durham, United States of America
| | - J Weinsaft
- Weill Cornell Medical College, Division of cardiology, New York, United States of America
| | - J Kim
- Weill Cornell Medical College, Division of cardiology, New York, United States of America
| | - J Heitner
- New York Methodist hospital, Cardiology, New York, United States of America
| | - A Farzaneh-Far
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
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16
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Ge Y, Antiochos P, Steel K, Bingham S, Abdullah S, Chen YY, Mikolich JR, Arai AE, Bandettini WP, Shanbhag SM, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Prognostic Value of Stress CMR Perfusion Imaging in Patients With Reduced Left Ventricular Function. JACC Cardiovasc Imaging 2020; 13:2132-2145. [PMID: 32771575 PMCID: PMC10823343 DOI: 10.1016/j.jcmg.2020.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the prognostic value of stress cardiac magnetic resonance imaging (CMR) in patients with reduced left ventricular (LV) systolic function. BACKGROUND Patients with ischemic cardiomyopathy are at risk from both myocardial ischemia and heart failure. Invasive testing is often used as the first-line investigation, and there is limited evidence as to whether stress testing can effectively provide risk stratification. METHODS In this substudy of a multicenter registry from 13 U.S. centers, patients with reduced LV ejection fraction (<50%), referred for stress CMR for suspected myocardial ischemia, were included. The primary outcome was cardiovascular death or nonfatal myocardial infarction. The secondary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, hospitalization for unstable angina or congestive heart failure, and unplanned late coronary artery bypass graft surgery. RESULTS Among 582 patients (mean age 62 ± 12 years, 34% women), 40% had a history of congestive heart failure, and the median LV ejection fraction was 39% (interquartile range: 28% to 45%). At median follow-up of 5.0 years, 97 patients had experienced the primary outcome, and 182 patients had experienced the secondary outcome. Patients with no CMR evidence of ischemia or late gadolinium enhancement (LGE) experienced an annual primary outcome event rate of 1.1%. The presence of ischemia, LGE, or both was associated with higher event rates. In a multivariate model adjusted for clinical covariates, ischemia and LGE were independent predictors of the primary (hazard ratio [HR]: 2.63; 95% confidence interval [CI]: 1.68 to 4.14; p < 0.001; and HR: 1.86; 95% CI: 1.05 to 3.29; p = 0.03) and secondary (HR: 2.14; 95% CI: 1.55 to 2.95; p < 0.001; and HR 1.70; 95% CI: 1.16 to 2.49; p = 0.007) outcomes. The addition of ischemia and LGE led to improved model discrimination for the primary outcome (change in C statistic from 0.715 to 0.765; p = 0.02). The presence and extent of ischemia were associated with higher rates of use of downstream coronary angiography, revascularization, and cost of care spent on ischemia testing. CONCLUSIONS Stress CMR was effective in risk-stratifying patients with reduced LV ejection fractions. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891).
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Affiliation(s)
- Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Panagiotis Antiochos
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, Texas
| | | | - Shuaib Abdullah
- Veteran Administration North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yi-Yun Chen
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
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Okasha O, Kazmirczak F, Chen KHA, Farzaneh-Far A, Shenoy C. Myocardial Involvement in Patients With Histologically Diagnosed Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis of Gross Pathological Images From Autopsy or Cardiac Transplantation Cases. J Am Heart Assoc 2020; 8:e011253. [PMID: 31070111 PMCID: PMC6585321 DOI: 10.1161/jaha.118.011253] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In patients with suspected cardiac sarcoidosis, late gadolinium enhancement on cardiovascular magnetic resonance imaging and/or 18F‐fluorodeoxyglucose uptake on positron emission tomography are often used to reach a clinical diagnosis of cardiac sarcoidosis. On the basis of data from the imaging literature of clinical cardiac sarcoidosis, no specific features of myocardial involvement are regarded as pathognomonic for cardiac sarcoidosis. Thus, a diagnosis of cardiac sarcoidosis is challenging to make. There has been no systematic analysis of histologically diagnosed cardiac sarcoidosis for patterns of myocardial involvement. We hypothesized that certain patterns of myocardial involvement are more frequent in histologically diagnosed cardiac sarcoidosis. Methods and Results We performed a systematic review and meta‐analysis of gross pathological images from the published literature of patients with histologically diagnosed cardiac sarcoidosis who underwent autopsy or cardiac transplantation. Thirty‐three eligible articles provided images of 49 unique hearts. Analysis of these hearts revealed certain features of myocardial involvement in >90% of cases: left ventricular (LV) subepicardial, LV multifocal, septal, and right ventricular free wall involvement. In contrast, other patterns were seen in 0% to 6% of cases: absence of gross LV myocardial involvement, isolated LV midmyocardial involvement, isolated LV subendocardial involvement, isolated LV transmural involvement, absence of septal involvement, or isolated involvement of only one LV level. Conclusions In this systematic review and meta‐analysis of histologically diagnosed cardiac sarcoidosis, we identified certain features of myocardial involvement that occurred frequently and others that occurred rarely or never. These patterns could aid the interpretation of cardiovascular magnetic resonance imaging and positron emission tomography imaging and improve the diagnosis and the prognostication of patients with suspected cardiac sarcoidosis. See Editorial Patel et al
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Affiliation(s)
- Osama Okasha
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Felipe Kazmirczak
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Ko-Hsuan Amy Chen
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Afshin Farzaneh-Far
- 2 Section of Cardiology Department of Medicine University of Illinois at Chicago Chicago IL
| | - Chetan Shenoy
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
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18
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Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina.
| | - Simone Romano
- Department of Internal Medicine, University of Verona, Verona, Italy
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19
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Antiochos P, Ge Y, Steel K, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol 2020; 76:945-957. [DOI: 10.1016/j.jacc.2020.06.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
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20
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Shenoy C, Romano S, Hughes A, Okasha O, Nijjar PS, Velangi P, Martin CM, Akçakaya M, Farzaneh-Far A. Cardiac Magnetic Resonance Feature Tracking Global Longitudinal Strain and Prognosis After Heart Transplantation. JACC Cardiovasc Imaging 2020; 13:1934-1942. [PMID: 32563650 DOI: 10.1016/j.jcmg.2020.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study determined the long-term prognostic significance of GLS assessed using CMR-FT in a large cohort of heart transplant recipients. BACKGROUND In heart transplant recipients, global longitudinal strain (GLS) assessed using echocardiography has shown promise in the prediction of clinical outcomes. We hypothesized that CMR feature tracking (CMR-FT) GLS is independently associated with long-term outcomes in heart transplant recipients. METHODS In a cohort of consecutive heart transplant recipients who underwent routine CMR for clinical surveillance, CMR-FT GLS was calculated from 3 long-axis cine CMR images. Associations between GLS and a composite endpoint of death or major adverse cardiac events (MACE), including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization, were investigated. RESULTS A total of 152 heart transplant recipients (age 54 ± 15 years; 29% women; 5.0 ± 5.4 years after heart transplantation) were included. The median GLS was -11.6% (interquartile range: -13.6% to -9.2%). Over a median follow-up of 2.6 years, 59 recipients reached the composite endpoint. On Kaplan-Meier analyses, recipients with GLS worse than the median had a higher estimated cumulative incidence of the composite endpoint compared with recipients with GLS better than the median (log rank p = 0.004). On multivariate Cox proportional hazards regression, GLS was independently associated with the composite endpoint after adjustment for cardiac allograft vasculopathy, history of rejection, left ventricular ejection fraction (LVEF), right ventricular EF, and presence of myocardial fibrosis, with a hazard ratio of 1.15 for every 1% worsening in GLS (95% confidence interval: 1.06 to 1.24; p < 0.001). Similar results were seen in subgroups of recipients with LVEF >50% and with no myocardial fibrosis. GLS provided incremental prognostic value over other variables in the multivariate model as determined by the log-likelihood chi-squared test. CONCLUSIONS In a large cohort of heart transplant recipients, CMR-FT GLS was independently associated with the long-term risk of death or MACE.
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Affiliation(s)
- Chetan Shenoy
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - Andrew Hughes
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Osama Okasha
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Prabhjot S Nijjar
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pratik Velangi
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Cindy M Martin
- Department of Medicine, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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21
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Kwong RY, Ge Y, Steel K, Bingham S, Abdullah S, Fujikura K, Wang W, Pandya A, Chen YY, Mikolich JR, Boland S, Arai AE, Bandettini WP, Shanbhag SM, Patel AR, Narang A, Farzaneh-Far A, Romer B, Heitner JF, Ho JY, Singh J, Shenoy C, Hughes A, Leung SW, Marji M, Gonzalez JA, Mehta S, Shah DJ, Debs D, Raman SV, Guha A, Ferrari VA, Schulz-Menger J, Hachamovitch R, Stuber M, Simonetti OP. Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain. J Am Coll Cardiol 2020; 74:1741-1755. [PMID: 31582133 PMCID: PMC8109181 DOI: 10.1016/j.jacc.2019.07.074] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. OBJECTIVES This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States. METHODS In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates. RESULTS In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (<1%) and coronary revascularization (1% to 3%), across all years of study follow-up. In contrast, patients with ischemia+/LGE+ experienced a >4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers. CONCLUSIONS In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891)
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Affiliation(s)
- Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yin Ge
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin Steel
- Cardiology Division, San Antonio Military Medical Center, San Antonio, Texas
| | | | - Shuaib Abdullah
- Veterans Administration North Texas Healthcare System, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kana Fujikura
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wei Wang
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yi-Yun Chen
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
| | - Sebastian Boland
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amit R Patel
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Akhil Narang
- Cardiology Division, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Afshin Farzaneh-Far
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Benjamin Romer
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - John F Heitner
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Jean Y Ho
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Jaspal Singh
- Division of Cardiology, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew Hughes
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Meera Marji
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California
| | - Sandeep Mehta
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Dany Debs
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Subha V Raman
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Avirup Guha
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Victor A Ferrari
- Cardiovascular Division, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeanette Schulz-Menger
- Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, and Helios Clinics, Cardiology, Berlin, Germany
| | - Rory Hachamovitch
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Matthias Stuber
- Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
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22
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Farzaneh-Far A, Romano S. Measuring longitudinal left ventricular function and strain using cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2020; 20:1259-1261. [PMID: 31157364 DOI: 10.1093/ehjci/jez097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
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Kwong RY, Farzaneh-Far A. Value of Late Gadolinium Enhancement Imaging in Diagnosis of Myocardial Infarction and Unobstructed Coronary Arteries. JACC Cardiovasc Imaging 2020; 13:1149-1151. [PMID: 32061557 DOI: 10.1016/j.jcmg.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
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24
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Evans KL, Stancu M, Nazir N, Farzaneh-Far A. MITRAL ANNULAR DISJUNCTION: WHEN YOU HAVE MAD, GET GAD(OLINIUM). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)34026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Romano S, Judd RM, Kim RJ, Heitner JF, Shah DJ, Shenoy C, Evans K, Romer B, Salazar P, Farzaneh-Far A. Feature-Tracking Global Longitudinal Strain Predicts Mortality in Patients With Preserved Ejection Fraction: A Multicenter Study. JACC Cardiovasc Imaging 2019; 13:940-947. [PMID: 31727563 DOI: 10.1016/j.jcmg.2019.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/03/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the prognostic value of global longitudinal strain (GLS) derived from cardiac magnetic resonance (CMR) feature-tracking in a large multicenter population of patients with preserved ejection fraction. BACKGROUND Ejection fraction is the principal parameter used clinically to assess cardiac mechanics and provides prognostic information. However, significant abnormalities of myocardial deformation can be present despite preserved ejection fraction. CMR feature-tracking techniques now allow assessment of strain from routine cine images, without specialized pulse sequences. Whether abnormalities of strain measured by using CMR feature-tracking have prognostic value in patients with preserved ejection fraction is unknown. METHODS Consecutive patients with preserved ejection fraction (≥50%) and a clinical indication for CMR at 4 U.S. medical centers were included in this retrospective study. Feature-tracking GLS was calculated from 3 long-axis cine views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between GLS and death. The incremental prognostic value of GLS was assessed in nested models. RESULTS Of the 1,274 patients in this study, 115 died during a median follow-up of 6.2 years. By Kaplan-Meier analysis, patients with GLS ≥ median (-20%) had significantly reduced event-free survival compared with those with GLS < median (log-rank test, p < 0.001). By Cox multivariable regression modeling, each 1% worsening in GLS was associated with a 22.8% increased risk of death after adjustment for clinical and imaging risk factors (hazard ratio: 1.228 per percent; p < 0.001). Addition of GLS in this model resulted in significant improvement in the global chi-square test (94 to 183; p < 0.001) and Harrell's C-statistic (0.75 to 0.83; p < 0.001). CONCLUSIONS GLS derived from CMR feature-tracking is a powerful independent predictor of mortality in patients with preserved ejection fraction, incremental to common clinical and imaging risk factors.
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Affiliation(s)
- Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - Robert M Judd
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Raymond J Kim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - John F Heitner
- Department of Cardiology, New York Methodist Hospital, New York, New York
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Chetan Shenoy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kaleigh Evans
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Benjamin Romer
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Pablo Salazar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
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26
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Velangi PS, Choo C, Chen KHA, Kazmirczak F, Nijjar PS, Farzaneh-Far A, Okasha O, Akçakaya M, Weinsaft JW, Shenoy C. Long-Term Embolic Outcomes After Detection of Left Ventricular Thrombus by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging: A Matched Cohort Study. Circ Cardiovasc Imaging 2019; 12:e009723. [PMID: 31707810 PMCID: PMC6941143 DOI: 10.1161/circimaging.119.009723] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is more sensitive than echocardiography for the detection of intracardiac thrombus because of its unique ability to identify thrombus based on tissue characteristics related to avascularity. The long-term prognostic significance of left ventricular (LV) thrombus detected by LGE CMR is unknown. METHODS We performed a matched cohort study of consecutive adult patients with LV thrombus detected by LGE CMR who were matched on the date of CMR, age, and LV ejection fraction to up to 3 patients without LV thrombus. We investigated the long-term incidence of a composite of embolic events: stroke, transient ischemic attack, or extracranial systemic arterial embolism. We also compared outcomes among patients with LV thrombus detected by LGE CMR stratified by whether the LV thrombus was also detected by echocardiography or not. RESULTS Of 157 LV thrombus patients, 155 were matched to 400 non-LV thrombus patients. During a median follow-up of 3.3 years, the cumulative incidence of embolism was significantly higher in LV thrombus patients compared with the matched non-LV thrombus patients (P<0.001), with annualized rates of 3.7% and 0.8% for LV thrombus and matched non-LV thrombus patients, respectively. LV thrombus was the only independent predictor of the composite embolic end point (hazard ratio, 3.99 [95% CI, 1.54-10.35]; P=0.004). The cumulative incidence of embolism was not different in patients with LV thrombus that was also detected by echocardiography versus patients with LV thrombus not detected by echocardiography (P=0.25). CONCLUSIONS Despite contemporary antithrombotic treatment, LV thrombus detected by LGE CMR is associated with a 4-fold higher long-term incidence of embolism compared with matched non-LV thrombus patients. LV thrombus detected by LGE CMR but not by echocardiography is associated with a similar risk of embolism as that detected by both LGE CMR and echocardiography.
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Affiliation(s)
- Pratik S. Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Christopher Choo
- Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Ko-Hsuan A. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Prabhjot S. Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois and Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan W. Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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27
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.,Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.,Royal Stoke University Hospital, Stoke-on-Trent, UK
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Hughes A, Okasha O, Farzaneh-Far A, Kazmirczak F, Nijjar PS, Velangi P, Akçakaya M, Martin CM, Shenoy C. Myocardial Fibrosis and Prognosis in Heart Transplant Recipients. Circ Cardiovasc Imaging 2019; 12:e009060. [PMID: 31610691 DOI: 10.1161/circimaging.119.009060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Myocardial fibrosis is a well-described histopathologic feature in heart transplant recipients. Whether myocardial fibrosis in heart transplant recipients is independently associated with clinical outcomes is unclear. We sought to determine whether myocardial fibrosis on late gadolinium enhancement cardiovascular magnetic resonance imaging in heart transplant recipients was independently associated with all-cause death or major adverse cardiac outcomes in the long-term. METHODS Using a cohort of consecutive heart transplant recipients that had cardiovascular magnetic resonance imaging, we determined the prevalence and the patterns of myocardial fibrosis and analyzed associations between myocardial fibrosis and a composite end point of all-cause death or major adverse cardiac events: retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. RESULTS One hundred and fifty-two heart transplant recipients (age, 54±15 years; 29% women; 5.0±5.4 years after heart transplantation) were included. Myocardial fibrosis was present in 18% (37% infarct pattern, 41% noninfarct pattern, and 22% both). Its prevalence was positively associated with cardiac allograft vasculopathy grade. With a median follow-up of 2.6 years, myocardial fibrosis was independently associated with all-cause death or major adverse cardiac events (hazard ratio, 2.88; 95% CI, 1.59-5.23; P<0.001) after adjustment for cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume. Every 1% increase in myocardial fibrosis was independently associated with a 6% higher hazard for all-cause death or major adverse cardiac events (hazard ratio, 1.06; 95% CI, 1.03-1.09; P<0.001). The addition of myocardial fibrosis variables to models with cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume resulted in significant improvements in model fit, suggesting incremental prognostic value. CONCLUSIONS In heart transplant recipients, myocardial fibrosis is seen on late gadolinium enhancement cardiovascular magnetic resonance imaging in 18%. Both the presence and the extent of myocardial fibrosis are independently associated with the long-term risk of all-cause death or major adverse cardiac events.
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Affiliation(s)
- Andrew Hughes
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL (A.F.-F.)
| | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Pratik Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN (M.A.)
| | - Cindy M Martin
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
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Romano S, Judd R, Kim R, Heitner J, Shah D, Shenoy C, Romer B, Salazar P, Farzaneh-Far A. 3225Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of all cause mortality in patients with preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ejection fraction is the principal measure used clinically to assess cardiac mechanics and provides significant prognostic information. However, echocardiographic strain imaging has shown significant abnormalities of myocardial deformation can be present despite preserved ejection fraction, which maybe associated with adverse prognosis. Cardiac-Magnetic-Resonance (CMR) feature-tracking techniques now allow assessment of strain from routine cine-images, without specialized pulse sequences. Whether abnormalities of strain measured using CMR feature-tracking have prognostic value in patients with preserved ejection fraction is unknown.
Purpose
To evaluate the prognostic value of CMR feature-tracking derived global longitudinal strain (GLS) in a large multicenter population of patients with preserved ejection fraction.
Methods
Consecutive patients with preserved ejection fraction (EF ≥50%) and a clinical indication for CMR at four US medical centers were included in this study. Feature-tracking GLS was calculated from 3 long-axis-cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between GLS and death. The incremental prognostic value of GLS was assessed in nested models.
Results
Of the 1274 patients in this study, 115 died during a median follow-up of 6.2 years. By Kaplan-Meier analysis, patients with GLS ≥ median (−20%) had significantly reduced event free survival compared to those with GLS < median (log-rank p<0.001) (Figure, top panel). The continuous relationship between GLS and the hazard of death is shown in the cubic spline (Figure, lower panel). By Cox multivariable regression modeling, each 1% worsening in GLS was associated with a 23.6% increased risk-of-death after adjustment for clinical and imaging risk factors (HR=1.236 per %; p<0.001). Addition of GLS in this model resulted in significant-improvement in the global-chi-square (67 to 168; p<0.0001) and Harrel's C-statistic (0.716 to 0.825; p<0.0001).
Conclusions
CMR feature-tracking derived GLS is a powerful independent predictor of mortality in patients with preserved ejection fraction, incremental to common clinical and imaging risk factors.
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Affiliation(s)
- S Romano
- University of Verona, Internal Medicine, Verona, Italy
| | - R Judd
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - R Kim
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - J Heitner
- New York Methodist hospital, Cardiology, New York, United States of America
| | - D Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
| | - C Shenoy
- University of Minnesota, Division of Cardiology, Department of Medicine, Minneapolis, United States of America
| | - B Romer
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
| | - P Salazar
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
| | - A Farzaneh-Far
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
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Kazmirczak F, Chen KHA, Adabag S, von Wald L, Roukoz H, Benditt DG, Okasha O, Farzaneh-Far A, Markowitz J, Nijjar PS, Velangi PS, Bhargava M, Perlman D, Duval S, Akçakaya M, Shenoy C. Assessment of the 2017 AHA/ACC/HRS Guideline Recommendations for Implantable Cardioverter-Defibrillator Implantation in Cardiac Sarcoidosis. Circ Arrhythm Electrophysiol 2019; 12:e007488. [PMID: 31431050 DOI: 10.1161/circep.119.007488] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators are used to prevent sudden cardiac death in patients with cardiac sarcoidosis. The most recent recommendations for implantable cardioverter-defibrillator implantation in these patients are in the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. These recommendations, based on observational studies or expert opinion, have not been assessed. We aimed to assess them. METHODS We performed a large retrospective cohort study of patients with biopsy-proven sarcoidosis and known or suspected cardiac sarcoidosis that underwent cardiovascular magnetic resonance imaging. Patients were followed for a composite end point of significant ventricular arrhythmia or sudden cardiac death. The discriminatory performance of the Guideline recommendations was tested using time-dependent receiver operating characteristic analyses. The optimal cutoff for the extent of late gadolinium enhancement predictive of the composite end point was determined using the Youden index. RESULTS In 290 patients, the class I and IIa recommendations identified all patients who experienced the composite end point during a median follow-up of 3.0 years. Patients meeting class I recommendations had a significantly higher incidence of the composite end point than those meeting class IIa recommendations. Left ventricular ejection fraction (LVEF) >35% with >5.7% late gadolinium enhancement on cardiovascular magnetic resonance imaging was as sensitive as and significantly more specific than LVEF >35% with any late gadolinium enhancement. Patients meeting 2 class IIa recommendations, LVEF >35% with the need for a permanent pacemaker and LVEF >35% with late gadolinium enhancement >5.7%, had high annualized event rates. Excluding 2 class IIa recommendations, LVEF >35% with syncope and LVEF >35% with inducible ventricular arrhythmia, resulted in improved discrimination for the composite end point. CONCLUSIONS We assessed the Guideline recommendations for implantable cardioverter-defibrillator implantation in patients with known or suspected cardiac sarcoidosis and identified topics for future research.
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Affiliation(s)
- Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Ko-Hsuan Amy Chen
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Selcuk Adabag
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis.,Division of Cardiology, Department of Medicine, Veterans Affairs Health Care System, Minneapolis, MN (S.A.)
| | - Lisa von Wald
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Henri Roukoz
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - David G Benditt
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago (A.F.-F.)
| | - Jeremy Markowitz
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Pratik S Velangi
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Maneesh Bhargava
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (M.B., D.P.), University of Minnesota Medical School, Minneapolis
| | - David Perlman
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (M.B., D.P.), University of Minnesota Medical School, Minneapolis
| | - Sue Duval
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis (M.A.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
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Romano S, Fava C, Minuz P, Farzaneh-Far A. Succinate dehydrogenase gene mutation with cardiac paraganglioma: multimodality imaging and pathological correlation. Eur Heart J 2019; 38:1853-1854. [PMID: 28158325 DOI: 10.1093/eurheartj/ehx007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Simone Romano
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Department of Internal Medicine, University of Verona, Verona, Italy
| | - Cristiano Fava
- Department of Internal Medicine, University of Verona, Verona, Italy
| | - Pietro Minuz
- Department of Internal Medicine, University of Verona, Verona, Italy
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
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Heitner JF, Kim RJ, Kim HW, Klem I, Shah DJ, Debs D, Farzaneh-Far A, Polsani V, Kim J, Weinsaft J, Shenoy C, Hughes A, Cargile P, Ho J, Bonow RO, Jenista E, Parker M, Judd RM. Prognostic Value of Vasodilator Stress Cardiac Magnetic Resonance Imaging: A Multicenter Study With 48 000 Patient-Years of Follow-up. JAMA Cardiol 2019; 4:256-264. [PMID: 30735566 PMCID: PMC6439546 DOI: 10.1001/jamacardio.2019.0035] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/04/2019] [Indexed: 12/14/2022]
Abstract
Importance Stress cardiac magnetic resonance imaging (CMR) is not widely used in current clinical practice, and its ability to predict patient mortality is unknown. Objective To determine whether stress CMR is associated with patient mortality. Design, Setting, and Participants Real-world evidence from consecutive clinically ordered CMR examinations. Multicenter study of patients undergoing clinical evaluation of myocardial ischemia. Patients with known or suspected coronary artery disease (CAD) underwent clinical vasodilator stress CMR at 7 different hospitals. An automated process collected data from the finalized clinical reports, deidentified and aggregated the data, and assessed mortality using the US Social Security Death Index. Main Outcomes and Measures All-cause patient mortality. Results Of the 9151 patients, the median (interquartile range) patient age was 63 (51-70) years, 55% were men, and the median (interquartile range) body mass index was 29 (25-33) (calculated as weight in kilograms divided by height in meters squared). The multicenter automated process yielded 9151 consecutive patients undergoing stress CMR, with 48 615 patient-years of follow-up. Of these patients, 4408 had a normal stress CMR examination, 4743 had an abnormal examination, and 1517 died during a median follow-up time of 5.0 years. Using multivariable analysis, addition of stress CMR improved prediction of mortality in 2 different risk models (model 1 hazard ratio [HR], 1.83; 95% CI, 1.63-2.06; P < .001; model 2: HR, 1.80; 95% CI, 1.60-2.03; P < .001) and also improved risk reclassification (net improvement: 11.4%; 95% CI, 7.3-13.6; P < .001). After adjustment for patient age, sex, and cardiac risk factors, Kaplan-Meier survival analysis showed a strong association between an abnormal stress CMR and mortality in all patients (HR, 1.883; 95% CI, 1.680-2.112; P < .001), patients with (HR, 1.955; 95% CI, 1.712-2.233; P < .001) and without (HR, 1.578; 95% CI, 1.235-2.2018; P < .001) a history of CAD, and patients with normal (HR, 1.385; 95% CI, 1.194-1.606; P < .001) and abnormal left ventricular ejection fraction (HR, 1.836; 95% CI, 1.299-2.594; P < .001). Conclusions and Relevance Clinical vasodilator stress CMR is associated with patient mortality in a large, diverse population of patients with known or suspected CAD as well as in multiple subpopulations defined by history of CAD and left ventricular ejection fraction. These findings provide a foundational motivation to study the comparative effectiveness of stress CMR against other modalities.
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Affiliation(s)
- John F. Heitner
- New York Presbyterian Brooklyn Methodist Hospital, New
York, New York
| | - Raymond J. Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham,
North Carolina
| | - Han W. Kim
- Duke Cardiovascular Magnetic Resonance Center, Durham,
North Carolina
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Durham,
North Carolina
| | - Dipan J. Shah
- Houston Methodist DeBakey Heart and Vascular Center,
Houston, Texas
| | - Dany Debs
- Houston Methodist DeBakey Heart and Vascular Center,
Houston, Texas
| | | | | | - Jiwon Kim
- Weill Cornell Medical Center, New York
| | | | | | | | | | - Jean Ho
- New York Presbyterian Brooklyn Methodist Hospital, New
York, New York
| | - Robert O. Bonow
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois
- Editor, JAMA Cardiology
| | - Elizabeth Jenista
- Duke Cardiovascular Magnetic Resonance Center, Durham,
North Carolina
| | - Michele Parker
- Duke Cardiovascular Magnetic Resonance Center, Durham,
North Carolina
| | - Robert M. Judd
- Duke Cardiovascular Magnetic Resonance Center, Durham,
North Carolina
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Romer B, Romano S, Evans K, Trybula M, Farzaneh-Far A. PROGNOSTIC IMPLICATIONS OF BLUNTED FEATURE TRACKING GLOBAL LONGITUDINAL STRAIN DURING CARDIOVASCULAR MAGNETIC RESONANCE (CMR) STRESS IMAGING. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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34
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Kazmirczak F, Nijjar PS, Zhang L, Hughes A, Chen KHA, Okasha O, Martin CM, Akçakaya M, Farzaneh-Far A, Shenoy C. Safety and prognostic value of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients. J Cardiovasc Magn Reson 2019; 21:9. [PMID: 30674318 PMCID: PMC6345066 DOI: 10.1186/s12968-018-0515-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance imaging (CMR) is a promising technique for this purpose. We aimed to evaluate the safety and the prognostic value of regadenoson stress CMR in heart transplant recipients. METHODS To evaluate the safety, we assessed adverse effects in a retrospective matched cohort study of consecutive heart transplant recipients who underwent regadenoson stress CMR matched in a 2:1 ratio to age- and gender-matched non-heart transplant patients. To evaluate the prognostic value, we compared the outcomes of patients with abnormal vs. normal regadenoson stress CMRs using a composite endpoint of myocardial infarction, percutaneous intervention, cardiac hospitalization, retransplantation or death. RESULTS For the safety analysis, 234 regadenoson stress CMR studies were included - 78 performed in 57 heart transplant recipients and 156 performed in non-heart transplant patients. Those in heart transplant recipients were performed at a median of 2.74 years after transplantation. Thirty-four (44%) CMR studies were performed in the first two years after heart transplantation. There were no differences in the rates of adverse effects between heart transplant recipients and non-heart transplant patients. To study the prognostic value of regadenoson stress CMRs, 20 heart transplant recipients with abnormal regadenoson stress CMRs were compared to 37 with normal regadenoson stress CMRs. An abnormal regadenoson stress CMR was associated with a significantly higher incidence of the composite endpoint compared with a normal regadenoson stress CMR (3-year cumulative incidence estimates of 32.1% vs. 12.7%, p = 0.034). CONCLUSIONS Regadenoson stress CMR is safe and well tolerated in heart transplant recipients, with no incidence of sinus node dysfunction or high-degree atrioventricular block, including in the first two years after heart transplantation. An abnormal regadenoson stress CMR identifies heart transplant recipients at a higher risk for major adverse cardiovascular events.
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Affiliation(s)
- Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Prabhjot S. Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Lei Zhang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN USA
| | - Andrew Hughes
- University of Minnesota Medical School, Minneapolis, MN USA
| | - Ko-Hsuan Amy Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Cindy M. Martin
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
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Romano S, Judd RM, Kim RJ, Kim HW, Klem I, Heitner J, Shah DJ, Jue J, White BE, Shenoy C, Farzaneh-Far A. Association of Feature-Tracking Cardiac Magnetic Resonance Imaging Left Ventricular Global Longitudinal Strain With All-Cause Mortality in Patients With Reduced Left Ventricular Ejection Fraction. Circulation 2019; 135:2313-2315. [PMID: 28584033 DOI: 10.1161/circulationaha.117.027740] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Simone Romano
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Robert M Judd
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Raymond J Kim
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Han W Kim
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Igor Klem
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - John Heitner
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Dipan J Shah
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Jennifer Jue
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Brent E White
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Chetan Shenoy
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.)
| | - Afshin Farzaneh-Far
- From Division of Cardiology, Department of Medicine, University of Illinois at Chicago (S.R., J.J., B.E.W., A.F-F.); Department of Medicine, University of Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.JK., H.W.K., I.K.); Department of Cardiology, New York Methodist Hospital (J.H.); Houston Methodist DeBakey Heart & Vascular Center, TX (D.J.S.); and Division of Cardiology, University of Minnesota Medical Center (C.S.).
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Romano S, Judd RM, Kim RJ, Kim HW, Heitner JF, Shah DJ, Devereux RB, Salazar P, Trybula M, Chia RC, Evans K, Farzaneh-Far A. Prognostic Implications of Mitral Annular Plane Systolic Excursion in Patients with Hypertension and a Clinical Indication for Cardiac Magnetic Resonance Imaging: A Multicenter Study. JACC Cardiovasc Imaging 2018; 12:1769-1779. [PMID: 30409557 DOI: 10.1016/j.jcmg.2018.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/17/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived mitral annular plane systolic excursion (MAPSE) in a large multicenter population of patients with hypertension. BACKGROUND In patients with hypertension, cardiac abnormalities are powerful predictors of adverse outcomes. Long-axis mitral annular movement plays a fundamental role in cardiac mechanics and is an early marker for a number of pathological processes. Given the adverse consequences of cardiac involvement in hypertension, the authors hypothesized that lateral MAPSE may provide incremental prognostic information in these patients. METHODS Consecutive patients with hypertension and a clinical indication for CMR at 4 U.S. medical centers were included in this study (n = 1,735). Lateral MAPSE was measured in the 4-chamber cine view. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models. RESULTS Over a median follow-up period of 5.1 years, 235 patients died. By Kaplan-Meier analysis, risk of death was significantly higher in patients with a lateral MAPSE < median (10 mm) (log-rank; p < 0.0001). Lateral MAPSE was associated with risk of death after adjustment for clinical and imaging risk factors (hazard ratio [HR]: 1.402-per-millimeter decrease; p < 0.001). Addition of lateral MAPSE in this model resulted in significant improvement in the C-statistic (0.735 to 0.815; p < 0.0001). Continuous net reclassification improvement was 0.739 (95% confidence interval: 0.601 to 0.902). Lateral MAPSE remained significantly associated with death even after adjustment for feature tracking global longitudinal strain (HR: 1.192-per-millimeter decrease; p < 0.001). Lateral MAPSE was independently associated with death among the subgroups of patients with preserved ejection fraction (HR = 1.339; p < 0.001) and in those without history of myocardial infarction (HR: 1.390; p < 0.001). CONCLUSIONS CMR-derived lateral MAPSE is a powerful, independent predictor of mortality in patients with hypertension and a clinical indication for CMR, incremental to common clinical and CMR risk factors. These findings may suggest a role for CMR-derived lateral MAPSE in identifying hypertensive patients at highest risk of death.
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Affiliation(s)
- Simone Romano
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, University of Verona, Verona, Italy
| | - Robert M Judd
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
| | - Raymond J Kim
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
| | - Han W Kim
- Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina
| | - John F Heitner
- Department of Cardiology, New York Methodist Hospital, New York, New York
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Pablo Salazar
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Michael Trybula
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Richard C Chia
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Kaleigh Evans
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Afshin Farzaneh-Far
- Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
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Indorkar R, Kwong RY, Romano S, White BE, Chia RC, Trybula M, Evans K, Shenoy C, Farzaneh-Far A. Global Coronary Flow Reserve Measured During Stress Cardiac Magnetic Resonance Imaging Is an Independent Predictor of Adverse Cardiovascular Events. JACC Cardiovasc Imaging 2018; 12:1686-1695. [PMID: 30409558 DOI: 10.1016/j.jcmg.2018.08.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the incremental prognostic value of global coronary flow reserve (CFR) in patients with known or suspected coronary artery disease who were undergoing stress cardiac magnetic resonance (CMR) imaging. BACKGROUND Coronary microvascular dysfunction results in impaired global CFR and is implicated in the development of both atherosclerosis and heart failure. Although noninvasive assessment of CFR with positron emission tomography provides independent prognostic information, the incremental prognostic value of CMR-derived CFR remains unclear. METHODS Consecutive patients undergoing stress perfusion CMR were prospectively enrolled (n = 507). Coronary sinus flow was measured using phase-contrast imaging at baseline (pre) and immediately after stress (peak) perfusion. CFR was calculated as the ratio of peak to pre-flow. Patients were followed for major adverse cardiac events (MACE): death, nonfatal myocardial infarction, heart failure hospitalization, sustained ventricular tachycardia, and late revascularization. Cox proportional hazards regression modeling was used to examine the association between CFR and MACE. The incremental prognostic value of CFR was assessed in nested models. RESULTS Over a median follow-up of 2.1 years, 80 patients experienced MACE. By Kaplan-Meier analysis, the risk of MACE was significantly higher in patients with CFR lower than the median (2.2) (log-rank p < 0.001); this remained significant after adjustment for the presence of ischemia and late gadolinium enhancement (LGE) (log-rank p < 0.001). CFR was significantly associated with the risk of MACE after adjustment for clinical and imaging risk factors, including ischemia extent, ejection fraction, and LGE size (hazard ratio: 1.238; p = 0.018). Addition of CFR in this model resulted in significant improvement in the C-index (from 0.70 to 0.75; p = 0.0087) and a continuous net reclassification improvement of 0.198 (95% confidence interval: 0.120 to 0.288). CONCLUSIONS CMR-derived CFR is an independent predictor of MACE in patients with known or suspected coronary artery disease, incremental to common clinical and CMR risk factors. These findings suggest a role for CMR-derived CFR in identifying patients at risk of adverse events following stress CMR, even in the absence of ischemia and LGE.
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Affiliation(s)
- Raksha Indorkar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Raymond Y Kwong
- Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - Brent E White
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Richard C Chia
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michael Trybula
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kaleigh Evans
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Chetan Shenoy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina.
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Romano S, Salazar P, Chia R, Judd R, Kim R, Heitner J, Shah D, Al-Yafi M, Farzaneh-Far A. P268Lateral mitral annular plane excursion measured using cardiac magnetic resonance imaging is an independent predictor of all cause mortality in patients with hypertension: a multicenter study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Romano
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - P Salazar
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - R Chia
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - R Judd
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - R Kim
- Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, United States of America
| | - J Heitner
- New York Methodist hospital, Cardiology, New York, United States of America
| | - D Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, United States of America
| | - M Al-Yafi
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
| | - A Farzaneh-Far
- University of Illinois at Chicago, Department of Medicine, Division of Cardiology, Chicago, United States of America
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Chia RC, Salazar P, Al-Yafi M, Romano S, Farzaneh-Far A. Secundum atrial septal defect. QJM 2018; 111:571-572. [PMID: 29462467 DOI: 10.1093/qjmed/hcy030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R C Chia
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - P Salazar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - M Al-Yafi
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - S Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - A Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
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Romano S, Farzaneh-Far A. Cardiac MRI for Detection of Cardiac Sarcoidosis. Radiology 2018; 288:659. [PMID: 30015582 DOI: 10.1148/radiol.2018180485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simone Romano
- From the Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Departments of Medicine and Radiology, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (A.F.F.); and Division of Cardiology, Department of Medicine, Duke University, Durham, NC (A.F.F.)
| | - Afshin Farzaneh-Far
- From the Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Departments of Medicine and Radiology, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (A.F.F.); and Division of Cardiology, Department of Medicine, Duke University, Durham, NC (A.F.F.)
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Indorkar R, Al-Yafi M, Romano S, Levin BR, Farzaneh-Far A. Cardiomyopathy in muscular dystrophy. QJM 2018; 111:267-268. [PMID: 29149277 DOI: 10.1093/qjmed/hcx220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Indorkar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - M Al-Yafi
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - S Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - B R Levin
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - A Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
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Affiliation(s)
- Pablo Salazar
- Section of Cardiology, Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920?S, Chicago, IL 60612, USA
| | - Raksha Indorkar
- Section of Cardiology, Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920?S, Chicago, IL 60612, USA
| | - Michael Dietrich
- Section of Cardiology, Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920?S, Chicago, IL 60612, USA
| | - Afshin Farzaneh-Far
- Section of Cardiology, Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL 60612, USA.,Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
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Romano S, Judd RM, Kim RJ, Kim HW, Klem I, Heitner JF, Shah DJ, Jue J, White BE, Indorkar R, Shenoy C, Farzaneh-Far A. Feature-Tracking Global Longitudinal Strain Predicts Death in a Multicenter Population of Patients With Ischemic and Nonischemic Dilated Cardiomyopathy Incremental to Ejection Fraction and Late Gadolinium Enhancement. JACC Cardiovasc Imaging 2018; 11:1419-1429. [PMID: 29361479 DOI: 10.1016/j.jcmg.2017.10.024] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the prognostic value of cardiac magnetic resonance (CMR) feature-tracking-derived global longitudinal strain (GLS) in a large multicenter population of patients with ischemic and nonischemic dilated cardiomyopathy. BACKGROUND Direct assessment of myocardial fiber deformation with GLS using echocardiography or CMR feature tracking has shown promise in providing prognostic information incremental to ejection fraction (EF) in single-center studies. Given the growing use of CMR for assessing persons with left ventricular (LV) dysfunction, we hypothesized that feature-tracking-derived GLS may provide independent prognostic information in a multicenter population of patients with ischemic and nonischemic dilated cardiomyopathy. METHODS Consecutive patients at 4 U.S. medical centers undergoing CMR with EF <50% and ischemic or nonischemic dilated cardiomyopathy were included in this study. Feature-tracking GLS was calculated from 3 long-axis cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the association between GLS and death. Incremental prognostic value of GLS was assessed in nested models. RESULTS Of the 1,012 patients in this study, 133 died during median follow-up of 4.4 years. By Kaplan-Meier analysis, the risk of death increased significantly with worsening GLS tertiles (log-rank p < 0.0001). Each 1% worsening in GLS was associated with an 89.1% increased risk of death after adjustment for clinical and imaging risk factors including EF and late gadolinium enhancement (LGE) (hazard ratio [HR]:1.891 per %; p < 0.001). Addition of GLS in this model resulted in significant improvement in the C-statistic (0.628 to 0.867; p < 0.0001). Continuous net reclassification improvement (NRI) was 1.148 (95% confidence interval: 0.996 to 1.318). GLS was independently associated with death after adjustment for clinical and imaging risk factors (including EF and late gadolinium enhancement) in both ischemic (HR: 1.942 per %; p < 0.001) and nonischemic dilated cardiomyopathy subgroups (HR: 2.101 per %; p < 0.001). CONCLUSIONS CMR feature-tracking-derived GLS is a powerful independent predictor of mortality in a multicenter population of patients with ischemic or nonischemic dilated cardiomyopathy, incremental to common clinical and CMR risk factors including EF and LGE.
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Affiliation(s)
- Simone Romano
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, University of Verona, Verona, Italy
| | - Robert M Judd
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Raymond J Kim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Han W Kim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Igor Klem
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - John F Heitner
- Department of Cardiology, New York Methodist Hospital, New York, New York
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Jennifer Jue
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Brent E White
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Raksha Indorkar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Chetan Shenoy
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
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Romano S, Judd RM, Kim RJ, Kim HW, Klem I, Heitner JF, Shah DJ, Jue J, Farzaneh-Far A. Left Ventricular Long-Axis Function Assessed with Cardiac Cine MR Imaging Is an Independent Predictor of All-Cause Mortality in Patients with Reduced Ejection Fraction: A Multicenter Study. Radiology 2017; 286:452-460. [PMID: 28914601 DOI: 10.1148/radiol.2017170529] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To evaluate the prognostic value of a simple index of left ventricular (LV) long-axis function-lateral mitral annular plane systolic excursion (MAPSE)-in a large multicenter population of patients with reduced ejection fraction (EF) who were undergoing cardiac magnetic resonance (MR) imaging. Materials and Methods This retrospective study included 1040 consecutive patients (mean age, 59.5 years ± 15.8) at four U.S. medical centers who were undergoing cardiac MR imaging for assessment of LV dysfunction with EF less than 50%. Lateral MAPSE was measured in the four-chamber cine view. The primary end point was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models. Results During a median follow-up of 4.4 years, 132 patients died. With Kaplan-Meier analysis, the risk of death increased significantly with decreasing tertiles of lateral MAPSE (log-rank P = .0001). Patients with relatively preserved lateral MAPSE (>9 mm) had very few deaths, regardless of whether their EF was above or below 35%. Patients with late gadolinium enhancement (LGE) and low lateral MAPSE had significantly reduced survival compared to those with LGE and high lateral MAPSE (log-rank P < .0001). Lateral MAPSE was independently associated with risk of death after adjustment for clinical and imaging risk factors, which were univariate predictors (age, body mass index, diabetes, LV end-diastolic volume index, LGE, EF) (hazard ratio = 2.051 per mm decrease; 95% confidence interval [CI]: 1.520, 2.768; P < .001). Inclusion of lateral MAPSE in this model resulted in significant improvement in model fit (likelihood ratio test P < .0001) and C statistic (increasing from 0.675 to 0.844; P < .0001). Continuous net reclassification improvement was 1.036 (95% CI: 0.878, 1.194). Conclusion Lateral MAPSE measured during routine cine cardiac MR imaging is a significant independent predictor of mortality in patients with LV dysfunction, incremental to common clinical and cardiac MR risk factors-including EF and LGE. © RSNA, 2017.
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Affiliation(s)
- Simone Romano
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Robert M Judd
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Raymond J Kim
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Han W Kim
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Igor Klem
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - John F Heitner
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Dipan J Shah
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Jennifer Jue
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Afshin Farzaneh-Far
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
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White B, Romano S, Judd R, Kim R, Kim H, Klem I, Heiner J, Shah D, Jue J, Indorkar R, Farzaneh-Far A. 5008Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of death in patients with reduced ejection fraction: a multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Recent introduction of hybrid positron emission tomography/magnetic resonance (PET/MR) scanners has created excitement regarding potential applications in cardiovascular medicine. This has led to a number of optimistic assessments of its potential value in the nuclear cardiology literature, although most published data are still at the feasibility or pre-clinical level. Such excitement is understandable and provides "fuel" for generation of the necessary clinical validation studies, which will be required. Given the current scrutiny from payers and government agencies to reduce the costs of cardiac imaging, the responsibility for showing additive benefit lies on the shoulders of those advocating for new, more expensive technologies. In the case of PET/MR, this will be a major challenge, given the high costs of the hybrid procedure and the need for potentially harmful ionizing radiation compared to a cardiac magnetic resonance (CMR)-only approach. The aim of this editorial is to provide a critical appraisal of the current evidence base for clinical use of PET/MR in cardiology.
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Affiliation(s)
- Afshin Farzaneh-Far
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Huang H, Nijjar PS, Misialek JR, Blaes A, Derrico NP, Kazmirczak F, Klem I, Farzaneh-Far A, Shenoy C. Accuracy of left ventricular ejection fraction by contemporary multiple gated acquisition scanning in patients with cancer: comparison with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:34. [PMID: 28335788 PMCID: PMC5364623 DOI: 10.1186/s12968-017-0348-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/24/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple gated acquisition scanning (MUGA) is a common imaging modality for baseline and serial assessment of left ventricular ejection fraction (LVEF) for cardiotoxicity risk assessment prior to, surveillance during, and surveillance after administration of potentially cardiotoxic cancer treatment. The objective of this study was to compare the accuracy of left ventricular ejection fractions (LVEF) obtained by contemporary clinical multiple gated acquisition scans (MUGA) with reference LVEFs from cardiovascular magnetic resonance (CMR) in consecutive patients with cancer. METHODS In a cross-sectional study, we compared MUGA clinical and CMR reference LVEFs in 75 patients with cancer who had both studies within 30 days. Misclassification was assessed using the two most common thresholds of LVEF used in cardiotoxicity clinical studies and practice: 50 and 55%. RESULTS Compared to CMR reference LVEFs, MUGA clinical LVEFs were only lower by a mean of 1.5% (48.5% vs. 50.0%, p = 0.17). However, the limits of agreement between MUGA clinical and CMR reference LVEFs were wide at -19.4 to 16.5%. At LVEF thresholds of 50 and 55%, there was misclassification of 35 and 20% of cancer patients, respectively. CONCLUSIONS MUGA clinical LVEFs are only modestly accurate when compared with CMR reference LVEFs. These data have significant implications on clinical research and patient care of a population with, or at risk for, cardiotoxicity.
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Affiliation(s)
- Hans Huang
- Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN USA
| | - Prabhjot S. Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Jeffrey R. Misialek
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN USA
| | | | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC USA
- Division of Cardiology, Duke University Medical Center, Durham, NC USA
| | - Afshin Farzaneh-Far
- Division of Cardiology, Duke University Medical Center, Durham, NC USA
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 USA
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Jue J, Romano S, White B, Indorkar R, Parikh D, Farzaneh-Far A. HEART RATE RESPONSE DURING REGADENOSON STRESS CARDIAC MAGNETIC RESONANCE IMAGING IS A PREDICTOR OF ADVERSE CARDIOVASCULAR OUTCOMES. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McGraw SA, Mirza O, Rangarajan V, Chacko SJ, Bauml MA, Farzaneh-Far A. Overall impact of outpatient stress cardiac magnetic resonance (CMR) imaging on clinical care is independent of appropriate use criteria. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032480 DOI: 10.1186/1532-429x-18-s1-q20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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