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Rahi W, Hussain I, Quinones MA, Zoghbi WA, Shah DJ, Nagueh SF. Noninvasive Prediction of Pulmonary Capillary Wedge Pressure in Patients With Normal Left Ventricular Ejection Fraction: Comparison of Cardiac Magnetic Resonance With Comprehensive Echocardiography. J Am Soc Echocardiogr 2024; 37:486-494. [PMID: 38354759 DOI: 10.1016/j.echo.2024.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) was recently reported to predict mean pulmonary capillary wedge pressure (PCWP). However, there is a paucity of data on its accuracy for estimation of PCWP in patients with normal left ventricular (LV) ejection fraction (EF). We sought to examine its accuracy against the invasive gold standard and to compare it with the accuracy of comprehensive echocardiography. METHODS Stable patients with EF of ≥50% who underwent right heart catheterization, CMR, and echocardiographic imaging within 1 week were included. Pulmonary capillary wedge pressure was estimated by CMR using a previously validated equation where PCWP is estimated based on the left atrial maximum volume and LV mass. Echocardiographic estimation of PCWP was based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines, taking into account the presence of myocardial disease. RESULTS The mean age of the 79 patients was 55 ± 15 years, and 58.2% were female. There were 33 patients with PCWP >15 mm Hg by right heart catheterization. Cardiac magnetic resonance prediction of PCWP had an area under the curve (AUC) = 0.72. In comparison, echocardiographic prediction of PCWP showed a higher accuracy (AUC = 0.87 vs AUC = 0.72; P = .008). CONCLUSIONS In patients with normal LV EF, CMR estimation of mean PCWP based on LV mass and left atrial volume has modest accuracy for detecting patients with mean PCWP >15 mm Hg. Comprehensive echocardiography predicts elevated PCWP with higher accuracy in comparison with CMR.
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Affiliation(s)
- Wissam Rahi
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Imad Hussain
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Miguel A Quinones
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - William A Zoghbi
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Dipan J Shah
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Sherif F Nagueh
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
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Magnus L, Schwein A, Chinnadurai P, Fontaine K, Autry K, Shah DJ, Grande-Allen KJ, Chakfé N, Bismuth J. Experimental Multi-Parametric MRI Characterization of Iliocaval Venous Thrombosis Pathological Changes. J Vasc Surg Venous Lymphat Disord 2024:101895. [PMID: 38679142 DOI: 10.1016/j.jvsv.2024.101895] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Iliocaval thrombotic obstruction is a challenging condition, especially since thrombus age and corresponding pathological remodeling at presentation are unknown, which directly impacts management. Our aim was to assess the ability of Magnetic Resonance Imaging (MRI) in determining age thresholds of experimentally created inferior vena cava (IVC) thrombosis in pigs. METHODS We used a previously described swine model of IVC thrombosis. Animals underwent MRI at baseline, immediately after thrombosis creation and after a follow-up period extending from 2 to 28 days. Thirteen animals were divided into 3 groups according to disease's chronicity: acute (AG, N1 = 5), subacute (SAG, N2 = 4) and chronic group (CG, N3 = 4) with a mean thrombosis age of respectively 6.4 ± 2.5, 15.7 ± 2.8 and 28 ± 5.7 days. A T1 weighted volumetric interpolated breath-hold examination sequence was used to anatomically delineate IVC thrombus as a region of interest. Three other MRI sequences were used to assess thrombus signal. RESULTS Kruskal-Wallis showed a statistically significant difference in T1 relaxation times after contrast injection (P = .026) between the 3 groups of chronicity: AG (360.2 ± 102.5) was significantly different from CG (336.7 ± 55.2 ms; P = .003) and SAG (354.1 ± 89.7 ms) was significantly different from AG (P = .027). There was a statistically significant difference in native T2 relaxation times (P = .038) between the 3 groups: AG (160 ± 86.7 ms) was significantly different from SAG (142.3 ± 55.4 ms; P = .027) and SAG was significantly different from CG (178.4 ± 11.7 ms; P = .004). CONCLUSIONS This study highlighted MRI characteristics in a swine model that may have the potential to significantly differentiate a subacute and a chronic stage from an acute stage of deep venous thrombosis in humans. Further clinical studies in humans are warranted.
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Affiliation(s)
- Louis Magnus
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Adeline Schwein
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia; Heart and Vascular Research Institute, Harry Perkins Medical Research Institute, Perth, WA 6009, Australia.
| | | | - Killian Fontaine
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
| | - Kathryn Jane Grande-Allen
- Department of Bioengineering, BioScience Research Collaborative, Rice University, Houston, Texas, USA.
| | - Nabil Chakfé
- Department of Vascular Surgery, Kidney Transplantation and Innovation, University Hospital of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France.
| | - Jean Bismuth
- Division of Vascular Surgery, USF Health Morsani School of Medicine, Tampa, Florida, USA.
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Khagi B, Belousova T, Short CM, Taylor AA, Bismuth J, Shah DJ, Brunner G. Convolutional Neural Networks to Study Contrast-Enhanced Magnetic Resonance Imaging-Based Skeletal Calf Muscle Perfusion in Peripheral Artery Disease. Am J Cardiol 2024; 220:56-66. [PMID: 38580040 DOI: 10.1016/j.amjcard.2024.03.035] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
Peripheral artery disease (PAD) is associated with impaired blood flow in the lower extremities and histopathologic changes of the skeletal calf muscles, resulting in abnormal microvascular perfusion. We studied the use of convolution neural networks (CNNs) to differentiate patients with PAD from matched controls using perfusion pattern features from contrast-enhanced magnetic resonance imaging (CE-MRI) of the skeletal calf muscles. We acquired CE-MRI based skeletal calf muscle perfusion in 56 patients (36 patients with PAD and 20 matched controls). Microvascular perfusion imaging was performed after reactive hyperemia at the midcalf level, with a temporal resolution of 409 ms. We analyzed perfusion scans up to 2 minutes indexed from the local precontrast arrival time frame. Skeletal calf muscles, including the anterior muscle, lateral muscle, deep posterior muscle group, and the soleus and gastrocnemius muscles, were segmented semiautomatically. Segmented muscles were represented as 3-dimensional Digital Imaging and Communications in Medicine stacks of CE-MRI perfusion scans for deep learning (DL) analysis. We tested several CNN models for the 3-dimensional CE-MRI perfusion stacks to classify patients with PAD from matched controls. A total of 2 of the best performing CNNs (resNet and divNet) were selected to develop the final classification model. A peak accuracy of 75% was obtained for resNet and divNet. Specificity was 80% and 94% for resNet and divNet, respectively. In conclusion, DL using CNNs and CE-MRI skeletal calf muscle perfusion can discriminate patients with PAD from matched controls. DL methods may be of interest for the study of PAD.
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Affiliation(s)
- Bijen Khagi
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Christina M Short
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Addison A Taylor
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jean Bismuth
- Division of Vascular Surgery, USF Health Morsani School of Medicine, Tampa, Florida
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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Saeed M, Bersali A, Darwish A, Qamar F, Maragiannis D, El-Tallawi KC, Malahfji M, Shah DJ. Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Aortic Regurgitation. Curr Cardiol Rep 2024:10.1007/s11886-024-02044-3. [PMID: 38517604 DOI: 10.1007/s11886-024-02044-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Cardiac magnetic resonance (CMR) is emerging as a valuable imaging modality for the assessment of aortic regurgitation (AR). In this review, we discuss the assessment of AR severity, left ventricular (LV) remodeling, and tissue characterization by CMR while highlighting the latest studies and addressing future research needs. RECENT FINDINGS Recent studies have further established CMR-based thresholds of AR severity and LV remodeling that are associated with adverse clinical outcomes, and lower than current guideline criteria. In addition, tissue profiling with late gadolinium enhancement (LGE) and extracellular volume (ECV) quantification can reliably assess adverse myocardial tissue remodeling which is also associated with adverse outcomes. The strengths and reproducibility of CMR in evaluating ventricular volumes, tissue characteristics, and regurgitation severity position it as an excellent modality in evaluating and following AR patients. Advanced CMR techniques for the detection of tissue remodeling have shown significant potential and merit further investigation.
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Affiliation(s)
- Mujtaba Saeed
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Akila Bersali
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Amr Darwish
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Fatima Qamar
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Dimitrios Maragiannis
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Kinan Carlos El-Tallawi
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Maan Malahfji
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Dipan J Shah
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, Weill Cornell Medical College, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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Khagi B, Belousova T, Short CM, Taylor A, Nambi V, Ballantyne CM, Bismuth J, Shah DJ, Brunner G. A machine learning-based approach to identify peripheral artery disease using texture features from contrast-enhanced magnetic resonance imaging. Magn Reson Imaging 2024; 106:31-42. [PMID: 38065273 DOI: 10.1016/j.mri.2023.11.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024]
Abstract
Diagnosing and assessing the risk of peripheral artery disease (PAD) has long been a focal point for medical practitioners. The impaired blood circulation in PAD patients results in altered microvascular perfusion patterns in the calf muscles which is the primary location of intermittent claudication pain. Consequently, we hypothesized that changes in perfusion and increase in connective tissue could lead to alterations in the appearance or texture patterns of the skeletal calf muscles, as visualized with non-invasive imaging techniques. We designed an automatic pipeline for textural feature extraction from contrast-enhanced magnetic resonance imaging (CE-MRI) scans and used the texture features to train machine learning models to detect the heterogeneity in the muscle pattern among PAD patients and matched controls. CE-MRIs from 36 PAD patients and 20 matched controls were used for preparing training and testing data at a 7:3 ratio with cross-validation (CV) techniques. We employed feature arrangement and selection methods to optimize the number of features. The proposed method achieved a peak accuracy of 94.11% and a mean testing accuracy of 84.85% in a 2-class classification approach (controls vs. PAD). A three-class classification approach was performed to identify a high-risk PAD sub-group which yielded an average test accuracy of 83.23% (matched controls vs. PAD without diabetes vs. PAD with diabetes). Similarly, we obtained 78.60% average accuracy among matched controls, PAD treadmill exercise completers, and PAD exercise treadmill non-completers. Machine learning and imaging-based texture features may be of interest in the study of lower extremity ischemia.
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Affiliation(s)
- Bijen Khagi
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Christina M Short
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Addison Taylor
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jean Bismuth
- Division of Vascular Surgery, USF Health Morsani School of Medicine, Tampa, FL, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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Arai AE, Schulz-Menger J, Shah DJ, Han Y, Bandettini WP, Abraham A, Woodard PK, Selvanayagam JB, Hamilton-Craig C, Tan RS, Carr J, Teo L, Kramer CM, Wintersperger BJ, Harisinghani MG, Flamm SD, Friedrich MG, Klem I, Raman SV, Haverstock D, Liu Z, Brueggenwerth G, Santiuste M, Berman DS, Pennell DJ. Stress Perfusion Cardiac Magnetic Resonance vs SPECT Imaging for Detection of Coronary Artery Disease. J Am Coll Cardiol 2023; 82:1828-1838. [PMID: 37914512 DOI: 10.1016/j.jacc.2023.08.046] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND GadaCAD2 was 1 of 2 international, multicenter, prospective, Phase 3 clinical trials that led to U.S. Food and Drug Administration approval of gadobutrol to assess myocardial perfusion and late gadolinium enhancement (LGE) in adults with known or suspected coronary artery disease (CAD). OBJECTIVES A prespecified secondary objective was to determine if stress perfusion cardiovascular magnetic resonance (CMR) was noninferior to single-photon emission computed tomography (SPECT) for detecting significant CAD and for excluding significant CAD. METHODS Participants with known or suspected CAD underwent a research rest and stress perfusion CMR that was compared with a gated SPECT performed using standard clinical protocols. For CMR, adenosine or regadenoson served as vasodilators. The total dose of gadobutrol was 0.1 mmol/kg body weight. The standard of reference was a 70% stenosis defined by quantitative coronary angiography (QCA). A negative coronary computed tomography angiography could exclude CAD. Analysis was per patient. CMR, SPECT, and QCA were evaluated by independent central core lab readers blinded to clinical information. RESULTS Participants were predominantly male (61.4% male; mean age 58.9 ± 10.2 years) and were recruited from the United States (75.0%), Australia (14.7%), Singapore (5.7%), and Canada (4.6%). The prevalence of significant CAD was 24.5% (n = 72 of 294). Stress perfusion CMR was statistically superior to gated SPECT for specificity (P = 0.002), area under the receiver operating characteristic curve (P < 0.001), accuracy (P = 0.003), positive predictive value (P < 0.001), and negative predictive value (P = 0.041). The sensitivity of CMR for a 70% QCA stenosis was noninferior and nonsuperior to gated SPECT. CONCLUSIONS Vasodilator stress perfusion CMR, as performed with gadobutrol 0.1 mmol/kg body weight, had superior diagnostic accuracy for diagnosis and exclusion of significant CAD vs gated SPECT.
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Affiliation(s)
| | - Jeanette Schulz-Menger
- Helios Klinikum Berlin Buch Klinik für Kardiologie und Nephrologie Abteilung Kardio-MRT, Berlin, Germany
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Yuchi Han
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Patricia Bandettini
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Arun Abraham
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pamela K Woodard
- Washington University School of Medicine, St Louis, Missouri, USA
| | | | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore
| | - James Carr
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lynette Teo
- National University Hospital, Singapore, Singapore
| | | | - Bernd J Wintersperger
- University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | - Igor Klem
- Duke University, Durham, North Carolina, USA
| | - Subha V Raman
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Zheyu Liu
- Bayer Pharmaceuticals LLC, Whippany, New Jersey, USA
| | | | | | | | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Uretsky S, Biederman RWW, Han Y, Jacob R, Martin ET, Langer M, Choi AD, Sultan I, Cavalcante JL, Shah DJ, Tong MS, Wolff SD, Guglielmo M, Pontone G. Symptoms, Outcomes, and Regurgitant Severity in Guideline-Directed Mitral Valve Surgery: A Multicenter Prospective Study. JACC Cardiovasc Imaging 2023; 16:1491-1493. [PMID: 37318393 DOI: 10.1016/j.jcmg.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 06/16/2023]
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Malahfji M, Nguyen DT, Graviss EA, Shah DJ. Reply: Cardiac Remodeling in Aortic Regurgitation. J Am Coll Cardiol 2023; 82:e125. [PMID: 37758444 DOI: 10.1016/j.jacc.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 10/03/2023]
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Nagueh SF, Nabi F, Chang SM, Al-Mallah M, Shah DJ, Bhimaraj A. Imaging for implementation of heart failure guidelines. Eur Heart J Cardiovasc Imaging 2023; 24:1283-1292. [PMID: 37418490 DOI: 10.1093/ehjci/jead163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023] Open
Abstract
The classification of heart failure with implications for pharmacological therapeutic interventions rests on defining ejection fraction (EF) which is an imaging parameter. Imaging can provide diagnostic clues as to aetiology of heart failure; it can also guide and help assess response to treatment. Echocardiography, CMR, cardiac computed tomography, positron emission tomography, and Tc 99 m pyrophosphate scanning provide information about the aetiology of heart failure. Further, echocardiography plays the primary role in the evaluation of LV diastolic function and the estimation of left ventricular (LV) filling pressures both at rest and with exercise during diastolic stress testing. Heart failure guidelines recognize four stages (A, B, C, and D) for heart failure. Cardiac imaging along with risk factors and clinical status is needed for identifying these stages. There are joint societal echocardiographic guidelines by American Society of Echocardiography (ASE) of Echocardiography and European Association of Cardiovascular Imaging that are applicable to the imaging of heart failure patients. There are also separate guidelines for the evaluation of patients being considered for LV assist device implantation and for multimodality imaging of patients with heart failure and preserved EF. Cardiac catheterization is needed in patients whose haemodynamic status is uncertain after clinical and echocardiographic evaluation and to evaluate for coronary artery disease. Myocardial biopsy can identify the presence of myocarditis or specific infiltrative diseases when the findings by non-invasive imaging are not conclusive.
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Affiliation(s)
- Sherif F Nagueh
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin, SM-1801, Houston, TX 77030, USA
| | - Faisal Nabi
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin, SM-1801, Houston, TX 77030, USA
| | - Su Min Chang
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin, SM-1801, Houston, TX 77030, USA
| | - Mouaz Al-Mallah
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin, SM-1801, Houston, TX 77030, USA
| | - Dipan J Shah
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin, SM-1801, Houston, TX 77030, USA
| | - Arvind Bhimaraj
- Department of Cardiology, Methodist DeBakey Heart and Vascular Center, 6550 Fannin, SM-1801, Houston, TX 77030, USA
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Tison GH, Abreau S, Barrios J, Lim LJ, Yang M, Crudo V, Shah DJ, Nguyen T, Hu G, Dixit S, Nah G, Arya F, Bibby D, Lee Y, Delling FN. Identifying Mitral Valve Prolapse at Risk for Arrhythmias and Fibrosis From Electrocardiograms Using Deep Learning. JACC Adv 2023; 2:100446. [PMID: 37936601 PMCID: PMC10629907 DOI: 10.1016/j.jacadv.2023.100446] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Mitral valve prolapse (MVP) is a common valvulopathy, with a subset developing sudden cardiac death or cardiac arrest. Complex ventricular ectopy (ComVE) is a marker of arrhythmic risk associated with myocardial fibrosis and increased mortality in MVP. OBJECTIVES The authors sought to evaluate whether electrocardiogram (ECG)-based machine learning can identify MVP at risk for ComVE, death and/or myocardial fibrosis on cardiac magnetic resonance (CMR) imaging. METHODS A deep convolutional neural network (CNN) was trained to detect ComVE using 6,916 12-lead ECGs from 569 MVP patients from the University of California-San Francisco between 2012 and 2020. A separate CNN was trained to detect late gadolinium enhancement (LGE) using 1,369 ECGs from 87 MVP patients with contrast CMR. RESULTS The prevalence of ComVE was 28% (160/569). The area under the receiver operating characteristic curve (AUC) of the CNN to detect ComVE was 0.80 (95% CI: 0.77-0.83) and remained high after excluding patients with moderate-severe mitral regurgitation [0.80 (95% CI: 0.77-0.83)] or bileaflet MVP [0.81 (95% CI: 0.76-0.85)]. AUC to detect all-cause mortality was 0.82 (95% CI: 0.77-0.87). ECG segments relevant to ComVE prediction were related to ventricular depolarization/repolarization (early-mid ST-segment and QRS from V1, V3, and III). LGE in the papillary muscles or basal inferolateral wall was present in 24% patients with available CMR; AUC for detection of LGE was 0.75 (95% CI: 0.68-0.82). CONCLUSIONS CNN-analyzed 12-lead ECGs can detect MVP at risk for ventricular arrhythmias, death and/or fibrosis and can identify novel ECG correlates of arrhythmic risk. ECG-based CNNs may help select those MVP patients requiring closer follow-up and/or a CMR.
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Affiliation(s)
- Geoffrey H. Tison
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Sean Abreau
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Joshua Barrios
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Lisa J. Lim
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Michelle Yang
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Valentina Crudo
- Division of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Dipan J. Shah
- Division of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Thuy Nguyen
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Gene Hu
- Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Shalini Dixit
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Gregory Nah
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Farzin Arya
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Dwight Bibby
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Yoojin Lee
- Department of Radiology, University of California-San Francisco, San Francisco, California, USA
| | - Francesca N. Delling
- Cardiovascular Division, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
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Rajiah PS, Moore A, Broncano J, Anand V, Kolluri N, Shah DJ, Flamm SD, François CJ. Diastology with Cardiac MRI: A Practical Guide. Radiographics 2023; 43:e220144. [PMID: 37535462 DOI: 10.1148/rg.220144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Diastolic filling of the ventricle is a complex interplay of volume and pressure, contingent on active energy-dependent myocardial relaxation and myocardial stiffness. Abnormal diastolic function is the hallmark of the clinical entity of heart failure with preserved ejection fraction (HFpEF), which is now the dominant type of heart failure and is associated with significant morbidity and mortality. Although echocardiography is the current first-line imaging modality used in evaluation of diastolic function, cardiac MRI (CMR) is emerging as an important technique. The principal role of CMR is to categorize the cause of diastolic dysfunction (DD) and distinguish other entities that manifest similarly to HFpEF, particularly infiltrative and pericardial disorders. CMR also provides prognostic information and risk stratification based on late gadolinium enhancement and parametric mapping techniques. Advances in hardware, sequences, and postprocessing software now enable CMR to diagnose and grade DD accurately, a role traditionally assigned to echocardiography. Two-dimensional or four-dimensional velocity-encoded phase-contrast sequences can measure flow and velocities at the mitral inflow, mitral annulus, and pulmonary veins to provide diastolic functional metrics analogous to those at echocardiography. The commonly used cine steady-state free-precession sequence can provide clues to DD including left ventricular mass, left ventricular filling curves, and left atrial size and function. MR strain imaging provides information on myocardial mechanics that further aids in diagnosis and prognosis of diastolic function. Research sequences such as MR elastography and MR spectroscopy can help evaluate myocardial stiffness and metabolism, respectively, providing additional insights on diastolic function. The authors review the physiology of diastolic function, mechanics of diastolic heart failure, and CMR techniques in the evaluation of diastolic function. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Alastair Moore
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Jordi Broncano
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Vidhu Anand
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Nikhil Kolluri
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Dipan J Shah
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Scott D Flamm
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
| | - Christopher J François
- From the Departments of Radiology (P.S.R., C.J.F.) and Cardiology (V.A., N.K.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; Department of Radiology, Baylor Health System, Dallas, Tex (A.M.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Cardiology, Houston Methodist Hospital, Houston, Tex (D.J.S.); and Cardiovascular Imaging Laboratory, Cleveland Clinic Foundation, Cleveland, Ohio (S.D.F.)
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Malahfji M, Senapati A, Debs D, Saeed M, Tayal B, Nguyen DT, Graviss EA, Shah DJ. Sex differences in myocardial remodeling and extracellular volume in aortic regurgitation. Sci Rep 2023; 13:11334. [PMID: 37443191 PMCID: PMC10344872 DOI: 10.1038/s41598-023-37444-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Whether sex differences exist in the cardiac remodeling related to aortic regurgitation (AR) is unclear. Cardiac magnetic resonance (CMR) is the current non-invasive reference standard for cardiac remodeling assessment and can evaluate tissue characteristics. This prospective cohort included patients with AR undergoing CMR between 2011 and 2020. We excluded patients with confounding causes of remodeling. We quantified left ventricular (LV) volume, mass, AR severity, replacement fibrosis by late Gadolinium enhancement (LGE), and extracellular expansion by extracellular volume fraction (ECV). We studied 280 patients (109 women), median age 59.5 (47.2, 68.6) years (P for age = 0.25 between sexes). Women had smaller absolute LV volume and mass than men across the spectrum of regurgitation volume (RVol) (P ≤ 0.01). In patients with ≥ moderate AR and with adjustment for body surface area, indexed LV end-diastolic volume and mass were not significantly different between sexes (all P > 0.5) but men had larger indexed LV end systolic volume and lower LV ejection fraction (P ≥ 0.01). Women were more likely to have NYHA class II or greater symptoms than men but underwent surgery at a similar rate. Prevalence and extent of LGE was not significantly different between sexes or across RVol. Increasing RVol was independently associated with increasing ECV in women, but not in men (adjusted P for interaction = 0.03). In conclusion, women had lower LV volumes and mass than men across AR severity but their ECV increased with higher regurgitant volume, while ECV did not change in men. Indexing to body surface area did not fully correct for the cardiac remodeling differences between men and women. Women were more likely to have symptoms but underwent surgery at a similar rate to men. Further research is needed to determine if differences in ECV would translate to differences in the course of AR and outcomes.
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Affiliation(s)
- Maan Malahfji
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Alpana Senapati
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Dany Debs
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mujtaba Saeed
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Bhupendar Tayal
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, TX, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, TX, USA
| | - Dipan J Shah
- Cardiovascular MRI Laboratory, Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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Malahfji M, Crudo V, Kaolawanich Y, Nguyen DT, Telmesani A, Saeed M, Reardon MJ, Zoghbi WA, Polsani V, Elliott M, Bonow RO, Graviss EA, Kim R, Shah DJ. Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation. J Am Coll Cardiol 2023; 81:1885-1898. [PMID: 36882135 DOI: 10.1016/j.jacc.2023.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Quantitative cardiac magnetic resonance (CMR) outcome studies in aortic regurgitation (AR) are few. It is unclear if volume measurements are beneficial over diameters. OBJECTIVES This study sought to evaluate the association of CMR quantitative thresholds and outcomes in AR patients. METHODS In a multicenter study, asymptomatic patients with moderate or severe AR on CMR with preserved left ventricular ejection fraction (LVEF) were evaluated. Primary outcome was development of symptoms or decrease in LVEF to <50%, development of guideline indications for surgery based on LV dimensions, or death under medical management. Secondary outcome was the same as the primary outcome, excluding surgery for remodeling indications. We excluded patients who underwent surgery within 30 days of CMR. Receiver-operating characteristic analyses for the association with outcomes were performed. RESULTS We studied 458 patients (median age: 60 years; IQR: 46-70 years). During a median follow-up of 2.4 years (IQR: 0.9-5.3 years), 133 events occurred. Optimal thresholds were regurgitant volume of 47 mL and regurgitant fraction of 43%, indexed LV end-systolic (iLVES) volume of 43 mL/m2, indexed LV end-diastolic volume of 109 mL/m2, and iLVES diameter of 2 cm/m2. In multivariable regression analysis, iLVES volume of ≥43 mL/m2 (HR: 2.53; 95% CI: 1.75-3.66; P < 0.001) and indexed LV end-diastolic volume of ≥109 mL/m2 were independently associated with the outcomes and provided additional discrimination improvement over iLVES diameter, whereas iLVES diameter was independently associated with the primary outcome but not the secondary outcome. CONCLUSIONS In asymptomatic AR patients with preserved LVEF, CMR findings can be used to guide management. CMR-based LVES volume assessment performed favorably compared to LV diameters.
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Affiliation(s)
- Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Valentina Crudo
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, Texas, USA
| | - Amr Telmesani
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Mujtaba Saeed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | - Michael Elliott
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Robert O Bonow
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, Texas, USA
| | - Raymond Kim
- Division of Cardiology, Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
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Satish P, Rosser C, Khoshnevis G, Shah DJ, Fida N. A STRONG INFECTION AND A WEAK HEART. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03945-1] [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: 03/06/2023]
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15
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Guta AC, Qamar F, Nguyen DT, Pedraza J, Polsani VR, Liu S, Elliott MD, Graviss E, Shah DJ. RACIAL DISPARITY OF SURVIVAL IN PATIENTS WITH FUNCTIONAL TRICUSPID REGURGITATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02379-3] [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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Malahfji M, Kitkungvan D, Senapati A, Nguyen DT, El-Tallawi C, Tayal B, Debs D, Crudo V, Graviss EA, Reardon MJ, Quinones M, Zoghbi WA, Shah DJ. Differences in Myocardial Remodeling and Tissue Characteristics in Chronic Isolated Aortic and Mitral Regurgitation. Circ Cardiovasc Imaging 2023; 16:e014684. [PMID: 36880378 DOI: 10.1161/circimaging.122.014684] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND The left ventricular hemodynamic load differs between aortic regurgitation (AR) and primary mitral regurgitation (MR). We used cardiac magnetic resonance to compare left ventricular remodeling patterns, systemic forward stroke volume, and tissue characteristics between patients with isolated AR and isolated MR. METHODS We assessed remodeling parameters across the spectrum of regurgitant volume. Left ventricular volumes and mass were compared against normal values for age and sex. We calculated forward stroke volume (planimetered left ventricular stroke volume-regurgitant volume) and derived a cardiac magnetic resonance-based systemic cardiac index. We assessed symptom status according to remodeling patterns. We also evaluated the prevalence of myocardial scarring using late gadolinium enhancement imaging, and the extent of interstitial expansion via extracellular volume fraction. RESULTS We studied 664 patients (240 AR, 424 primary MR), median age of 60.7 (49.5-69.9) years. AR led to more pronounced increases in ventricular volume and mass compared with MR across the spectrum of regurgitant volume (P<0.001). In ≥moderate regurgitation, AR patients had a higher prevalence of eccentric hypertrophy (58.3% versus 17.5% in MR; P<0.001), whereas MR patients had normal geometry (56.7%) followed by myocardial thinning with low mass/volume ratio (18.4%). The patterns of eccentric hypertrophy and myocardial thinning were more common in symptomatic AR and MR patients (P<0.001). Systemic cardiac index remained unchanged across the spectrum of AR, whereas it progressively declined with increasing MR volume. Patients with MR had a higher prevalence of myocardial scarring and higher extracellular volume with increasing regurgitant volume (P value for trend <0.001), whereas they were unchanged across the spectrum of AR (P=0.24 and 0.42, respectively). CONCLUSIONS Cardiac magnetic resonance identified significant heterogeneity in remodeling patterns and tissue characteristics at matched degrees of AR and MR. Further research is needed to examine if these differences impact reverse remodeling and clinical outcomes after intervention.
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Affiliation(s)
- Maan Malahfji
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Danai Kitkungvan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
- Division of Cardiology, Department of Internal Medicine, University of Texas McGovern School of Medicine, Houston (D.K.)
| | - Alpana Senapati
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
- Intermountain Medical Center, Salt Lake City, UT (A.S.)
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, TX (D.T.N., E.A.G.)
| | - Carlos El-Tallawi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Bhupendar Tayal
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Dany Debs
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Valentina Crudo
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, TX (D.T.N., E.A.G.)
| | - Michael J Reardon
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Miguel Quinones
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - William A Zoghbi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (M.M., D.K., A.S., C.E.-T., B.T., D.D., V.C., M.J.R., M.Q., W.A.Z., D.J.S.)
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Malahfji M, Kaolawanich Y, Nguyen DT, Crudo VL, Telmesani A, Saeed M, Reardon MJ, Zoghbi WA, Elliott MD, Polsani VR, Graviss E, Kim RJ, Shah DJ. MYOCARDIAL SCAR AND OUTCOMES IN CHRONIC AORTIC REGURGITATION: DATA FROM THE AR CONSORTIUM OF THE SCMR REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02418-x] [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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Malahfji M, Crudo VL, Kaolawanich Y, Nguyen DT, Telmesani A, Saeed M, Reardon MJ, Zoghbi WA, Polsani VR, Elliott MD, Graviss E, Kim RJ, Shah DJ. IMPACT OF CARDIAC REMODELING ON OUTCOMES OF CHRONIC AORTIC REGURGITATION: DATA FROM THE UNITED STATES CMR-AR CONSORTIUM OF THE SCMR REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02376-8] [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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19
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Guta AC, Qamar F, Nguyen DT, Pedraza J, Polsani VR, Liu S, Elliott MD, Graviss E, Shah DJ. IMPACT OF FUNCTIONAL TRICUSPID REGURGITATION ON EXCESS MORTALITY: A LARGE MULTICENTER STUDY USING CARDIAC MAGNETIC RESONANCE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01784-9] [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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Gimnich OA, Belousova T, Short CM, Taylor AA, Nambi V, Morrisett JD, Ballantyne CM, Bismuth J, Shah DJ, Brunner G. Magnetic Resonance Imaging-Derived Microvascular Perfusion Modeling to Assess Peripheral Artery Disease. J Am Heart Assoc 2023; 12:e027649. [PMID: 36688362 PMCID: PMC9973623 DOI: 10.1161/jaha.122.027649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/14/2022] [Indexed: 01/24/2023]
Abstract
Background Computational fluid dynamics has shown good agreement with contrast-enhanced magnetic resonance imaging measurements in cardiovascular disease applications. We have developed a biomechanical model of microvascular perfusion using contrast-enhanced magnetic resonance imaging signal intensities derived from skeletal calf muscles to study peripheral artery disease (PAD). Methods and Results The computational microvascular model was used to study skeletal calf muscle perfusion in 56 individuals (36 patients with PAD, 20 matched controls). The recruited participants underwent contrast-enhanced magnetic resonance imaging and ankle-brachial index testing at rest and after 6-minute treadmill walking. We have determined associations of microvascular model parameters including the transfer rate constant, a measure of vascular leakiness; the interstitial permeability to fluid flow which reflects the permeability of the microvasculature; porosity, a measure of the fraction of the extracellular space; the outflow filtration coefficient; and the microvascular pressure with known markers of patients with PAD. Transfer rate constant, interstitial permeability to fluid flow, and microvascular pressure were higher, whereas porosity and outflow filtration coefficient were lower in patients with PAD than those in matched controls (all P values ≤0.014). In pooled analyses of all participants, the model parameters (transfer rate constant, interstitial permeability to fluid flow, porosity, outflow filtration coefficient, microvascular pressure) were significantly associated with the resting and exercise ankle-brachial indexes, claudication onset time, and peak walking time (all P values ≤0.013). Among patients with PAD, interstitial permeability to fluid flow, and microvascular pressure were higher, while porosity and outflow filtration coefficient were lower in treadmill noncompleters compared with treadmill completers (all P values ≤0.001). Conclusions Computational microvascular model parameters differed significantly between patients with PAD and matched controls. Thus, computational microvascular modeling could be of interest in studying lower extremity ischemia.
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Affiliation(s)
- Olga A. Gimnich
- Penn State Heart and Vascular Institute, Pennsylvania State University College of MedicineHersheyPA
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular CenterHouston Methodist HospitalHoustonTX
| | - Christina M. Short
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Addison A. Taylor
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Michael E DeBakey VA Medical CenterHoustonTX
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Department of Medicine, Section of CardiologyBaylor College of MedicineHoustonTX
- Michael E DeBakey VA Medical CenterHoustonTX
| | - Joel D. Morrisett
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Christie M. Ballantyne
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Department of Medicine, Section of CardiologyBaylor College of MedicineHoustonTX
| | - Jean Bismuth
- Division of Vascular and Endovascular SurgeryLouisiana State University Health Sciences CenterNew OrleansLA
| | - Dipan J. Shah
- Methodist DeBakey Heart and Vascular CenterHouston Methodist HospitalHoustonTX
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, Pennsylvania State University College of MedicineHersheyPA
- Section of Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
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Lewandowski D, Yang EY, Nguyen DT, Khan MA, Malahfji M, El Tallawi C, Chamsi Pasha MA, Graviss EA, Shah DJ, Nagueh SF. Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk Stratification. JACC Cardiovasc Imaging 2023:S1936-878X(23)00032-3. [PMID: 37038874 DOI: 10.1016/j.jcmg.2022.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/27/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis. OBJECTIVES In this study, the authors sought to determine the association of LV diastolic function by to echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations. METHODS A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV). RESULTS Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03). CONCLUSIONS Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.
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Affiliation(s)
| | - Eric Y Yang
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Mohammad A Khan
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Maan Malahfji
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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23
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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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24
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Guta AC, El-Tallawi KC, Nguyen DT, Qamar F, Nguyen T, Zoghbi WA, Lawrie G, Graviss EA, Shah DJ. Prevalence and Clinical Implications of Tricuspid Valve Prolapse Based on Magnetic Resonance Diagnostic Criteria. J Am Coll Cardiol 2023; 81:S0735-1097(22)07642-2. [PMID: 36813687 DOI: 10.1016/j.jacc.2022.11.052] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND Tricuspid valve prolapse (TVP) is an uncertain diagnosis with unknown clinical significance because of a scarcity of published data. OBJECTIVES In this study, cardiac magnetic resonance was used to: 1) propose diagnostic criteria for TVP; 2) evaluate the prevalence of TVP in patients with primary mitral regurgitation (MR); and 3) identify the clinical implications of TVP with regard to tricuspid regurgitation (TR). METHODS Forty-one healthy volunteers were analyzed to identify normal tricuspid leaflet displacement and propose criteria for TVP. A total of 465 consecutive patients with primary MR (263 with mitral valve prolapse [MVP] and 202 with nondegenerative mitral valve disease [non-MVP]) were phenotyped for the presence and clinical significance of TVP. RESULTS The proposed TVP criteria included right atrial displacement of ≥2 mm for the anterior and posterior tricuspid leaflets and ≥3 mm for the septal leaflet. Thirty-one (24%) subjects with single-leaflet MVP and 63 (47%) with bileaflet MVP met the proposed criteria for TVP. TVP was not evident in the non-MVP cohort. Patients with TVP were more likely to have severe MR (38.3% vs 18.9%; P < 0.001) and advanced TR (23.4% of patients with TVP demonstrated moderate or severe TR vs 6.2% of patients without TVP; P < 0.001), independent of right ventricular systolic function. CONCLUSIONS TR in subjects with MVP should not be routinely considered functional, as TVP is a prevalent finding associated with MVP and more often associated with advanced TR compared with patients with primary MR without TVP. A comprehensive assessment of tricuspid anatomy should be an important component of the preoperative evaluation for mitral valve surgery.
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Affiliation(s)
- Andrada C Guta
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | - Duc T Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Fatima Qamar
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Thuy Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Gerald Lawrie
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Edward A Graviss
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
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25
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Osztrogonacz P, Berczeli M, Chinnadurai P, Chang SM, Shah DJ, Lumsden AB. Dynamic Imaging of Aortic Pathologies: Review of Clinical Applications and Imaging Protocols. Methodist Debakey Cardiovasc J 2023; 19:4-14. [PMID: 36910554 PMCID: PMC10000327 DOI: 10.14797/mdcvj.1172] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 03/09/2023] Open
Abstract
The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies. However, despite growing evidence of their advantages in the literature, they have not been routinely adopted. In order to understand the role of these emerging modalities, one must understand their principles, advantages, and limitations in the context of various clinical scenarios. In this review, we provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions.
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Affiliation(s)
- Peter Osztrogonacz
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Marton Berczeli
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Ponraj Chinnadurai
- Houston Methodist Hospital, Houston, Texas, US.,Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, US
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26
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Ajmone Marsan N, Delgado V, Shah DJ, Pellikka P, Bax JJ, Treibel T, Cavalcante JL. Valvular heart disease: shifting the focus to the myocardium. Eur Heart J 2023; 44:28-40. [PMID: 36167923 PMCID: PMC9805407 DOI: 10.1093/eurheartj/ehac504] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/12/2022] [Accepted: 08/26/2022] [Indexed: 01/05/2023] Open
Abstract
Adverse cardiac remodelling is the main determinant of patient prognosis in degenerative valvular heart disease (VHD). However, to give an indication for valvular intervention, current guidelines include parameters of cardiac chamber dilatation or function which are subject to variability, do not directly reflect myocardial structural changes, and, more importantly, seem to be not sensitive enough in depicting early signs of myocardial dysfunction before irreversible myocardial damage has occurred. To avoid irreversible myocardial dysfunction, novel biomarkers are advocated to help refining indications for intervention and risk stratification. Advanced echocardiographic modalities, including strain analysis, and magnetic resonance imaging have shown to be promising in providing new tools to depict the important switch from adaptive to maladaptive myocardial changes in response to severe VHD. This review, therefore, summarizes the current available evidence on the role of these new imaging biomarkers in degenerative VHD, aiming at shifting the clinical perspective from a valve-centred to a myocardium-focused approach for patient management and therapeutic decision-making.
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Affiliation(s)
- Nina Ajmone Marsan
- Department of Cardiology, Leiden Univesity Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden Univesity Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
- Department of Cardiology, Germans Trias i Pujol Hospital, Carretera de Canyet s/n. 08916 Badalona, Barcelona, Spain
| | - Dipan J Shah
- Division of Cardiovascular Imaging, Weill Cornell Medical College, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St, Houston, TX 77030, USA
| | - Patricia Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden Univesity Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Thomas Treibel
- Department of Cardiology, Barts Heart Centre and University College London, West Smithfield, London EC1A 7BE, UK
| | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute at Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
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27
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Telmesani A, Chang SM, Faza N, Little SH, Shah DJ. Role of Multimodality Imaging in Transcatheter Structural Interventions. Methodist Debakey Cardiovasc J 2023; 19:91-104. [PMID: 37213875 PMCID: PMC10198236 DOI: 10.14797/mdcvj.1209] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
Cardiac imaging is the backbone for safe and optimal transcatheter structural interventions. Transthoracic echocardiogram is the initial modality to assess valvular disorders, while transesophageal echocardiogram is best to delineate the mechanism of valvular regurgitation, preprocedural assessment for transcatheter edge-to-edge repair, and for intraprocedural guidance. Cardiac computed tomography is the modality of choice for assessing calcifications, maneuvering multiplaner reconstruction of different cardiac structures, preprocedural planning for various transcatheter valve replacement, and assessing for hypoattenuated leaflet thickening and reduced leaflet motion. Cardiac magnetic resonance imaging is best known for most accurate volumetric assessment of valvular regurgitation and chamber size quantification. Cardiac positron emission tomography is the only modality that could assess active infection through using fluorine 18 fluorodeoxyglucose radiotracer.
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Affiliation(s)
- Amr Telmesani
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Nadeen Faza
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Stephen H. Little
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Dipan J. Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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28
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Delling FN, Noseworthy PA, Adams DH, Basso C, Borger M, Bouatia-Naji N, Elmariah S, Evans F, Gerstenfeld E, Hung J, Tourneau TL, Lewis J, Miller MA, Norris RA, Padala M, Perazzolo-Marra M, Shah DJ, Weinsaft JW, Enriquez-Sarano M, Levine RA. Research Opportunities in the Treatment of Mitral Valve Prolapse: JACC Expert Panel. J Am Coll Cardiol 2022; 80:2331-2347. [PMID: 36480975 PMCID: PMC9981237 DOI: 10.1016/j.jacc.2022.09.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 12/10/2022]
Abstract
In light of the adverse prognosis related to severe mitral regurgitation, heart failure, or sudden cardiac death in a subset of patients with mitral valve prolapse (MVP), identifying those at higher risk is key. For the first time in decades, researchers have the means to rapidly advance discovery in the field of MVP thanks to state-of-the-art imaging techniques, novel omics methodologies, and the potential for large-scale collaborations using web-based platforms. The National Heart, Lung, and Blood Institute recently initiated a webinar-based workshop to identify contemporary research opportunities in the treatment of MVP. This report summarizes 3 specific areas in the treatment of MVP that were the focus of the workshop: 1) improving management of degenerative mitral regurgitation and associated left ventricular systolic dysfunction; 2) preventing sudden cardiac death in MVP; and 3) understanding the mechanisms and progression of MVP through genetic studies and small and large animal models, with the potential of developing medical therapies.
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Affiliation(s)
- Francesca N. Delling
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA
| | - Peter A. Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - David H. Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Sammy Elmariah
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA,Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frank Evans
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Edward Gerstenfeld
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA
| | - Judy Hung
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | - John Lewis
- Heart Valve Voice US, Washington, DC, USA
| | - Marc A. Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Muralidhar Padala
- Department of Surgery (Cardiothoracic Surgery Division), Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Dipan J. Shah
- Department of Cardiology, Houston Methodist, Weill Cornell Medical College, Houston, Texas, USA
| | | | | | - Robert A. Levine
- Massachusetts General Hospital Cardiac Ultrasound Laboratory, Boston, Massachusetts, USA
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29
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Darty S, Jenista E, Kim RJ, Dyke C, Simonetti OP, Radike M, Bryant J, Lawton CB, Freitag N, Shah DJ, Bucciarelli-Ducci C, Raman S, Plein S, Elliott MD. Society for cardiovascular magnetic resonance recommendations for training and competency of CMR technologists. J Cardiovasc Magn Reson 2022; 24:68. [PMID: 36464719 PMCID: PMC9721081 DOI: 10.1186/s12968-022-00900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 12/07/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) recommendations for training and competency of cardiovascular magnetic resonance (CMR) technologists document will define the knowledge, experiences and skills required for a technologist to be competent in CMR imaging. By providing a framework for CMR training and competency the overarching goal is to promote the performance of high-quality CMR and to foster the increased adoption of CMR into clinical care.
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Affiliation(s)
- Stephen Darty
- Division of Cardiology, Duke University, Durham, NC, USA
| | | | - Raymond J Kim
- Division of Cardiology, Duke University, Durham, NC, USA
| | | | | | - Monika Radike
- Department of Radiology, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - Jen Bryant
- National Heart Centre, Singapore, Singapore
| | | | - Nicole Freitag
- Division of Cardiology, Allina Health, Minneapolis, MN, USA
| | - Dipan J Shah
- Division of Cardiology, Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Subha Raman
- Division of Cardiology, Indiana University, Indianapolis, IN, USA
| | - Sven Plein
- Division of Cardiology, University of Leeds, Leeds, UK
| | - Michael D Elliott
- Atrium Health/Sanger Heart & Vascular Institute, Charlotte, NC, USA.
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30
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Vidula MK, Rajewska-Tabor J, Cao JJ, Kang Y, Craft J, Mei W, Chandrasekaran PS, Clark DE, Poenar AM, Gorecka M, Malahfji M, Cowan E, Kwan JM, Reinhardt SW, Al-Tabatabaee S, Doeblin P, Villa ADM, Karagodin I, Alvi N, Christia P, Spetko N, Cassar MP, Park C, Nambiar L, Turgut A, Azad MR, Lambers M, Wong TC, Salerno M, Kim J, Elliott M, Raman B, Neubauer S, Tsao CW, LaRocca G, Patel AR, Chiribiri A, Kelle S, Baldassarre LA, Shah DJ, Hughes SG, Tong MS, Pyda M, Simonetti OP, Plein S, Han Y. Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement. JACC Cardiovasc Imaging 2022; 16:609-624. [PMID: 36752429 PMCID: PMC9833283 DOI: 10.1016/j.jcmg.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/05/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. OBJECTIVES The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). METHODS This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction-confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. RESULTS In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003). CONCLUSIONS In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.
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Affiliation(s)
- Mahesh K Vidula
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justyna Rajewska-Tabor
- Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland
| | - J Jane Cao
- St. Francis Hospital, Roslyn, New York, USA
| | - Yu Kang
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Daniel E Clark
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ana-Maria Poenar
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Miroslawa Gorecka
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Maan Malahfji
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Eilidh Cowan
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Jennifer M Kwan
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Samuel W Reinhardt
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Ilya Karagodin
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nazia Alvi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Nicholas Spetko
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark Philip Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Christine Park
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lakshmi Nambiar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alper Turgut
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mahan Roosta Azad
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Timothy C Wong
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gina LaRocca
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Lauren A Baldassarre
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dipan J Shah
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Sean G Hughes
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S Tong
- Division of Cardiology, The Ohio State University, Columbus, Ohio, USA
| | - Malgorzata Pyda
- Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Yuchi Han
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Cardiology, The Ohio State University, Columbus, Ohio, USA.
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Valderrábano M, Rojas SCF, Lador A, Patel A, Schurmann PA, Tapias C, Rodríguez D, Sáenz LC, Malahjfi M, Shah DJ, Mathuria N, Dave AS. Substrate Ablation by Multivein, Multiballoon Coronary Venous Ethanol for Refractory Ventricular Tachycardia in Structural Heart Disease. Circulation 2022; 146:1644-1656. [PMID: 36321460 PMCID: PMC9712228 DOI: 10.1161/circulationaha.122.060882] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/16/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ablation of ventricular tachycardia (VT) in the setting of structural heart disease often requires extensive substrate elimination that is not always achievable by endocardial radiofrequency ablation. Epicardial ablation is not always feasible. Case reports suggest that venous ethanol ablation (VEA) through a multiballoon, multivein approach can lead to effective substrate ablation, but large data sets are lacking. METHODS VEA was performed in 44 consecutive patients with ablation-refractory VT (ischemic, n=21; sarcoid, n=3; Chagas, n=2; idiopathic, n=18). Targeted veins were selected by mapping coronary veins on the epicardial aspect of endocardial scar (identified by bipolar voltage <1.5 mV), using venography and signal recording with a 2F octapolar catheter or by guidewire unipolar signals. Epicardial mapping was performed in 15 patients. Vein segments in the epicardial aspect of VT substrates were treated with double-balloon VEA by blocking flow with 1 balloon while injecting ethanol through the lumen of the second balloon, forcing (and restricting) ethanol between balloons. Multiple balloon deployments and multiple veins were used as needed. In 22 patients, late gadolinium enhancement cardiac magnetic resonance imaged the VEA scar and its evolution. RESULTS Median ethanol delivered was 8.75 (interquartile range, 4.5-13) mL. Injected veins included interventricular vein (6), diagonal (5), septal (12), lateral (16), posterolateral (7), and middle cardiac vein (8), covering the entire range of left ventricular locations. Multiple veins were targeted in 14 patients. Ablated areas were visualized intraprocedurally as increased echogenicity on intracardiac echocardiography and incorporated into 3-dimensional maps. After VEA, vein and epicardial ablation maps showed elimination of abnormal electrograms of the VT substrate. Intracardiac echocardiography demonstrated increased intramural echogenicity at the targeted region of the 3-dimensional maps. At 1 year of follow-up, median of 314 (interquartile range, 198-453) days of follow-up, VT recurrence occurred in 7 patients, for a success of 84.1%. CONCLUSIONS Multiballoon, multivein intramural ablation by VEA can provide effective substrate ablation in patients with ablation-refractory VT in the setting of structural heart disease over a broad range of left ventricular locations.
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Affiliation(s)
- Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Adi Lador
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Apoor Patel
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Paul A. Schurmann
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | | | | | - Maan Malahjfi
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Dipan J. Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Nilesh Mathuria
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Amish S. Dave
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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Fuentes Rojas SC, Malahjfi M, Tavares L, Patel A, Schurmann PA, Dave AS, Tapias C, Rodríguez D, Sáenz LC, Korolev S, Papiashvili G, Peichl P, Kautzner J, Blaszyk K, Malaczynska-Rajpold K, Chen T, Santangeli P, Shah DJ, Valderrábano M. Acute and Long-Term Scar Characterization of Venous Ethanol Ablation in the Left Ventricular Summit. JACC Clin Electrophysiol 2022; 9:28-39. [PMID: 37166222 DOI: 10.1016/j.jacep.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA. OBJECTIVES The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS. METHODS VEA was performed in 59 patients with LVS ventricular arrhythmias. Targeted intramural veins were selected by electrograms from a 2F octapolar catheter or by guide-wire unipolar signals. Median ethanol delivered was 4 mL (IQR: 4-7 mL). Ablated areas were estimated intraprocedurally as increased echogenicity on intracardiac echocardiography (ICE) and incorporated into 3-dimensional maps. In 44 patients, late gadolinium enhancement cardiac magnetic resonance (CMR) imaged VEA scar and its evolution. RESULTS ICE-demonstrated increased intramural echogenicity (median volume of 2 mL; IQR: 1.7-4.3) at the targeted region of the 3-dimensional maps. Post-ethanol CMR showed intramural scar of 2.5 mL (IQR: 2.1-3.5 mL). Early (within 48 hours after VEA) CMR showed microvascular obstruction (MVO) in 30 of 31 patients. Follow-up CMR after a median of 51 (IQR: 41-170) days showed evolution of MVO to scar. ICE echogenicity and CMR scar volumes correlated with each other and with ethanol volume. Ventricular function and interventricular septum remained intact. CONCLUSIONS VEA leads to intramural ablation that can be tracked intraprocedurally by ICE and creates regions of MVO that are chronically replaced by myocardial scar. VEA scar volume does not compromise septal integrity or ventricular function.
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Malahfji M, Ahmed AI, Han Y, Jung AK, Alnabelsi T, Nabi F, Shah DJ, Aljizeeri A, Poitrasson-Rivière A, Ficaro E, Mahmarian JJ, Al-Mallah MH. Left ventricular mass on positron emission tomography: Validation against cardiovascular magnetic resonance. J Nucl Cardiol 2022; 29:1632-1642. [PMID: 33629247 DOI: 10.1007/s12350-021-02537-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is an important clinical finding that is independently associated with mortality and cardiovascular events. We aimed to assess the interstudy variability of LV mass quantitation between PET and CMR. METHODS Patients who underwent both PET and CMR within 1 year were identified from prospective institutional registries. LV mass on PET was compared against LV mass on CMR using several statistical measures of agreement. RESULTS A total of 105 patients (mean age 60 ± 14 years, 67.6% male) were included. The median (interquartile range, IQR) duration between CMR and PET was 47 (11-154) days. The median (IQR) LV mass values were 168.0 g (126.0-202.0) on CMR and 174.0 g (150.0-212.0) with PET (absolute mean difference 29.42 ± 25.3). There was a good correlation (Spearman ρ = 0.81, P < 0.001; Intraclass Correlation Coefficient 0.78, 95% CI 0.70-0.85, P < 0.001) with moderate limits of agreement (95% limits of agreement - 63.78 to 83.7.) Results were consistent, albeit with moderate correlation, in subgroups of patients with LVH, in patients with myocardial infarction, in patients with LV ejection fraction < 50%, and those with limited image quality. LV mass on PET tended to be underestimated at high values compared to CMR. CONCLUSION We demonstrate good correlation and reproducibility of LV mass quantitation by PET against the reference standard of CMR across a wide range of normal and diseased hearts with a tendency of PET to underestimate mass at higher mass values.
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Affiliation(s)
- Maan Malahfji
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ahmed Ibrahim Ahmed
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Aaron K Jung
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Talal Alnabelsi
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Dipan J Shah
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - John J Mahmarian
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
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Vejpongsa P, Xu J, Quinones MA, Shah DJ, Zoghbi WA. Differences in Cardiac Remodeling in Left-Sided Valvular Regurgitation: Implications for Optimal Definition of Significant Aortic Regurgitation. JACC Cardiovasc Imaging 2022; 15:1730-1741. [PMID: 35842362 DOI: 10.1016/j.jcmg.2022.05.006] [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: 03/23/2022] [Revised: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Grading of aortic regurgitation (AR) and mitral regurgitation (MR) is similar in the cardiology guidelines despite distinct differences in left ventricular (LV) adaptive pathophysiology. OBJECTIVES This study compared differences in LV remodeling in patients with similar degrees of AR and MR severity and evaluated optimal cutoffs for significant AR in relation to the outcome of aortic valve replacement or repair (AVR) during follow-up. METHODS From 2008 to 2018, consecutive patients with isolated AR or MR who had cardiovascular magnetic resonance (CMR) were identified and CMR parameters were compared. Patients with left ventricular ejection fraction (LVEF) <50%, ischemic scar >5%, valve stenosis, or concomitant regurgitation were excluded. Patients were followed longitudinally for AVR. RESULTS Baseline characteristics of isolated AR (n = 418) and isolated MR (n = 1,073) were comparable except for higher male proportion and hypertension in AR, while heart failure was more prevalent in MR. Indexed LV end-diastolic and end-systolic volumes and mass were higher in AR compared with MR at the same level of regurgitant fraction. During follow-up (mean 2.1 years), 18.7% of AR patients underwent AVR based on symptoms or LV remodeling. Interestingly, 38.0% of patients that underwent AVR within 3 months after CMR did not meet severe AVR by current guidelines of AR severity. AR regurgitant fraction>35% had high sensitivity (86%) and specificity (88%) for identifying patients who underwent AVR. CONCLUSIONS For similar regurgitation severity, LV remodeling is different in AR compared with MR. Cardiac symptoms and significant LV remodeling in AR requiring AVR occur frequently in patients with less severity than currently proposed. The study findings suggest that the optimal threshold for severe AR with CMR is different than MR and is lower than currently stated in the guidelines.
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Affiliation(s)
- Pimprapa Vejpongsa
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jiaqiong Xu
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Miguel A Quinones
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Ali HJR, Kassi M, Agrawal T, Shah DJ, Alnabelsi T, El-Tallawi C, Al-Mallah M, Bhimaraj A. Inflammatory Cardiomyopathies. JACC Case Rep 2022; 4:632-638. [PMID: 35615210 PMCID: PMC9125516 DOI: 10.1016/j.jaccas.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/05/2022]
Abstract
We present 3 cases of inflammatory cardiomyopathies illustrating the need for a multimodality imaging and multidisciplinary approach for diagnosis and treatment. (Level of Difficulty: Intermediate.)
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Kerani D, Patel HA, Zhang TJ, Lin A, Ozel O, Vahidy FS, McCane D, Dinh TN, Ling KC, Chiu D, Volpi JJ, GADHIA RAJANR, Shah DJ, Chamsi-Pasha M, Garg T. Abstract TP105: Optimizing The Utilization Of Cardiac Magnetic Resonance Imaging Among Patients With Ischemic Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp105] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The current AHA guidelines recommend (class IIb) advanced cardiac imaging in an embolic stroke of unknown source (ESUS). We aim to better characterize the role of cardiac MRI (cMRI) in the evaluation of stroke patients and determine patient characteristics that may increase the positive predictive value of cMRI.
Method:
A retrospective review of stroke patients at a comprehensive stroke center, who had cMRI between 12/2016 and 11/2020 was conducted using institutional registries. Ischemic stroke patients with ESUS, cryptogenic (with ESUS as a competing etiology), and cardioembolic etiologies were included. Cases with TIA, large vessel, small vessel, or hemodynamic etiologies were excluded. Cardioembolic etiology was defined as newly diagnosed Afib patients with TTE abnormalities including wall motion abnormalities and/or reduced LVEF <50%, stroke while compliant with anticoagulation for known Afib, or among whom the timing of restarting anticoagulation was in question. TTE and cMRI results from all cases were reviewed for remarkable findings, most notably intracardiac thrombus, and analyzed if a change in anti-thrombotic therapy was directly attributable to cMRI results.
Results:
As per our criteria, 250 cases (Female 44.4%, Black 29.6%, Age mean: 65.2 years) were included, of whom 146 (58.4%) were ESUS, 86 (34.4%) were cryptogenic, and 18 (7.2%) were cardioembolic. Sixteen (6.4%) revealed intracardiac thrombus, of which 10 had LV thrombus, 5 had LA thrombus, and 1 had RA thrombus along with questionable PFO on cMRI. Of these, 14 (87.5%) had an escalation of anti-thrombotic therapy. For the other 2 cases, despite cMRI obtained due to low LVEF and revealing LA thrombus, antithrombotic regimen was not changed. Eight (3.2%) additional patients were placed on anticoagulation secondary to incidental findings.
Conclusion:
In this large retrospective analysis of 250 select stroke cases, escalation of anti-thrombotic therapy from anti-platelets to full dose anti-coagulation was indicated in 14 patients (5.6%) with addition of cMRI. Further analysis of data is in process to determine the subset of stroke patients who would benefit the most from cMRI.
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Affiliation(s)
- Danish Kerani
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | | | - Tony J Zhang
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | - Andy Lin
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | - Osman Ozel
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | | | - David McCane
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | | | | | - David Chiu
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | - John J Volpi
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
| | | | - Dipan J Shah
- Dept of Cardiology, Houston Methodist Hosp, Houston, TX
| | | | - Tanu Garg
- Dept of Neurology, Houston Methodist Hosp, Houston, TX
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Balakrishna AM, Ismayl M, Thandra A, Walters R, Ganesan V, Anugula D, Shah DJ, Aboeata A. Diagnostic value of Cardiac Magnetic Resonance Imaging and Intracoronary Optical Coherence Tomography in patients with a working diagnosis of Myocardial Infarction with Non-obstructive Coronary Arteries - A Systematic review and Meta-analysis. Curr Probl Cardiol 2022; 48:101126. [PMID: 35120967 DOI: 10.1016/j.cpcardiol.2022.101126] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to study the efficacy of cardiac magnetic resonance imaging (CMR) and intracoronary optical coherence tomography (OCT) in detecting the etiology of myocardial infarction with non-obstructive coronary arteries (MINOCA). METHODS A systematic search was conducted in PubMed, Medline, and Cochrane databases. Search terms used: Myocardial infarction, Coronary angiography, Normal coronary arteries, CMR, and OCT. Inclusion criteria was fulfilled by 18 studies. Meta-analysis was performed with 15 studies. RESULTS A total of 2697 patients were included. The mean age of all the patients was 51.5 and 56.4% were men. CMR established diagnosis in 74% of the patients; 29% had acute myocarditis, 18% had true myocardial infarction and 12% had takotsubo cardiomyopathy. Combining OCT with CMR was better at finding the etiology than either modality individually. CONCLUSION CMR is integral in identifying the etiology of MINOCA. Coupling OCT and CMR is better than either technique individually at finding the cause.
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Affiliation(s)
| | - Mahmoud Ismayl
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Abhishek Thandra
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Ryan Walters
- Department of Clinical Research, Creighton University, Omaha, NE, USA
| | - Vaishnavi Ganesan
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Dixitha Anugula
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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Crudo VL, Ahmed AI, Cowan EL, Shah DJ, Al-Mallah MH, Malahfji M. Acute and Subclinical Myocardial Injury in COVID-19. Methodist Debakey Cardiovasc J 2022; 17:22-30. [PMID: 34992721 PMCID: PMC8680173 DOI: 10.14797/mdcvj.1038] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic that, at the time of this writing, has led to 178,000,000 cases worldwide and more than 3,875,000 deaths. Cardiovascular complications of COVID-19 have become the focus of investigation after many hospitalized COVID-19 patients-with or without established cardiovascular disease-incurred clinical or subclinical myocardial injury, including isolated biomarker elevations, myocardial infarction, arrhythmia, heart failure, myocarditis, and cardiogenic shock. In this review, we highlight the most recent evidence of the prevalence and potential etiologies of acute and subclinical myocardial injury in COVID-19 patients.
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Affiliation(s)
- Valentina L Crudo
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Ahmed I Ahmed
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Eilidh L Cowan
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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Shenoy C, Grizzard JD, Shah DJ, Kassi M, Reardon MJ, Zagurovskaya M, Kim HW, Parker MA, Kim RJ. Cardiovascular magnetic resonance imaging in suspected cardiac tumour: a multicentre outcomes study. Eur Heart J 2021; 43:71-80. [PMID: 34545397 PMCID: PMC8720142 DOI: 10.1093/eurheartj/ehab635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/08/2021] [Revised: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) imaging is a key diagnostic tool for the evaluation of patients with suspected cardiac tumours. Patient management is guided by the CMR diagnosis, including no further testing if a mass is excluded or if only a pseudomass is found. However, there are no outcomes studies validating this approach. METHODS AND RESULTS In this multicentre study of patients undergoing clinical CMR for suspected cardiac tumour, CMR diagnoses were assigned as no mass, pseudomass, thrombus, benign tumour, or malignant tumour. A final diagnosis was determined after follow-up using all available data. The primary endpoint was all-cause mortality. Among 903 patients, the CMR diagnosis was no mass in 25%, pseudomass in 16%, thrombus in 16%, benign tumour in 17%, and malignant tumour in 23%. Over a median of 4.9 years, 376 patients died. Compared with the final diagnosis, the CMR diagnosis was accurate in 98.4% of patients. Patients with CMR diagnoses of pseudomass and benign tumour had similar mortality to those with no mass, whereas those with malignant tumour [hazard ratio (HR) 3.31 (2.40-4.57)] and thrombus [HR 1.46 (1.00-2.11)] had greater mortality. The CMR diagnosis provided incremental prognostic value over clinical factors including left ventricular ejection fraction, coronary artery disease, and history of extracardiac malignancy (P < 0.001). CONCLUSION In patients with suspected cardiac tumour, CMR has high diagnostic accuracy. Patients with CMR diagnoses of no mass, pseudomass, and benign tumour have similar long-term mortality. The CMR diagnosis is a powerful independent predictor of mortality incremental to clinical risk factors.
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Affiliation(s)
- Chetan Shenoy
- University of Minnesota Medical Center, Cardiovascular Division, Department of Medicine, 420 Delaware St MMC 508, Minneapolis, MN, USA
| | - John D Grizzard
- Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA, USA
| | - Dipan J Shah
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Mahwash Kassi
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Michael J Reardon
- Houston Methodist Hospital, 6550 Fannin St Suite 1901, Houston, TX, USA
| | - Marianna Zagurovskaya
- Virginia Commonwealth University Medical Center, 1250 E. Marshall Street, Richmond, VA, USA
| | - Han W Kim
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
| | - Michele A Parker
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
| | - Raymond J Kim
- Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Rm IE-58 Durham, NC 27710, USA
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Shah DJ, El-Tallawi KC. Not All Flails Are Created Equal. J Am Coll Cardiol 2021; 78:2547-2549. [PMID: 34915985 DOI: 10.1016/j.jacc.2021.10.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Malahfji M, Senapati A, Shah DJ. The Authors' Reply. JACC Cardiovasc Imaging 2021; 14:2271. [PMID: 34736601 DOI: 10.1016/j.jcmg.2021.09.026] [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] [Received: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
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Uretsky S, Aggarwal N, van Heeswijk RB, Rajpal S, Rowin E, Taylor MD, Verjans JW, Wokhlu A, Markl M, Raman SV, Shah DJ. Standards for writing Society for Cardiovascular Magnetic Resonance (SCMR) endorsed guidelines, expert consensus, and recommendations: a report of the publications committee. J Cardiovasc Magn Reson 2021; 23:129. [PMID: 34732221 PMCID: PMC8567541 DOI: 10.1186/s12968-021-00801-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Seth Uretsky
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, Morristown, NJ, USA.
| | | | - Ruud B van Heeswijk
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Saurabh Rajpal
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ethan Rowin
- CardioVascular Center, Tufts Medical Center, Boston, MA, USA
| | - Michael D Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Johan W Verjans
- Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Anita Wokhlu
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Michael Markl
- Departments of Radiology and Biomedical Engineering, Northwestern University, Feinberg School of Medicine and McCormick School of Engineering, Evanston, USA
| | - Subha V Raman
- Indiana University and IU Health, Indianapolis, IN, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, 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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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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Shah DJ. Guest Editor Dipan J. Shah Lends Expertise and Insight to Special Issue on Cardiovascular Imaging. Methodist Debakey Cardiovasc J 2021; 16:74. [PMID: 32670465 DOI: 10.14797/mdcj-16-2-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Tayal B, Delling FN, Malahfji M, Shah DJ. Cardiac Imaging for Risk Assessment of Malignant Ventricular Arrhythmias in Patients With Mitral Valve Prolapse. Front Cardiovasc Med 2021; 8:574446. [PMID: 33659277 PMCID: PMC7917057 DOI: 10.3389/fcvm.2021.574446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022] Open
Abstract
Recent studies have described the occurrence of complex ventricular arrhythmias and sudden cardiac death among patients with mitral valve prolapse (MVP). The reported incidence rate of sudden cardiac death or ventricular tachycardia is about 1–1.5% among patients with MVP. Various imaging markers have been associated with this increased risk, including mitral annular disjunction, replacement fibrosis by late gadolinium enhancement, and mechanical dispersion. In this review, we briefly discuss how multimodality cardiac imaging can be applied to identify MVP patients with high risk of sudden cardiac death and complex ventricular arrhythmias.
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Affiliation(s)
- Bhupendar Tayal
- Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States.,Department of Cardiolgy, Aalborg University Hospital, Aalborg, Denmark
| | - Francesa N Delling
- Department of Cardiolgy, University of California, San Francisco, San Francisco, CA, United States
| | - Maan Malahfji
- Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States
| | - Dipan J Shah
- Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States
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Lopes BBC, Kwon DH, Shah DJ, Lesser JR, Bapat V, Enriquez-Sarano M, Sorajja P, Cavalcante JL. Importance of Myocardial Fibrosis in Functional Mitral Regurgitation: From Outcomes to Decision-Making. JACC Cardiovasc Imaging 2021; 14:867-878. [PMID: 33582069 DOI: 10.1016/j.jcmg.2020.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/02/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 12/27/2022]
Abstract
Functional mitral regurgitation (FMR) is a common and complex valve disease, in which severity and risk stratification is still a conundrum. Although risk increases with FMR severity, it is modulated by subjacent left ventricular (LV) disease. The extent of LV remodeling and dysfunction is traditionally evaluated by echocardiography, but a growing body of evidence shows that myocardial fibrosis (MF) assessment by cardiac magnetic resonance (CMR) may complement risk stratification and inform treatment decisions. This review summarizes the current knowledge on the comprehensive evaluation that CMR can provide for patients with FMR, in particular for the assessment of MF and its potential impact in clinical decision-making.
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Affiliation(s)
- Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dipan J Shah
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Gimnich OA, Holbrook J, Belousova T, Short CM, Taylor AA, Nambi V, Morrisett JD, Ballantyne CM, Bismuth J, Shah DJ, Brunner G. Relation of Magnetic Resonance Imaging Based Arterial Signal Enhancement to Markers of Peripheral Artery Disease. Am J Cardiol 2021; 140:140-147. [PMID: 33144163 DOI: 10.1016/j.amjcard.2020.10.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/24/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022]
Abstract
Peripheral artery disease (PAD) is associated with impaired lower extremity function. We hypothesized that contrast-enhanced magnetic resonance imaging (CE-MRI) based arterial signal enhancement (SE) measures are associated with markers of PAD. A total of 66 participants were enrolled, 10 were excluded due to incomplete data, resulting in 56 participants for the final analyses (36 PAD, 20 matched controls). MR imaging was performed postreactive hyperemia using bilateral thigh blood-pressure cuffs. First pass-perfusion images were acquired at the mid-calf region with a high-resolution saturation recovery gradient echo pulse sequence, and arterial SE was measured for the lower extremity arteries. As expected, peak walking time (PWT) was reduced in PAD patients compared with controls (282 [248 to 317] sec, vs 353 [346 to 360] sec; p = 0.002), and postexercise ankle brachial index (ABI) decreased in PAD patients but not in controls (PAD: 0.75 ± 0.2, 0.60 [0.5 to 0.7]; p <0.001; vs Controls: 1.17 ± 0.1, 1.19 [1.1 to 1.2]; p = 0.50). Intraclass correlation coefficients were excellent for inter- and intraobserver variability of arterial tracings (n = 10: 0.95 (95%-confidence interval [CI]: 0.94 to 0.96), n = 9: 1.0 (CI: 1.0 to 1.0). Minimum arterial SE was reduced in PAD patients compared with matched controls (128 [110 to 147] A.U. vs 192 [149 to 234] A.U., p = 0.003). Among PAD patients but not in controls the maximum arterial SE was associated with the estimated glomerular filtration rate (eGFR), a marker of renal function (n = 36, ß = 1.37, R2 = 0.12, p = 0.025). In conclusion, CE-MRI first-pass arterial perfusion is impaired in PAD patients compared with matched controls and associated with markers of lower extremity ischemia.
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Affiliation(s)
- Olga A Gimnich
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jonathan Holbrook
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Tatiana Belousova
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Christina M Short
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Addison A Taylor
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Michael E DeBakey VA Medical Center, Houston, Texas
| | - Vijay Nambi
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Michael E DeBakey VA Medical Center, Houston, Texas; Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Joel D Morrisett
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Christie M Ballantyne
- Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Sections of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Jean Bismuth
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Gerd Brunner
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Sections of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
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Zhang Q, Werys K, Popescu IA, Biasiolli L, Ntusi NAB, Desai M, Zimmerman SL, Shah DJ, Autry K, Kim B, Kim HW, Jenista ER, Huber S, White JA, McCann GP, Mohiddin SA, Boubertakh R, Chiribiri A, Newby D, Prasad S, Radjenovic A, Dawson D, Schulz-Menger J, Mahrholdt H, Carbone I, Rimoldi O, Colagrande S, Calistri L, Michels M, Hofman MBM, Anderson L, Broberg C, Andrew F, Sanz J, Bucciarelli-Ducci C, Chow K, Higgins D, Broadbent DA, Semple S, Hafyane T, Wormleighton J, Salerno M, He T, Plein S, Kwong RY, Jerosch-Herold M, Kramer CM, Neubauer S, Ferreira VM, Piechnik SK. Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study. Int J Cardiol 2021; 330:251-258. [PMID: 33535074 PMCID: PMC7994017 DOI: 10.1016/j.ijcard.2021.01.026] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials. PURPOSE To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use. METHODS MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites. RESULTS T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R2 > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions. CONCLUSIONS The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Iulia A Popescu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Bette Kim
- Mount Sinai West Hospital; Icahn School of Medicine at Mount Sinai, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Canada
| | - Gerry P McCann
- Department of cardiovascular sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, UK
| | - Saidi A Mohiddin
- Inherited Cardiovascular Diseases, Barts Heart Centre, London, UK
| | - Redha Boubertakh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Amedeo Chiribiri
- King's College London and Guy's and St Thomas' NHS Foundation Trust, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, College of Life Sciences and Medicine, University of Aberdeen, UK
| | | | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | | | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Michelle Michels
- Erasmus MC, department of cardiology, Rotterdam, the Netherlands
| | - Mark B M Hofman
- dept. Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lisa Anderson
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | | | | | | | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | | | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Scott Semple
- Edinburgh Imaging, Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | - Taigang He
- The Cardiology Clinical Academic Group (CAG), St George's University of London, St George's University Hospitals NHS Foundation Trust, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | | | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Zhan Y, Debs D, Khan MA, Nguyen DT, Graviss EA, Khalaf S, Little SH, Reardon MJ, Nagueh S, Quiñones MA, Kleiman N, Zoghbi WA, Shah DJ. Natural History of Functional Tricuspid Regurgitation Quantified by Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2021; 76:1291-1301. [PMID: 32912443 DOI: 10.1016/j.jacc.2020.07.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 06/11/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Quantitation of tricuspid regurgitant (TR) severity can be challenging with conventional echocardiographic imaging and may be better evaluated using cardiovascular magnetic resonance (CMR). OBJECTIVES In patients with functional TR, this study sought to examine the relationship between TR volume (TRVol) and TR fraction (TRF) with all-cause mortality. METHODS We examined 547 patients with functional TR using CMR to quantify TRVol and TRF. The primary outcome was all-cause mortality. Thresholds for mild, moderate, and severe TR were derived based on natural history outcome data. RESULTS During a median follow-up of 2.6 years (interquartile range: 1.7 to 3.3 years), there were 93 deaths, with an estimated 5-year survival of 79% (95% confidence interval [CI]: 73% to 83%). After adjustment of clinical and imaging variables, including RV function, both TRF (adjusted hazard ratio [AHR] per 10% increment: 1.26; 95% CI: 1.10 to 1.45; p = 0.001) and TRVol (AHR per 10-ml increment: 1.15; 95% CI: 1.04 to 1.26; p = 0.004) were associated with mortality. Patients in the highest-risk strata of TRVol ≥45 ml or TRF ≥50% had the worst prognosis (AHR: 2.26; 95% CI: 1.36 to 3.76; p = 0.002 for TRVol and AHR: 2.60; 95% CI: 1.45 to 4.66; p = 0.001 for TRF). CONCLUSIONS This is the first study to use CMR to assess independent prognostic implications of functional TR. Both TRF and TRVol were associated with increased mortality after adjustment for clinical and imaging covariates, including right ventricular ejection fraction. A TRVol of ≥45 ml or TRF of ≥50% identified patients in the highest-risk strata for mortality. These CMR thresholds should be used for patient selection in future trials to determine if tricuspid valve intervention improves outcomes in this high-risk group.
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Affiliation(s)
- Yang Zhan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Department of Cardiology, Regina General Hospital, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Dany Debs
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Mohammad A Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Shaden Khalaf
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Stephen H Little
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Michael J Reardon
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Sherif Nagueh
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Miguel A Quiñones
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Neal Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - William A Zoghbi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
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