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Lo Presti S, Eck BL, Reyaldeen R, Nguyen C, Tang WHW, Flamm SD, Seiberlich N, Lima da Cruz G, Prieto C, Kwon DH. Fingerprinting MINOCA: Unraveling Clues With Quantitative CMR. JACC Case Rep 2023; 7:101722. [PMID: 36776793 DOI: 10.1016/j.jaccas.2022.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 02/04/2023]
Abstract
In the following case series, we describe the clinical presentation of 2 patients with myocardial infarction with nonobstructive coronary arteries with different underlying pathophysiologic mechanisms. In both scenarios, cardiac magnetic resonance (CMR) imaging provided comprehensive tissue characterization with both conventional parametric mapping techniques and CMR fingerprinting. These cases demonstrate the diagnostic utility for CMR to elucidate the underlying etiology and appropriate therapeutic strategy. (Level of Difficulty: Advanced.).
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2
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Harries I, Biglino G, Ford K, Nelson M, Rego G, Srivastava P, Williams M, Berlot B, De Garate E, Baritussio A, Liang K, Baquedano M, Chavda N, Lawton C, Shearn A, Otton S, Lowry L, Nightingale AK, Carlos Plana J, Marks D, Emanueli C, Bucciarelli-Ducci C. Prospective multiparametric CMR characterization and MicroRNA profiling of anthracycline cardiotoxicity: A pilot translational study. Int J Cardiol Heart Vasc 2022; 43:101134. [PMID: 36389268 PMCID: PMC9647504 DOI: 10.1016/j.ijcha.2022.101134] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
Background Anthracycline cardiotoxicity is a significant clinical challenge. Biomarkers to improve risk stratification and identify early cardiac injury are required. Objectives The purpose of this pilot study was to prospectively characterize anthracycline cardiotoxicity using cardiovascular magnetic resonance (CMR), echocardiography and MicroRNAs (MiRNAs), and identify baseline predictors of LVEF recovery. Methods Twenty-four patients (age 56 range 18-75 years; 42 % female) with haematological malignancy scheduled to receive anthracycline chemotherapy (median dose 272 mg/m2 doxorubicin equivalent) were recruited and evaluated at three timepoints (baseline, completion of chemotherapy, and 6 months after completion of chemotherapy) with multiparametric 1.5 T CMR, echocardiography and circulating miRNAs sequencing. Results Seventeen complete datasets were obtained. CMR left ventricular ejection fraction (LVEF) fell significantly between baseline and completion of chemotherapy (61 ± 3 vs 53 ± 3 %, p < 0.001), before recovering significantly at 6-month follow-up (55 ± 3 %, p = 0.018). Similar results were observed for 3D echocardiography-derived LVEF and CMR-derived longitudinal, circumferential and radial feature-tracking strain. Patients were divided into tertiles according to LVEF recovery (poor recovery, partial recovery, good recovery). CMR-derived mitral annular plane systolic excursion (MAPSE) was significantly different at baseline in patients exhibiting poor LVEF recovery (11.7 ± 1.5 mm) in comparison to partial recovery (13.7 ± 2.7 mm), and good recovery (15.7 ± 3.1 mm; p = 0.028). Furthermore, baseline miRNA-181-5p and miRNA-221-3p expression were significantly higher in this group. T2 mapping increased significantly on completion of chemotherapy compared to baseline (54.0 ± 4.6 to 57.8 ± 4.9 ms, p = 0.001), but was not predictive of LVEF recovery. No changes to LV mass, extracellular volume fraction, T1 mapping or late gadolinium enhancement were observed. Conclusions Baseline CMR-derived MAPSE, circulating miRNA-181-5p, and miRNA-221-3p were associated with poor recovery of LVEF 6 months after completion of anthracycline chemotherapy, suggesting their potential predictive role in this context. T2 mapping increased significantly on completion of chemotherapy but was not predictive of LVEF recovery.
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Key Words
- CMR, cardiovascular magnetic resonance
- Cancer therapeutics-related cardiac dysfunction
- Cardio-oncology
- Cardiovascular magnetic resonance
- ECV, extracellular volume
- LAVi, left atrial volume indexed
- LGE, late gadolinium enhancement
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MAPSE, mitral annular plane systolic excursion
- MiRNAs, MicroRNAs
- iLVEDV, left ventricular end-diastolic volume indexed
- iLVESV, indexed left ventricular end-systolic volume indexed
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Affiliation(s)
- Iwan Harries
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
- Myocardial Function – National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Bristol Biomedical Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kerrie Ford
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Martin Nelson
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Gui Rego
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Prashant Srivastava
- Myocardial Function – National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Williams
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Bostjan Berlot
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Estefania De Garate
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Anna Baritussio
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Kate Liang
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Mai Baquedano
- NIHR Bristol Biomedical Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nikesh Chavda
- Bristol Heamatology and Oncology Centre, University Hospitals Bristol NHS Trust, Bristol United Kingdom, UK
| | - Christopher Lawton
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Andrew Shearn
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | | | | | - Angus K. Nightingale
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | | | - David Marks
- Bristol Heamatology and Oncology Centre, University Hospitals Bristol NHS Trust, Bristol United Kingdom, UK
| | - Costanza Emanueli
- Myocardial Function – National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Bristol Biomedical Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys’ and St Thomas NHS Foundation Trust, London
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College, London
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Rabbani M, Satriano A, Garcia J, Thompson S, Wu JN, Pejevic M, Anderson T, Dufour A, Phillips A, White JA. Limits of Cardiovascular Adaptation During an Extreme Ultramarathon: Insights From Serial Multidimensional, Multiparametric CMR. JACC Case Rep 2022; 4:1104-1109. [PMID: 36124158 PMCID: PMC9481903 DOI: 10.1016/j.jaccas.2022.05.028] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Extreme endurance athletic challenges provide unique opportunities to study the cardiovascular system's capacity for structural, functional, and hemodynamic adaptation. The authors present a case of a male subject who ran 2,469 km, with serial multiparametric cardiac magnetic resonance imaging used to demonstrate adaptive and maladaptive alterations in cardiac remodeling and myocardial tissue health. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Mohamad Rabbani
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Alessandro Satriano
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Julio Garcia
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Skye Thompson
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Jian-Nong Wu
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Milada Pejevic
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Todd Anderson
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Antoine Dufour
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - Aaron Phillips
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cummings School of Medicine, University of Calgary, Alberta, Canada
| | - James A. White
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Cummings School of Medicine, University of Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Alberta, Canada
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Abstract
BACKGROUND Cirrhotic cardiomyopathy refers to the structural and functional changes in the heart leading to either impaired systolic, diastolic, electrocardiographic, and neurohormonal changes associated with cirrhosis and portal hypertension. Cirrhotic cardiomyopathy is present in 50% of patients with cirrhosis and is clinically seen as impaired contractility, diastolic dysfunction, hyperdynamic circulation, and electromechanical desynchrony such as QT prolongation. In this review, we will discuss the cardiac physiology principles underlying cirrhotic cardiomyopathy, imaging techniques such as cardiac magnetic resonance imaging and scintigraphy, cardiac biomarkers, and newer echocardiographic techniques such as tissue Doppler imaging and speckle tracking, and emerging treatments to improve outcomes. METHODS We reviewed available literature from MEDLINE for randomized controlled trials, cohort studies, cross-sectional studies, and real-world outcomes using the search terms "cirrhotic cardiomyopathy," "left ventricular diastolic dysfunction," "heart failure in cirrhosis," "liver transplantation," and "coronary artery disease". RESULTS Cirrhotic cardiomyopathy is associated with increased risk of complications such as hepatorenal syndrome, refractory ascites, impaired response to stressors including sepsis, bleeding or transplantation, poor health-related quality of life and increased morbidity and mortality. The evaluation of cirrhotic cardiomyopathy should also guide the feasibility of procedures such as transjugular intrahepatic portosystemic shunt, dose titration protocol of betablockers, and liver transplantation. The use of targeted heart rate reduction is of interest to improve cardiac filling and improve the cardiac output using repurposed heart failure drugs such as ivabradine. Liver transplantation may also reverse the cirrhotic cardiomyopathy; however, careful cardiac evaluation is necessary to rule out coronary artery disease and improve cardiac outcomes in the perioperative period. CONCLUSION More data are needed on the new diagnostic criteria, molecular and biochemical changes, and repurposed drugs in cirrhotic cardiomyopathy. The use of advanced imaging techniques should be incorporated in clinical practice.
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Key Words
- 2-AG, 2-arachidonylglycerol
- 2D, two-dimensional
- AEA, Anandamide
- ANP, Atrial Natriuretic Peptide
- ASE, the American Society of Echocardiography
- AUC, area under the curve
- BA, bile acid
- BNP, Brain natriuretic peptide
- CAD, coronary artery disease
- CB-1, cannabinoid −1
- CCM, Cirrhotic Cardiomyopathy
- CMR, cardiovascular magnetic resonance imaging
- CO, cardiac output
- CT, computed tomography
- CTP, Child–Turcotte–Pugh
- CVP, central venous pressure
- DT, deceleration Time
- ECG, electrocardiogram
- ECV, extracellular volume
- EF, Ejection fraction
- EMD, electromechanical desynchrony
- ESLD, end-stage liver disease
- FXR, Farnesoid X receptor
- GI, gastrointestinal
- GLS, Global Longitudinal strain
- HCN, Hyperpolarization-activated cyclic nucleotide–gated
- HE, hepatic encephalopathy
- HF, heart failure
- HO, Heme oxygenase
- HPS, hepatopulmonary syndrome
- HR, heart rate
- HRS, hepatorenal syndrome
- HVPG, hepatic venous pressure gradient
- HfmrEF, heart failure with mid-range ejection fraction
- HfrEF, heart failure with reduced ejection fraction
- IVC, Inferior Vena Cava
- IVCD, IVC Diameter
- IVS, intravascular volume status
- L-NAME, NG-nitro-L-arginine methyl ester
- LA, left atrium
- LAVI, LA volume index
- LGE, late gadolinium enhancement
- LT, liver transplant
- LV, left ventricle
- LVDD, left ventricular diastolic dysfunction
- LVEDP, left ventricular end-diastolic pressure
- LVEDV, LV end diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, LV end systolic volume
- LVOT, left ventricular outflow tract
- MAP, mean arterial pressure
- MELD, Model for End-Stage Liver Disease
- MR, mitral regurgitation
- MRI, Magnetic resonance imaging
- MV, mitral valve
- NAFLD, Nonalcoholic fatty liver disease
- NO, nitric oxide
- NOS, Nitric oxide synthases
- NTProBNP, N-terminal proBNP
- PAP, pulmonary artery pressure
- PCWP, pulmonary capillary wedged pressure
- PHT, portal hypertension
- PWD, Pulsed-wave Doppler
- RV, right ventricle
- RVOT, right ventricular outflow tract
- SA, sinoatrial
- SD, standard deviation
- SV, stroke volume
- SVR, Systemic vascular resistance
- TDI, tissue Doppler imaging
- TIPS, transjugular intrahepatic portosystemic shunt
- TR, Tricuspid valve
- TRPV1, transient receptor potential cation channel subfamily V member 1
- TTE, transthoracic echocardiography
- USG, ultrasonography
- VTI, velocity time integral
- beta blocker
- cirrhotic cardiomyopathy
- hemodynamics in cirrhosis
- left ventricular diastolic dysfunction
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Affiliation(s)
| | - Madhumita Premkumar
- Address for correspondence: Dr. Madhumita Premkumar, M.D., D.M., Department of Hepatology, Postgraduate Institute of Medical Education and Research, 60012, Chandigarh, India. Tel.: ++91-9540951061 (mobile)
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Mouhayar EN, Hammond D, Lopez-Mattei J, Banchs J, Konopleva M, Pemmaraju N. Reversible Myocardial Edema Secondary to Tagraxofusp-Induced Capillary Leak Syndrome. JACC CardioOncol 2021; 3:752-755. [PMID: 34988487 PMCID: PMC8702795 DOI: 10.1016/j.jaccao.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elie N Mouhayar
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Danielle Hammond
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Banchs
- Department of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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O'Quinn R, Ferrari VA, Daly R, Hundley G, Baldassarre LA, Han Y, Barac A, Arnold A. Cardiac Magnetic Resonance in Cardio-Oncology: Advantages, Importance of Expediency, and Considerations to Navigate Pre-Authorization. JACC CardioOncol 2021; 3:191-200. [PMID: 34396324 DOI: 10.1016/j.jaccao.2021.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
Diagnosis of acute and late cardiotoxicity from cancer therapeutics has become increasingly important as the scope of cardio-oncology increases exponentially, both in terms of the number of people affected and the types of therapies it encompasses. Cardiac magnetic resonance (CMR) is a tool that can offer unparalleled diagnostic information compared with other imaging modalities, but its utilization is often delayed, at the expense of patient care, due to the need for insurance pre-authorization. This paper highlights situations in which CMR is preferred as the diagnostic modality and provides examples of diagnoses more likely to be approved by insurance companies. It also provides specific cardio-oncology diagnoses or questions to help the clinical cardio-oncologist navigate the pre-authorization process. Evolving therapies for cancer improve patient survival but can result in cardiotoxicity. CMR can help diagnose, prognosticate, and offer insight to guide the management of cardiotoxicity. Pre-authorization for CMR, used by insurance companies, often leads to consequential delays in patient care. Advocacy and education of insurance payers and providers are essential to overcome these obstacles.
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Key Words
- 2D, 2-dimensional
- ACC, American College of Cardiology
- CAD, coronary artery disease
- CMR, cardiac magnetic resonance
- CTRCD, cancer treatment–related cardiac dysfunction
- ECV, extracellular volume
- GLS, global longitudinal strain
- ICI, immune checkpoint inhibitors
- LGE, late gadolinium enhancement
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MACE, major adverse cardiovascular event
- RV, right ventricular
- cardiac magnetic resonance
- cardio-oncology
- cardiotoxicity
- chemotherapy
- left ventricular dysfunction
- pre-authorization
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Dixit NM, Churchill A, Nsair A, Hsu JJ. Post-Acute COVID-19 Syndrome and the cardiovascular system: What is known? Am Heart J Plus 2021; 5:100025. [PMID: 34192289 PMCID: PMC8223036 DOI: 10.1016/j.ahjo.2021.100025] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
Post-Acute COVID-19 Syndrome (PACS) is defined by persistent symptoms >3-4 weeks after onset of COVID-19. The mechanism of these persistent symptoms is distinct from acute COVID-19 although not completely understood despite the high incidence of PACS. Cardiovascular symptoms such as chest pain and palpitations commonly occur in PACS, but the underlying cause of symptoms is infrequently known. While autopsy studies have shown that the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rarely causes direct myocardial injury, several syndromes such as myocarditis, pericarditis, and Postural Orthostatic Tachycardia Syndrome have been implicated in PACS. Additionally, patients hospitalized with acute COVID-19 who display biomarker evidence of myocardial injury may have underlying coronary artery disease revealed by the physiological stress of SARS-CoV-2 infection and may benefit from medical optimization. We review what is known about PACS and the cardiovascular system and propose a framework for evaluation and management of related symptoms.
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Key Words
- ACE2, angiotensin converting enzyme-2
- AF/AFL, atrial fibrillation or flutter
- CBT, cognitive behavioral therapy
- CFS, Chronic Fatigue Syndrome
- CMR, cardiac magnetic resonance imaging
- CRP, C-reactive protein
- CV, cardiovascular
- Cardiology
- Coronavirus Disease 2019
- ECG, electrocardiography
- ECV, extracellular volume
- LGE, late gadolinium enhancement
- Long COVID
- Long-Haul COVID
- MCAS, Mast Cell Activation Syndrome
- MERS, Middle East Respiratory Syndrome
- POTS, Post-Acute COVID-19 Syndrome
- SARS-COV-1, Severe Acute Respiratory Syndrome Coronavirus-1
- SARS-CoV-2
- T1MI, type 1 myocardial infarction
- T2MI, type 2 myocardial infarction
- TTT, tilt table testing
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Affiliation(s)
- Neal M. Dixit
- Department of Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Austin Churchill
- School of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Ali Nsair
- Department of Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA,Division of Cardiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Jeffrey J. Hsu
- Department of Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA,Division of Cardiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095, USA,Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA,Corresponding author at: UCLA Center for Health Sciences, A2-237, 650 Charles E. Young Dr. South, Los Angeles, CA 90095-1679, USA
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Huang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, Liu W, Zeng H, Tao Q, Xia L. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 13:2330-2339. [PMID: 32763118 PMCID: PMC7214335 DOI: 10.1016/j.jcmg.2020.05.004] [Citation(s) in RCA: 357] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Objectives This study evaluated cardiac involvement in patients recovered from coronavirus disease-2019 (COVID-19) using cardiac magnetic resonance (CMR). Background Myocardial injury caused by COVID-19 was previously reported in hospitalized patients. It is unknown if there is sustained cardiac involvement after patients' recovery from COVID-19. Methods Twenty-six patients recovered from COVID-19 who reported cardiac symptoms and underwent CMR examinations were retrospectively included. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Edema ratio and LGE were assessed in post-COVID-19 patients. Cardiac function, native T1/T2, and ECV were quantitatively evaluated and compared with controls. Results Fifteen patients (58%) had abnormal CMR findings on conventional CMR sequences: myocardial edema was found in 14 (54%) patients and LGE was found in 8 (31%) patients. Decreased right ventricle functional parameters including ejection fraction, cardiac index, and stroke volume/body surface area were found in patients with positive conventional CMR findings. Using quantitative mapping, global native T1, T2, and ECV were all found to be significantly elevated in patients with positive conventional CMR findings, compared with patients without positive findings and controls (median [interquartile range]: native T1 1,271 ms [1,243 to 1,298 ms] vs. 1,237 ms [1,216 to 1,262 ms] vs. 1,224 ms [1,217 to 1,245 ms]; mean ± SD: T2 42.7 ± 3.1 ms vs. 38.1 ms ± 2.4 vs. 39.1 ms ± 3.1; median [interquartile range]: 28.2% [24.8% to 36.2%] vs. 24.8% [23.1% to 25.4%] vs. 23.7% [22.2% to 25.2%]; p = 0.002; p < 0.001, and p = 0.002, respectively). Conclusions Cardiac involvement was found in a proportion of patients recovered from COVID-19. CMR manifestation included myocardial edema, fibrosis, and impaired right ventricle function. Attention should be paid to the possible myocardial involvement in patients recovered from COVID-19 with cardiac symptoms.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- AHA, American Heart Association
- BSA, body surface area
- CI, cardiac index
- CMR, cardiac magnetic resonance
- CO, cardiac output
- COVID-19, coronavirus disease-2019
- ECV, extracellular volume
- EDV, end-diastolic volume
- EF, ejection fraction
- ER, edema ratio
- ESV, end-systolic volume
- FA, flip angle
- FOV, field of view
- IQR, interquartile range
- LGE, late gadolinium enhancement
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- PSIR, phase-sensitive inversion-recovery
- RT-PCR, reverse transcription and polymerase chain reaction
- RV, right ventricle
- RVEF, right ventricular ejection fraction
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- SI, signal intensity
- SSFP, steady state free precession
- STIR, short tau inversion recovery
- SV, stroke volume
- T2WI, T2-weighted imaging
- TE, echo time
- TR, repetition time
- cardiac involvement
- cardiac magnetic resonance imaging
- coronavirus disease-2019
- hs-cTnI, high-sensitive cardiac troponin I
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MESH Headings
- Adult
- COVID-19
- China
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/therapy
- Edema, Cardiac/diagnostic imaging
- Edema, Cardiac/etiology
- Edema, Cardiac/pathology
- Female
- Fibrosis
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/therapy
- Predictive Value of Tests
- Remission Induction
- Retrospective Studies
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peijun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Han
- Department of Radiology, Wuhan No.1 Hospital, Wuhan, China
| | - Chenao Zhan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiyong Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Qian Tao
- Division of Imaging Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Ananthakrishna R, Lloyd R, Kuss BJ, Selvanayagam JB. Cardiac Amyloidosis: The Importance of Surveillance in a Patient With an Initial Negative Cardiac Biopsy. JACC Case Rep 2020; 2:282-285. [PMID: 34317223 PMCID: PMC8298295 DOI: 10.1016/j.jaccas.2019.11.041] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 11/06/2022]
Abstract
Cardiac amyloidosis is a progressive disorder and is sometimes difficult to diagnose even when suspected in the appropriate clinical setting. We present an interesting case of rapidly progressive light-chain cardiac amyloidosis and highlights the importance of close monitoring even when the initial biopsy and imaging findings are not pathognomonic for amyloidosis. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Rajiv Ananthakrishna
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Rachael Lloyd
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Bryone J. Kuss
- Department of Molecular Medicine (Haematology and Molecular Genetics), Flinders University, Adelaide, Australia
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Minegishi S, Kato S, Takase-Minegishi K, Horita N, Azushima K, Wakui H, Ishigami T, Kosuge M, Kimura K, Tamura K. Native T1 time and extracellular volume fraction in differentiation of normal myocardium from non-ischemic dilated and hypertrophic cardiomyopathy myocardium: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2019; 25:100422. [PMID: 31517037 PMCID: PMC6737306 DOI: 10.1016/j.ijcha.2019.100422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/18/2019] [Accepted: 09/02/2019] [Indexed: 11/02/2022]
Abstract
Background Both native T1 time and extracellular volume (ECV) fraction have been shown to be important measures for the detection of myocardial fibrosis. However, ECV determination requires the administration of an intravenous contrast agent, whereas native T1 mapping can be performed without a contrast agent. Methods Here, we conducted a meta-analysis of myocardial native T1 data obtained for non-ischemic cardiomyopathy (NIC) patients and controls. A literature review included studies that applied T1 mapping using modified Look-Locker inversion recovery to measure myocardial fibrosis, and the results were validated by comparing datasets for dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) patients and healthy controls (HCs). Results We identified 16 eligible studies. Pooled mean differences (MDs) and 95% confidence intervals (CIs) were estimated as follows. Native T1 at 1.5-T, DCM vs. HC: MD = 45.26 (95% CI: 30.92-59.59); HCM vs. HC: MD = 47.09 (95% CI: 32.42-61.76). Native T1 at 3.0-T, DCM vs. HC: MD = 82.52 (95% CI: 47.60-117.44); HCM vs. HC: MD = 115.87 (95% CI: 50.71-181.04). ECV at 1.5-T, DCM vs. HC: MD = 4.26 (95% CI: 3.06-5.46); HCM vs. HC: MD = 1.49 (95% CI: -1.45-4.43). ECV at 3.0-T, DCM vs. HC: MD = 8.40 (95% CI: 2.94-13.86); HCM vs. HC: MD = 8.02 (95% CI: 5.45-1-0.59). Conclusion In conclusion, native T1 values were significantly different between NIC patients and controls. Native T1 mapping may be a useful noninvasive method to detect diffuse myocardial fibrosis in NIC patients.
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Key Words
- CI, confidence interval
- CMR, cardiac magnetic resonance
- DCM, dilated cardiomyopathy
- Dilated cardiomyopathy
- ECV, extracellular volume
- Extracellular volume fraction
- HC, healthy control
- HCM, hypertrophic cardiomyopathy
- Hypertrophic cardiomyopathy
- LGE-MRI, late gadolinium-enhanced magnetic resonance imaging
- MD, mean difference
- MINORS, Methodological Index for Non-Randomized Studies
- MOLLI, modified Look-Locker inversion recovery
- Meta-analysis
- NIC, non-ischemic cardiomyopathy
- Native T1 mapping
- SCD, sudden cardiac death
- SD, standard deviation
- Systematic review
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Affiliation(s)
- Shintaro Minegishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kengo Azushima
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoaki Ishigami
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masami Kosuge
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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