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Tanihata A, Shibata A, Yoshida T, Kitada R, Izumiya Y, Fukuda D. Hemoglobin is an independent predictor of improvement exercise tolerance in male patients with non-ischemic cardiomyopathy. Heart Vessels 2024; 39:412-426. [PMID: 38411633 DOI: 10.1007/s00380-024-02358-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024]
Abstract
Exercise intolerance is a symptom of chronic heart failure (CHF). The magnitude of exercise tolerance, as measured by peak oxygen uptake (peak VO2), is strongly associated with prognosis in patients with CHF. We aimed to evaluate the factors associated with improved exercise tolerance in patients with HF. In this prospective study, we recruited patients who were diagnosed with non-ischemic cardiomyopathy between September 2017 and September 2021. All patients underwent cardiopulmonary exercise testing at discharge and 6 months after enrollment. The patients were stratified according to whether peak VO2 was increased or not at 6 months. One hundred patients with a reduced left-ventricular ejection fraction (LVEF < 50%) were enrolled. Improvement of peak VO2 was observed in 74 patients. In male patients, hemoglobin level was higher in the increased peak VO2 group than in the non-increased group (15.0 ± 1.9 g/dL vs. 13.1 ± 2.1 g/dL; p < 0.01). Baseline hemoglobin level was positively correlated with the percentage change in peak VO2 (Spearman's r = 0.248, p = 0.040). Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly less frequent in the increased peak VO2 group than in the non-increased group (log-rank test, p = 0.032). Multivariate logistic regression analysis identified hemoglobin level as an independent predictor of improved peak VO2 [odds ratio (OR) 1.60; 95% confidence interval (CI) 1.05-2.44; p = 0.027]. Baseline hemoglobin level is an independent predictor of improved peak VO2 in male patients with non-ischemic cardiomyopathy.
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Affiliation(s)
- Akiko Tanihata
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Atsushi Shibata
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Toshitake Yoshida
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Ryoko Kitada
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Anjuna R, Paulius S, Manuel GG, Audra B, Jurate N, Monika R. Diagnostic value of cardiothoracic ratio in patients with non-ischaemic cardiomyopathy: comparison to cardiovascular magnetic resonance imaging. Curr Probl Diagn Radiol 2024; 53:353-358. [PMID: 38281842 DOI: 10.1067/j.cpradiol.2024.01.011] [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: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To determine the reliability of the cardiothoracic ratio (CTR) as a simple method to assess the cardiac size and function in patients with non-ischemic cardiomyopathy (NICM). METHODS In a sample of 91 patients (66 patients with diagnosed non-ischemic cardiomyopathy and 25 controls) we calculated the CTR on a posteroanterior chest radiograph and ventricular and atrial size based on accepted cardiovascular magnetic resonance (CMR) imaging values. Left and right ventricular ejection fraction was also calculated. The CTR and cardiac chamber size were compared between patients with NICM and healthy individuals. The distinction between normal and increased cardiac chamber size was made using published normal CMR reference values stratified by age and gender. RESULTS CTR values were higher in the NICM group (50.7±5.5 % Vs. 45.3±4.7 %, p<0.001). Likewise, LVEDVi, LV indexed mass, LA indexed volume, LA indexed area, and RA indexed area were higher, and LVEF and RVEF were lower in patients with non-ischemic cardiomyopathy (p < 0.05). In patients with non-ischemic cardiomyopathy, the greatest correlation between CTR and CMR values was with LVEDVi (ρ=0.4, p < 0.001), LA indexed volume (ρ=0.5, p < 0.001), LA indexed area (ρ=0.5, p < 0.001) and RA indexed area (ρ=0.4, p < 0.001). However, the correlation strength was only moderate. CONCLUSION Despite patients with NICM had higher CTR values than the control group, a substantial proportion of these patients showed normal CTRs (<50 %). This fact limits the usefulness of CTR to reliably predict NICM. Correlation between CTR and heart chamber dilation on CMR was only weak to moderate.
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Affiliation(s)
- Reghunath Anjuna
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, Thomas Drive L14 3 PE, United Kingdom
| | - Simkus Paulius
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, Thomas Drive L14 3 PE, United Kingdom; Department of Radiology, Lithuanian Health Sciences University Hospital Kaunas Clinics, Eiveniu 2, Kaunas 50161, Lithuania
| | - Gutierrez Gimeno Manuel
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, Thomas Drive L14 3 PE, United Kingdom
| | - Banisauskaite Audra
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, Thomas Drive L14 3 PE, United Kingdom; Department of Radiology, Lithuanian Health Sciences University Hospital Kaunas Clinics, Eiveniu 2, Kaunas 50161, Lithuania
| | - Noreikaite Jurate
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, Thomas Drive L14 3 PE, United Kingdom
| | - Radike Monika
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, Thomas Drive L14 3 PE, United Kingdom.
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Lund-Andersen C, Yafasova A, Høfsten D, Thune JJ, Philbert BT, Nielsen JC, Thøgersen AM, Haarbo J, Videbæk L, Gustafsson F, Svendsen JH, Pehrson S, Køber L. Association between QRS shortening and mortality after cardiac resynchronization therapy: Results from the DANISH study. Int J Cardiol 2024; 399:131700. [PMID: 38168556 DOI: 10.1016/j.ijcard.2023.131700] [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: 10/09/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Changes in QRS duration (∆QRS) are often used in the clinical setting to evaluate the effect of cardiac resynchronization therapy (CRT), although an association between ∆QRS and outcomes is not firmly established. We aimed to assess the association between mortality and ∆QRS after CRT in patients from the DANISH (Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischemic Systolic Heart Failure on Mortality) study. METHODS We included all patients from DANISH who received a CRT device and had available QRS duration data before and after implantation. Cox proportional hazards models were used to assess associations between ∆QRS (post-CRT QRS minus pre-CRT QRS) and mortality. RESULTS Complete data were available in 572 patients. Median baseline QRS duration was 160 ms (IQR [146;180]). Post-CRT QRS was recorded a median of 48 days (IQR [33;86]) after implantation, and the median ∆QRS was -14 ms (IQR [-38;-3]). During a median follow-up of 4.1 years (IQR [2.5;5.8]), 106 patients died. In crude Cox regression, all-cause mortality was reduced by 6% per 10 ms shortening of QRS (HR 0.94; CI: 0.88-1.00, p = 0.04). The effect did not remain significant after multivariable adjustment (HR 1.01, CI: 0.93-1.10, p = 0.77). Further, no association was found between ∆QRS and improvement of New York Heart Association functional class at 6 months (OR 1.03, CI: 0.96-1.10, p = 0.42). CONCLUSION In a large cohort of patients with non-ischemic cardiomyopathy, reduction of QRS duration after CRT was not associated with changes in mortality during long-term follow-up.
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Affiliation(s)
- Casper Lund-Andersen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Adelina Yafasova
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna M Thøgersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital - Gentofte, Gentofte, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Sugawara M, Kondo Y, Ryuzaki S, Yoshino Y, Chiba T, Ito R, Kajiyama T, Nakano M, Kobayashi Y. Long-term prognosis and prognostic factors after primary prophylactic implantable cardioverter-defibrillator therapy. J Cardiol 2024:S0914-5087(24)00024-8. [PMID: 38382578 DOI: 10.1016/j.jjcc.2024.02.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Little is known regarding which patients with ischemic cardiomyopathy (ICM) should be considered for prophylactic therapies, such as an implantable cardioverter-defibrillator (ICD), in the primary percutaneous intervention era. The aim of this study was to investigate the influence of non-sustained ventricular tachycardia (NSVT) on major adverse cardiac events (MACE) in heart failure with reduced ejection fraction (HFrEF) patients. METHODS We retrospectively analyzed patients of ICM and non-ICM who underwent ICD implantation at our institute from October 2006 to August 2020. MACE were defined as composite outcome of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies. RESULTS A total of 167 patients were enrolled [male, 138 (83 %); age, 62.1 ± 11.7 years; left ventricular ejection fraction, 23.5 ± 6.1 %; left ventricular diastolic diameter, 67.4 ± 9.0 mm; atrial fibrillation, 47 (28 %); NSVT, 124 (74 %); use of class III antiarrhythmic drugs, 55 (33 %); ischemic cardiomyopathy, 56 (34 %); cardiac resynchronization therapy, 73 (44 %)]. The median follow-up duration was 61 months. MACE occurred with 71 patients (43 %). When comparing baseline characteristics of the patients, left ventricular ejection fraction (p = 0.02) and atrial fibrillation (p = 0.04) were significantly associated with MACE. The multivariable Cox analysis for the target variable MACE identified atrial fibrillation (hazard ratio 2.00; 95 % confidence index 1.18-3.37; p = 0.01) as an independent predictor for MACE. CONCLUSIONS Prior NSVT before ICD implantation was not an independent predictor of future MACE in patients with HFrEF with primary prophylactic ICD. In contrast, atrial fibrillation was associated with worse prognosis. To predict the prognosis of patients with primary prophylactic ICD, these factors should be assessed as comprehensive risk stratification factors for MACE.
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Affiliation(s)
- Masafumi Sugawara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Satoko Ryuzaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yutaka Yoshino
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshinori Chiba
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takatsugu Kajiyama
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Zhao Y, Quan E, Zeng T, Huang Z, Luo Y, Peng L, Li S, Liu J, Chong Y, Cao H. Type 1 diabetes, its complications, and non-ischemic cardiomyopathy: a mendelian randomization study of European ancestry. Cardiovasc Diabetol 2024; 23:31. [PMID: 38218861 PMCID: PMC10787423 DOI: 10.1186/s12933-023-02117-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a significant risk factor for a range of cardiovascular diseases. Nonetheless, the causal relationship between T1D and non-ischemic cardiomyopathy (NICM) remains to be elucidated. Furthermore, the mechanisms responsible for the progression from T1D to NICM have not been definitively characterized. OBJECTIVE The aim of this study was to conduct a Mendelian randomization (MR) study to investigate the causal effects of T1D and its complications on the development of NICM. Additionally, this study aimed to conduct a mediation analysis to identify potential mediators within this correlation. METHODS Genetic variants were used as instrumental variables for T1D. The summary data for T1D were obtained from two genome-wide association study datasets. The summary data for T1D with complications and NICM were obtained from the Finnish database. Two-sample MR, multivariable MR and mediation MR were conducted in this study. RESULTS The study revealed a causal association between T1D, T1D with complications, and NICM (with odds ratios of 1.02, 95% CI 1.01-1.04, p = 1.17e-04 and 1.03, 95% CI 1.01-1.05, p = 3.15e-3). Even after adjusting for confounding factors such as body mass index and hypertension, T1D remained statistically significant (with odds ratio of 1.02, 95% CI 1.01-1.04, p = 1.35e-4). Mediation analysis indicated that monokine induced by gamma interferon may play a mediating role in the pathogenesis of T1D-NICM (mediation effect indicated by odds ratio of 1.005, 95% CI 1.001-1.01, p = 4.9e-2). CONCLUSION The study demonstrates a causal relationship between T1D, its complications, and NICM. Additionally, monokine induced by gamma interferon may act as a potential mediator in the pathogenesis of T1D-NICM.
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Affiliation(s)
- Yunyue Zhao
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Enxi Quan
- Department of Clinical Pharmacy, Guangzhou First People's Hospital, Guangzhou, 511457, China
| | - Tao Zeng
- Department of Infectious Diseases, Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Zhuoshan Huang
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yanting Luo
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Long Peng
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Suhua Li
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Jinlai Liu
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Yutian Chong
- Department of Infectious Diseases, Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Hong Cao
- Department of Infectious Diseases, Guangdong Key Laboratory of Liver Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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Nguyen ET, Ordovas K, Herbst P, Kozor R, Ng MY, Natale L, Nijveldt R, Salgado R, Sanchez F, Shah D, Stojanovska J, Valente AM, Westwood M, Plein S. Competency based curriculum for cardiovascular magnetic resonance: A position statement of the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2023; 26:100006. [PMID: 38215698 DOI: 10.1016/j.jocmr.2023.100006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/14/2024] Open
Abstract
This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR).
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Affiliation(s)
- Elsie T Nguyen
- University Medical Imaging Toronto, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada.
| | | | - Phil Herbst
- Cardiology, Stellenbosch University, South Africa
| | - Rebecca Kozor
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Division Chief of Cardiac Imaging, HKU-Shenzhen Hospital, China
| | | | - Robin Nijveldt
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - Rodrigo Salgado
- Antwerp University Hospital and University of Antwerp, Belgium; Dept. of Radiology, Holy Heart Lier, Belgium
| | - Felipe Sanchez
- Hospital Barros Luco Trudeau - Clinica Santa Maria, Santiago, Chile
| | - Dipan Shah
- Division of Cardiovascular Imaging, Houston, TX, USA
| | | | - Anne Marie Valente
- Harvard Medical School, Boston Children's Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Westwood
- Centre for Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Sven Plein
- British Heart Foundation Professor of Cardiovascular Imaging, University of Leeds, United Kingdom
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Kondo Y, Noda T, Takanashi Y, Sasaki S, Sato Y, Nitta T, Aizwa Y, Ohe T, Kurita T. Two-Year Outcomes of Primary Prophylactic Use of Defibrillators for Ischemic and Non-Ischemic Cardiomyopathy - Propensity Score-Matched Analysis From the Nippon Storm Study. Circ J 2023:CJ-23-0613. [PMID: 38057099 DOI: 10.1253/circj.cj-23-0613] [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: 12/08/2023]
Abstract
BACKGROUND In 2016, the DANISH study reported negative results regarding the efficacy of implantable cardioverter-defibrillators (ICDs) in patients with non-ischemic cardiomyopathy (NICM) and reduced left ventricular ejection fraction (LVEF). In this study we determined the efficacy of using ICDs for primary prophylaxis in patients with NICM.Methods and Results: We selected 1,274 patients with underlying cardiac disease who were enrolled in the Nippon Storm Study. We analyzed the data of 451 patients with LVEF ≤35% due to NICM or ischemic cardiomyopathy (ICM) who underwent ICD implantation for primary prophylaxis (men, 78%; age, 65±12 years; LVEF, 25±6.4%; cardiac resynchronization therapy, 73%; ICM, 33%). After propensity score matching, we compared the baseline covariates between groups: NICM (132 patients) and ICM (132 patients). The 2-year appropriate ICD therapy risks were 27.7% and 12.2% in the NICM and ICM groups, respectively (hazard ratio, 0.390 [95% confidence interval, 0.218-0.701]; P=0.002). CONCLUSIONS This subanalysis of propensity score-matched patients from the Nippon Storm Study revealed that the risk of appropriate ICD therapy was significantly higher in patients with NICM than in those with ICM.
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Affiliation(s)
- Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Hospital
| | - Yukiko Takanashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | | | - Yoshifusa Aizwa
- Department of Research and Development, Tachikawa Medical Center
| | | | - Takashi Kurita
- Department of Internal Medicine, Faculty of Medicine, Kindai University
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Wang J, Huo L, Lin X, Fang L, Hacker M, Niu N, Li X. Molecular imaging of fibroblast activation in multiple non-ischemic cardiomyopathies. EJNMMI Res 2023; 13:39. [PMID: 37155002 PMCID: PMC10167070 DOI: 10.1186/s13550-023-00986-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND This pilot study is aimed to perform a pilot visualization study to investigate in vivo fibroblast activation in non-ischemic cardiomyopathies by 68Ga-FAPI-04 PET/CT. METHODS Twenty-nine consecutive patients with symptomatic non-ischemic cardiomyopathies who underwent 68Ga-FAPI-04 PET/CT were prospectively recruited. Clinical characteristics and echocardiographic parameters were recorded. Cardiac uptake was quantified by standardized uptake values (SUVmax, SUVmean, SUVR) and left ventricular metabolism volume. The relationship between 68Ga-FAPI-04 uptake with clinical and echocardiography parameters was investigated. RESULTS Heterogeneous 68Ga-FAPI-04 uptake was observed in different subtypes of non-ischemic cardiomyopathies. Twenty-two (75.9%) patients showed elevated 68Ga-FAPI-04 uptake in the left ventricle, and 10 (34.5%) patients also showed slightly diffuse elevated uptake in the right ventricle. Cardiac uptake values were significantly correlated with enlarged ventricular volume evaluated by echocardiography. CONCLUSION FAPI PET/CT presents a potential value for in vivo visualization and quantification of fibroblast activation on the molecular level. Further study is warranted for investigating the theranostic and prognostic value of elevated FAP signal.
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Affiliation(s)
- Jingnan Wang
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Na Niu
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China.
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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Kotake Y, Nalliah CJ, Campbell T, Bennett RG, Turnbull S, Kumar S. Comparison of the arrhythmogenic substrate for ventricular tachycardia in patients with ischemic vs non-ischemic cardiomyopathy - insights from high-density, multi-electrode catheter mapping. J Interv Card Electrophysiol 2023; 66:5-14. [PMID: 34787768 DOI: 10.1007/s10840-021-01088-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the differences of arrhythmogenic substrate using high-density mapping in ventricular tachycardia (VT) patients with ischemic (ICM) vs non-ischemic cardiomyopathy (NICM). METHODS Data from patients presenting for VT ablation from December 2016 to December 2020 at Westmead Hospital were reviewed. RESULTS Sixty consecutive patients with structural heart disease (ICM 57%, NICM 43%, mean age 66 years) having catheter ablation of scar-related VT with pre-dominant left ventricular involvement were included. ICM was associated with larger proportion of dense scar area (bipolar; 19 [12-29]% vs 6 [3-10]%, P < 0.001, unipolar; 20 [12-32]% vs 11 [7-19]%, P = 0.01) compared with NICM. However, the scar ratio (unipolar dense scar [%]/bipolar dense scar [%]) was significantly higher in NICM patients (1.2 [0.8-1.7] vs 1.7 [1.3-2.3], P = 0.003). Larger scar area in ICM was paralleled by higher proportion of complex electrograms (6 [2-13] % vs 3 [1-5] %, P = 0.01), longer and wider voltage based conducting channels, higher incidence of late potential-based conducting channels, longer VT cycle-length (399 ± 80 ms vs 359 ± 68 ms, P = 0.04) and greater maximal stimulation-QRS interval among sites with good pace-map correlation (75 [51-99]ms vs 48 [31-73]ms, P = 0.02). Ventricular arrhythmia (VA) storm was more highly prevalent in ICM than NICM (50% vs 23%, P = 0.03). During the follow-up period, NICM had a significantly higher cumulative incidence for the VA recurrence than ICM (P = 0.03). CONCLUSIONS High-density multi-electrode catheter mapping of left ventricular arrhythmogenic substrate of NICM tends to show smaller dense scar area and higher scar ratio, compared with ICM, suggestive the extent of epicardial/intramural substrate, with paucity of substrate targets for ablation, which results in the worse outcomes with ablation.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Chrishan J Nalliah
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Hawkesbury Road, Westmead, NSW, 2145, Australia.
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10
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Watanabe M, Kashimura T, Ishizuka M, Kase M, Sakai R, Fujiki S, Takayama T, Ishihara S, Ozaki K, Inomata T. Baseline Blood Pressure and Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy with Spontaneous Mechanical Alternans. Intern Med 2022. [PMID: 36351583 DOI: 10.2169/internalmedicine.0711-22] [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: 11/09/2022] Open
Abstract
Background Spontaneous mechanical alternans (MA), or pulsus alternans, has been observed in heart failure patients with hypertension or tachycardia for 150 years and is considered a sign of a poor prognosis. However, in some dilated cardiomyopathy (DCM) patients with MA, optimal medical therapy (OMT) brings left ventricular reverse remodeling (LVRR), a preferable prognostic indicator. This study examined the probability of LVRR in DCM patients with spontaneous MA and whether or not LVRR can be predicted by the baseline blood pressure or heart rate. Methods and Results Thirty-three newly diagnosed DCM patients were retrospectively examined. Spontaneous MA was observed during diagnostic cardiac catheterization in at least 1 of the pressure waveforms of the aorta, left ventricle, pulmonary artery, or right ventricle in 10 patients (30%) (MA-group). LVRR after OMT was achieved roughly equally in the MA group (6 of 10, 60%) and the non-MA group (12 of 23, 52%). In the MA group, those who achieved LVRR had a significantly higher baseline systolic aortic pressure (more than 120 mmHg in all 6 patients) than those who did not, although the baseline heart rate did not show a significant correlation with LVRR. In contrast, in the non-MA group, LVRR was unrelated to the baseline aortic pressure or heart rate. Conclusions The probability of LVRR in newly-diagnosed DCM patients with spontaneous MA was similar to that in those without spontaneous MA. Spontaneous MA may not necessarily be a sign of a poor prognosis if observed in patients with a preserved blood pressure.
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Affiliation(s)
- Mitsuhiro Watanabe
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takeshi Kashimura
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Mitsuo Ishizuka
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Mayumi Kase
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Ryohei Sakai
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Shinya Fujiki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Tsugumi Takayama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Shiro Ishihara
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
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11
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Zhong P, Huang H. Epicardial adipose tissue (EAT): A prognostic factor in patients with non-ischemic cardiomyopathy. Int J Cardiol 2022:S0167-5273(22)01034-8. [PMID: 35810919 DOI: 10.1016/j.ijcard.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022]
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12
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Ghannam M, Liang J, Attili A, Cochet H, Jais P, Latchamsetty R, Jongnarangsin K, Morady F, Gordon D, Bogun F. Magnetic Resonance Imaging and Histopathology of Catheter Ablation Lesions after Ventricular Tachycardia Ablation in Patients with Nonischemic Cardiomyopathy. Heart Rhythm 2022; 19:1642-1649. [PMID: 35772697 DOI: 10.1016/j.hrthm.2022.06.027] [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: 04/24/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) imaging may help identify radiofrequency ablation lesions. This has been poorly described in patients with non-ischemic cardiomyopathy (NICM). OBJECTIVES To describe LGE-CMR characteristics of ablation lesions in patients with NICM and correlate with histopathology. METHODS Twenty-six patients (24 males, 38±14 ejection fraction, 61±9 age), with CMR imaging after VT ablation were included. Areas of both dark and bright core lesions correlating with prior radiofrequency ablation lesions were identified. Histology was performed on an explanted heart. RESULTS The mean time between the ablation procedure and the LGE-CMR study was 8[2-20] months. Twenty-three/26 patients demonstrated dark-core lesions (volume 2.16±1.8 cm3, thickness 3.6±1.3 mm) with a transmurality of 42±16%, overlaying areas of intramural or transmural LGE. Fourteen/26 patients demonstrated bright core lesions (volume 0.8±0.6 cm3, depth 4.15±1.76 mm) with a transmurality of 34±14%, which was located in areas without underlying LGE in 11/13 patients. Both dark and bright core lesions were visualized on standard clinical LGE-CMR imaging obtained in the acute setting and chronic settings (within 3 days and up to 2090 days post ablation). Histopathologic analysis demonstrated coagulation necrosis in the area that corresponded to dark core lesions in the post ablation CMR. CONCLUSION Ablation lesions can be detected by LGE-CMR after VT ablation in NICM patients and have a different appearance than scar tissue. These lesions can be observed in the acute and chronic settings after ablations.
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Affiliation(s)
| | | | | | - Hubert Cochet
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Pierre Jais
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | | | | | | | - David Gordon
- Department of Pathology University of Michigan, Ann Arbor, MI, USA
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13
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Ojha V, Khalique OK, Khurana R, Lorenzatti D, Leung SW, Lawton B, Slesnick TC, Cavalcante JC, Ducci CB, Patel AR, Prieto CC, Plein S, Raman SV, Salerno M, Parwani P. Highlights of the Virtual Society for Cardiovascular Magnetic Resonance 2022 Scientific Conference: CMR: improving cardiovascular care around the world. J Cardiovasc Magn Reson 2022; 24:38. [PMID: 35725565 PMCID: PMC9207863 DOI: 10.1186/s12968-022-00870-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
The 25th Society for Cardiovascular Magnetic Resonance (SCMR) Annual Scientific Sessions saw 1524 registered participants from more than 50 countries attending the meeting virtually. Supporting the theme "CMR: Improving Cardiovascular Care Around the World", the meeting included 179 invited talks, 52 sessions including 3 plenary sessions, 2 keynote talks, and a total of 93 cases and 416 posters. The sessions were designed so as to showcase the multifaceted role of cardiovascular magnetic resonance (CMR) in identifying and prognosticating various myocardial pathologies. Additionally, various social networking sessions as well as fun activities were organized. The major areas of focus for the future are likely to be rapid efficient and high value CMR exams, automated and quantitative acquisition and post-processing using artificial intelligence and machine learning, multi-contrast imaging and advanced vascular imaging including 4D flow.
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Affiliation(s)
- Vineeta Ojha
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Steve W Leung
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | | | | | | | | | - Amit R Patel
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Claudia C Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Subha V Raman
- Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, IN, USA
| | - Michael Salerno
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda University Medical Center, Loma Linda, CA, USA.
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14
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Valzania C, Massaro G, Spadotto A, Muraglia L, Frisoni J, Martignani C, Ziacchi M, Diemberger I, Fanti S, Boriani G, Biffi M, Galié N. Ten-year follow-up of cardiac resynchronization therapy patients with non-ischemic dilated cardiomyopathy assessed by radionuclide angiography: a single-center cohort study. J Interv Card Electrophysiol 2022; 64:723-731. [PMID: 35175490 DOI: 10.1007/s10840-022-01117-z] [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: 06/28/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Relatively few data are available on long-term survival and incidence of ventricular arrhythmias in cardiac resynchronization therapy (CRT) patients. We investigated long-term outcomes of CRT patients with non-ischemic dilated cardiomyopathy stratified as responders or non-responders according to radionuclide angiography. METHODS Fifty patients with non-ischemic dilated cardiomyopathy undergoing CRT were assessed by equilibrium Tc99 radionuclide angiography with bicycle exercise at baseline and after 3 months. Intra- and interventricular dyssynchrony were derived by Fourier phase analysis. Patient clinical outcome was assessed after 10 years. RESULTS At 3 months, 50% of patients were identified as CRT responders according to an increase in LV ejection fraction ≥ 5%. During a follow-up of 109 ± 48 months, 30% of patients died and 6% underwent heart transplantation. Age and history of paroxysmal atrial fibrillation were found to be predictors of all-cause mortality. CRT responders showed lower risk of death from cardiac causes than non-responders. At follow-up, 38% of patients presented at least one episode of sustained ventricular tachycardia, with a similar percentage between responders and non-responders. CONCLUSION At long-term follow-up, non-ischemic CRT recipients identified as responders by radionuclide angiography were found to be at lower risk of worsening heart failure death than non-responders. Long-term risk for sustained ventricular arrhythmia was similar between CRT responders and non-responders.
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Affiliation(s)
- Cinzia Valzania
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.
| | - Giulia Massaro
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Alberto Spadotto
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Lorenzo Muraglia
- Department of Nuclear Medicine, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jessica Frisoni
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Cristian Martignani
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Igor Diemberger
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Nazzareno Galié
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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15
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Zhang Z, Chen X, Wan Q, Wang H, Qi N, You Z, Yuan J, Hu L, Sun H, Wang Z, Hu C, Zhao J. A two-stage cardiac PET and late gadolinium enhancement MRI co-registration method for improved assessment of non-ischemic cardiomyopathies using integrated PET/MR. Eur J Nucl Med Mol Imaging 2022; 49:2199-2208. [PMID: 35031812 DOI: 10.1007/s00259-022-05681-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Respiratory motion causes mismatches between PET images of the myocardium and the corresponding cardiac MR images in cardiac integrated PET/MR. The mismatch may affect the attenuation correction and the diagnosis of non-ischemic cardiomyopathies. In this study, we present a two-stage cardiac PET and MR late gadolinium enhancement (LGE) co-registration method, which seeks to improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration using an integrated whole-body PET/MR system. METHODS The proposed PET and LGE two-stage co-registration method was evaluated through comparison with one-stage direct co-registration and no-registration. One hundred and ninety-one slices of LGE and forty lesions were studied. Two trained nuclear medicine physicians independently assessed the displacement between LGE and PET to qualitatively evaluate the co-registration quality. The changes of the mean SUV in the normal myocardium and the LGE-enhanced lesions before and after image co-registration were measured to quantitatively evaluate the accuracy and value of image co-registration. RESULTS The two-stage method had an improved image registration score (4.93 ± 0.89) compared with the no-registration method (3.49 ± 0.84, p value < 0.001) and the single-stage method (4.23 ± 0.81, p value < 0.001). Furthermore, the two-stage method led to increased SUV value in the myocardium (3.87 ± 2.56) compared with the no-registration method (3.14 ± 1.92, p value < 0.001) and the single-stage method (3.32 ± 2.16, p value < 0.001). The mean SUV in the LGE lesion significantly increased from 2.51 ± 2.09 to 2.85 ± 2.35 (p value < 0.001) after the two-stage co-registration. CONCLUSION The proposed two-stage registration method significantly improved the co-registration between PET and LGE in integrated PET/MR imaging. The technique may improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration. REGISTERED NO DF-2020-085,2020.04.30.
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Affiliation(s)
- Zheng Zhang
- The Institute of Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,United Imaging Healthcare Co. Ltd., Shanghai, 201807, China
| | - Xing Chen
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Qing Wan
- Department of Cardiovascular Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Haiyan Wang
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Na Qi
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Zhiwen You
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Jianmin Yuan
- United Imaging Healthcare Co. Ltd., Shanghai, 201807, China
| | - Lingzhi Hu
- United Imaging Healthcare Co. Ltd., Shanghai, 201807, China
| | - Hongwei Sun
- United Imaging Healthcare Co. Ltd., Shanghai, 201807, China
| | - Zhe Wang
- United Imaging Healthcare Co. Ltd., Shanghai, 201807, China
| | - Chenxi Hu
- The Institute of Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
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16
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Koya T, Watanabe M, Kamada R, Hagiwara H, Nakao M, Kadosaka T, Koizumi T, Anzai T. Hybrid epicardial ventricular tachycardia ablation with lateral thoracotomy in a patient with a history of left ventricular reconstruction surgery. J Cardiol Cases 2022; 25:37-41. [PMID: 35024067 DOI: 10.1016/j.jccase.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
Although a hybrid procedure involving surgical access may be feasible for epicardial catheter ablation in individuals with prior cardiac surgery, surgical approaches in thoracotomy are important in patients with advanced adhesions. We performed an epicardial ventricular tachycardia (VT) ablation in a patient with dilated phase hypertrophic cardiomyopathy after left ventricular reconstruction. We gained surgical epicardial access via lateral thoracotomy based on the anticipated VT circuit in the apical anteroseptal area, which was estimated using prior endocardial mapping. The remaining epicardial myocardium around the surgical incision was involved in the central isthmus, and the VT was eliminated by radiofrequency catheter ablation. <Learning objective: Postoperative adhesions hampered the percutaneous catheter approach by subxiphoid puncture in patients with a history of cardiac surgery. Combining anatomical consideration by computed tomography imaging and information from endocardial ablation helped to perform a minimally invasive surgical epicardial approach. The remaining epicardial myocardium around the surgical incision was assumed to be involved in the reentry circuit of the ventricular tachycardia in a patient diagnosed with dilated-phase hypertrophic cardiomyopathy with a previous history of left ventricular reconstruction.>.
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17
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Sakakibara T, Suwa K, Ushio T, Wakayama T, Alley M, Saotome M, Satoh H, Maekawa Y. Intra-Left Ventricular Hemodynamics Assessed with 4D Flow Magnetic Resonance Imaging in Patients with Left Ventricular Thrombus. Int Heart J 2021; 62:1287-1296. [PMID: 34853222 DOI: 10.1536/ihj.20-792] [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: 11/18/2022]
Abstract
Left ventricular thrombus (LVT) has been identified to be crucial in patients with reduced ejection fraction (EF). Three-dimensional cine phase-contrast magnetic resonance imaging (4D flow MRI) can visualize the intra-LV vortex during diastole and quantify the maximum flow velocity (Vmax) at the apex. In this study, we investigated whether the change in the intra-LV vortex was associated with the presence of LVT in patients with cardiac disease.In total, 36 patients (63.5 ± 11.9 years, 28 men, 12/24 with/without LVT) with diffuse LV dysfunction underwent 4D flow MRI. The relative vortex area using streamline images and Vmax of blood flow toward the apex at the apical left ventricle were evaluated. The correlation between the relative vortex area and Vmax was assessed using Pearson's correlation coefficient. The ability to detect LVT was evaluated using the area under the curve (AUC) of the receiver operating characteristic.The relative vortex area was found to be smaller (27 ± 10% versus 45 ± 11%, P = 0.000026), whereas Vmax at the apical left ventricle was lower (19.1 ± 4.4 cm/second versus 27.4 ± 8.9 cm/second, P = 0.0006) in patients with LVT. Vmax at the apical left ventricle demonstrated significant correlations with the relative vortex area (r = 0.43, P = 0.01) and relative transverse length of the vortex (r = 0.45, P = 0.007). The AUC was 0.91 for the relative vortex area, whereas it was 0.80 for Vmax in the apical left ventricle.A smaller LV vortex and lower flow velocity at the LV apex were associated with LVT in patients with reduced EF.
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Affiliation(s)
- Tomoaki Sakakibara
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Takasuke Ushio
- Department of Radiology, Hamamatsu University School of Medicine
| | | | - Marcus Alley
- Division of Radiology, Stanford University School of Medicine, Stanford
| | - Masao Saotome
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
| | - Hiroshi Satoh
- Department of Cardiology, Fujinomiya City General Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine
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18
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Halbfass P, Ludwig D, Sonne K, Nentwich K, Ene E, Berkovitz A, Foldyna B, Barth S, Müller J, Lehmkuhl L, Lüsebrink U, Waechter C, Deneke T. Acute and long-term outcomes of VT radiofrequency catheter ablation in patients with versus without an intramural septal substrate. Indian Pacing Electrophysiol J 2021:S0972-6292(21)00147-9. [PMID: 34655759 DOI: 10.1016/j.ipej.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/06/2021] [Revised: 09/04/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Aim of this study was to evaluate efficacy and safety of ventricular tachycardia (VT) catheter ablation in patients with structural heart disease (SHD) in relation to the presence of an intramural septal substrate. Methods Consecutive patients undergoing VT ablation between January 2019 and October 2020 were included. All patients were stratified based on the presence of relevant septal substrate and freedom from VT recurrences were analyzed. Results In total, 199 consecutive patients (64.2 ± 13.0 years; 89% male; 55% ischemic cardiomyopathy (ICM)) undergoing VT ablation were included. 129/199 patients (65%) showed significant septal substrate (55/90 patients (61%) with non-ischemic cardiomyopathy (NICM) compared to 74/109 patients (68%) with ICM; p = 0.37). Acute procedural success with elimination of all inducible VTs was achieved in 66/70 patients (94%) without and in 103/129 patients (80%) with a septal substrate (p = 0.007). In the cohort including patients with a clinical FU, 15/60 patients (25%) without a septal substrate and 48/123 patients (39%) with a septal substrate experienced VT recurrence during a FU of 8.1 ± 5.9 months (p = 0.069). Conclusion Presence of septal VT substrate in patients with a structural heart disease or coronary artery disease is common. Acute success of VT catheter ablation was significantly higher and mid-term success tended to be higher in patients without a septal substrate.
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19
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Shams P, Sultan FAT. Clinical Characteristics, Cardiac Magnetic Resonance Features, and Outcomes of Patients with Dilated Cardiomyopathy - An Experience from a South Asian Country. J Clin Imaging Sci 2021; 11:40. [PMID: 34345530 PMCID: PMC8326073 DOI: 10.25259/jcis_126_2021] [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: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives: The objectives of the study were to evaluate the clinical presentation, cardiac magnetic resonance (CMR) features, and outcomes of patients with dilated cardiomyopathy (DCM). Material and Methods: A retrospective study was conducted at a tertiary care center of Pakistan. All patients who underwent CMR for further evaluation of DCM during the period of 2011–2019 and in whom CMR confirmed the diagnosis of DCM, were included in the study. Patients were followed up in the year 2020 for all-cause mortality and cardiovascular hospitalizations. Results: A total of 75 patients were included in the study. The mean age was 38.7 ± 13 with the majority (n = 57, 76%) being male. Dyspnea was the most common presenting symptom (n = 68, 90.7%). The mean left ventricle ejection fraction (LVEF) by CMR was 29.3 ± 12 and mean left ventricle stroke volume (LVSV) was 66.5 ± 31. Late gadolinium enhanced (LGE) was present in 28 (37.3%) patients. Follow-up was available in 61 patients with the mean follow-up duration of 39.7 ± 27 months. Most patients (40, 65.6%) experienced all-cause major adverse cardiovascular events (MACE) during the follow-up and mortality was observed in 10 (16.4%) patients. LVSV by CMR (P = 0.03), LVEF by CMR (P = 0.02), and presence of pericardial effusion (PE) (P = 0.01) were significantly associated with all-cause MACE. On multiregression analysis, SV by CMR was associated with all cause MACE (P = 0.048). The presence of LGE was associated with higher mortality (P = 0.03). Conclusion: LVSV, LVEF by CMR, and PE were significantly associated with all-cause MACE. LGE was associated with higher mortality. Our cohort had a relatively younger age of presentation and diagnosis, and a greater mortality on follow-up, when compared with other regions of the world.
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Affiliation(s)
- Pirbhat Shams
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Fateh Ali Tipoo Sultan
- Department of Medicine (Cardiology), Aga Khan University Hospital, Karachi, Sindh, Pakistan
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20
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Goto K, Masuda T, Ohashi J, Nakatsu Y, Nakamura F. Biventricular Thrombi Associated with Cardiac Systolic Dysfunction and Disseminated Intravascular Coagulation from Heat Stroke. Int Heart J 2021; 62:687-694. [PMID: 33994503 DOI: 10.1536/ihj.20-558] [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: 11/18/2022]
Abstract
A 58-year-old man with non-ischemic cardiomyopathy visited a hospital once a month after his first hospitalization for heart failure. Three months later, he presented with consciousness impairment and heat stroke. Blood tests showed multiple organ failure, and echocardiography revealed biventricular thrombi. After admission, intensive care was provided, and anticoagulation therapy was initiated. The echocardiographic findings in the third week confirmed the complete disappearance of thrombi. Biventricular thrombi associated with disseminated intravascular coagulation from heat stroke is rare. We report the case of a patient who was treated with anticoagulation therapy only, without surgical intervention.
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Affiliation(s)
- Kohsaku Goto
- Department of Cardiology, Shioda Memorial Hospital
| | | | | | | | - Fumitaka Nakamura
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center
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21
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Bergonti M, Casella M, Compagnucci P, Russo AD, Tondo C. Electroanatomic Mapping System and Intracardiac-Echo to Guide Endomyocardial Biopsy. Card Electrophysiol Clin 2021; 13:381-392. [PMID: 33990276 DOI: 10.1016/j.ccep.2021.02.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interest in endomyocardial biopsy (EMB) has progressively grown during the past decade. Still, its use remains limited to highly specialized centers, mostly because it is considered an invasive procedure with poor diagnostic yield and inherent complications. Indeed, the diagnostic performance of EMB is strictly linked to the sample of myocardium we can obtain. If we can precisely localize areas of diseased myocardium, sampling error or inadequate withdrawals are minimized. In this state-of-the-art review, we provide guidance on how to technically and practically perform EMB guided by electroanatomic voltage mapping and intracardiac echocardiography, and review the evidence supporting this combined approach.
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Affiliation(s)
- Marco Bergonti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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22
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Tan SML, Ong CC, Tan KB, Chin HL, Paliwal PR, Ng KWP, Lin W. Subclinical Cardiomyopathy in Miyoshi Myopathy Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging. Int Heart J 2021; 62:186-192. [PMID: 33518658 DOI: 10.1536/ihj.20-354] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dysferlin is a sarcolemmal protein present in muscle cells. It is responsible for muscle membrane repair. Dysferlin gene (DYSF) mutation, resulting in deficiency in this protein, is termed dysferlinopathy. Clinically, it manifests as early adulthood onset of muscle weakness with markedly elevated creatine kinase levels. The main phenotypes are limb-girdle muscular dystrophy type 2B (LGMD2B), affecting proximal muscles, and Miyoshi myopathy (MM), affecting distal muscles. Dysferlin is also present in cardiomyocytes, and case reports have emerged of cardiac abnormalities in dysferlinopathy. While routine methods of cardiac screening, namely, electrocardiography or echocardiography, are convenient and noninvasive, they often exhibit insufficient diagnostic sensitivity for detecting subclinical cardiac remodeling during early stages of cardiomyopathy. Cardiac magnetic resonance imaging though can provide accurate assessment of cardiac chamber sizes and function. With gadolinium administration, it can also detect areas of myocardial scarring and fibrosis. Early diagnosis of neuromuscular disease-related cardiomyopathy is of clinical significance, as appropriate treatment can retard myocardial fibrosis, delaying cardiomyopathy progression. We present a case of a patient with MM incidentally diagnosed with concomitant cardiomyopathy.
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Affiliation(s)
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Kong Bing Tan
- Yong Loo Lin School of Medicine, National University of Singapore.,Department of Pathology, National University Hospital
| | - Hui-Lin Chin
- Yong Loo Lin School of Medicine, National University of Singapore.,Division of Paediatric Genetics & Metabolism, Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute
| | - Prakash R Paliwal
- Yong Loo Lin School of Medicine, National University of Singapore.,Division of Neurology, Department of Medicine, National University Hospital
| | - Kay Wei Ping Ng
- Yong Loo Lin School of Medicine, National University of Singapore.,Division of Neurology, Department of Medicine, National University Hospital
| | - Weiqin Lin
- Yong Loo Lin School of Medicine, National University of Singapore.,Department of Cardiology, National University Heart Centre
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23
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Yin H, Favreau-Lessard AJ, deKay JT, Herrmann YR, Robich MP, Koza RA, Prudovsky I, Sawyer DB, Ryzhov S. Protective role of ErbB3 signaling in myeloid cells during adaptation to cardiac pressure overload. J Mol Cell Cardiol 2020; 152:1-16. [PMID: 33259856 DOI: 10.1016/j.yjmcc.2020.11.009] [Citation(s) in RCA: 8] [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: 05/25/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Myeloid cells play an important role in a wide variety of cardiovascular disorders, including both ischemic and non-ischemic cardiomyopathies. Neuregulin-1 (NRG-1)/ErbB signaling has recently emerged as an important factor contributing to the control of inflammatory activation of myeloid cells after an ischemic injury. However, the role of ErbB signaling in myeloid cells in non-ischemic cardiomyopathy is not fully understood. This study investigated the role of ErbB3 receptors in the regulation of early adaptive response using a mouse model of transverse aortic constriction (TAC) for non-ischemic cardiomyopathy. METHODS AND RESULTS TAC surgery was performed in groups of age- and sex-matched myeloid cell-specific ErbB3-deficient mice (ErbB3MyeKO) and control animals (ErbB3MyeWT). The number of cardiac CD45 immune cells, CD11b myeloid cells, Ly6G neutrophils, and Ly6C monocytes was determined using flow cytometric analysis. Five days after TAC, survival was dramatically reduced in male but not female ErbB3MyeKO mice or control animals. The examination of lung weight to body weight ratio suggested that acute pulmonary edema was present in ErbB3MyeKO male mice after TAC. To determine the cellular and molecular mechanisms involved in the increased mortality in ErbB3MyeKO male mice, cardiac cell populations were examined at day 3 post-TAC using flow cytometry. Myeloid cells accumulated in control but not in ErbB3MyeKO male mouse hearts. This was accompanied by increased proliferation of Sca-1 positive non-immune cells (endothelial cells and fibroblasts) in control but not ErbB3MyeKO male mice. No significant differences in intramyocardial accumulation of myeloid cells or proliferation of Sca-1 cells were found between the groups of ErbB3MyeKO and ErbB3MyeWT female mice. An antibody-based protein array analysis revealed that IGF-1 expression was significantly downregulated only in ErbB3MyeKO mice hearts compared to control animals after TAC. CONCLUSION Our data demonstrate the crucial role of myeloid cell-specific ErbB3 signaling in the cardiac accumulation of myeloid cells, which contributes to the activation of cardiac endothelial cells and fibroblasts and development of an early adaptive response to cardiac pressure overload in male mice.
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Affiliation(s)
- Haifeng Yin
- Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | | | - Joanne T deKay
- Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Yodit R Herrmann
- Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Michael P Robich
- Maine Medical Center Research Institute, Scarborough, ME, United States of America; Maine Medical Center, Cardiovascular Institute, Portland, ME, United States of America
| | - Robert A Koza
- Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Igor Prudovsky
- Maine Medical Center Research Institute, Scarborough, ME, United States of America
| | - Douglas B Sawyer
- Maine Medical Center Research Institute, Scarborough, ME, United States of America; Maine Medical Center, Cardiovascular Institute, Portland, ME, United States of America
| | - Sergey Ryzhov
- Maine Medical Center Research Institute, Scarborough, ME, United States of America.
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24
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Kim EK, Lee GY, Jang SY, Chang SA, Kim SM, Park SJ, Choi JO, Park SW, Choe YH, Lee SC, Oh JK. The Extent of Late Gadolinium Enhancement Can Predict Adverse Cardiac Outcomes in Patients with Non-Ischemic Cardiomyopathy with Reduced Left Ventricular Ejection Fraction: A Prospective Observational Study. Korean J Radiol 2020; 22:324-333. [PMID: 32932562 PMCID: PMC7909865 DOI: 10.3348/kjr.2020.0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The clinical course of an individual patient with heart failure is unpredictable with left ventricle ejection fraction (LVEF) only. We aimed to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived myocardial fibrosis extent and to determine the cutoff value for event-free survival in patients with non-ischemic cardiomyopathy (NICM) who had severely reduced LVEF. MATERIALS AND METHODS Our prospective cohort study included 78 NICM patients with significantly reduced LV systolic function (LVEF < 35%). CMR images were analyzed for the presence and extent of late gadolinium enhancement (LGE). The primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, heart transplantation, implantable cardioverter-defibrillator discharge for major arrhythmia, and hospitalization for congestive heart failure within 5 years after enrollment. RESULTS A total of 80.8% (n = 63) of enrolled patients had LGE, with the median LVEF of 25.4% (19.8-32.4%). The extent of myocardial scarring was significantly higher in patients who experienced MACE than in those without any cardiac events (22.0 [5.5-46.1] %LV vs. 6.7 [0-17.1] %LV, respectively, p = 0.008). During follow-up, 51.4% of patients with LGE ≥ 12.0 %LV experienced MACE, along with 20.9% of those with LGE ≤ 12.0 %LV (log-rank p = 0.001). According to multivariate analysis, LGE extent more than 12.0 %LV was independently associated with MACE (adjusted hazard ratio, 6.71; 95% confidence interval, 2.54-17.74; p < 0.001). CONCLUSION In NICM patients with significantly reduced LV systolic function, the extent of LGE is a strong predictor for long-term adverse cardiac outcomes. Event-free survival was well discriminated with an LGE cutoff value of 12.0 %LV in these patients.
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Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Yeon Lee
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Yi Jang
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung A Chang
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ji Park
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Oh Choi
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sang Chol Lee
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jae K Oh
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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25
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Zhang ZH, Meng FQ, Hou XF, Qian ZY, Wang Y, Qiu YH, Jiang ZY, Du AJ, Qin CT, Zou JG. Clinical characteristics and long-term prognosis of ischemic and non-ischemic cardiomyopathy. Indian Heart J 2020; 72:93-100. [PMID: 32534695 PMCID: PMC7296233 DOI: 10.1016/j.ihj.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives The different etiology of HF has different prognostic risk factors. Prognosis assessment of ICM and NICM has important clinical value. This study is aimed to explore the predicting factors for ICM and NICM. Methods 1082 HFrEF patients were retrospectively enrolled from Jan. 01, 2016 to Dec. 31, 2017. On Jan. 31, 2019, 873 patients were enrolled for analysis excluding incomplete, unfollowed, and unexplained data. The patients were divided into ischemic and non-ischemic group. The differences in clinical characteristics and long-term prognosis between the two groups were analyzed, and multivariate Cox analysis was used to predict the respective all-cause mortality, SCD and rehospitalization of CHF. Results 873 patients aged 64(53,73) were divided into two groups: ICM (403, 46.16%) and NICM. At the end, 203 died (111 in ICM, 54.68%), of whom 87 had SCD (53 in ICM, 60.92%) and 269 had rehospitalization for HF(134 in ICM, 49.81%). Independent risk factors affecting all-cause mortality in ICM: DM, previous hospitalization of HF, age, eGFR, LVEF; for SCD: PVB, eGFR, Hb, revascularization; for readmission of HF: low T3 syndrome, PVB, DM, previous hospitalization of HF, eGFR. Otherwise; factors affecting all-cause mortality in NICM: NYHA III-IV, paroxysmal AF/AFL, previous hospitalization of HF, β-blocker; for SCD: low T3 syndrome, PVB, nitrates, sodium, β-blocker; for rehospitalization of HF: paroxysmal AF/AFL, previous admission of HF, LVEF. Conclusions Both all-cause mortality and SCD in ICM is higher than that in NICM. Different etiologies of CHF have different risk factors affecting the prognosis.
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Affiliation(s)
- Zhi-Hua Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China; Department of Cardiology, Jiangning Hospital Affiliated to Nanjing Medical University, Jiangsu, China
| | - Fan-Qi Meng
- Department of Cardiology, Xiamen Cardiovascular Disease Hospital, Xiamen, China
| | - Xiao-Feng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhi-Yong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yuan-Hao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhe-Yu Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - An-Jie Du
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Chao-Tong Qin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Jian-Gang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
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26
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Yang S, Liu Z, Hu Y, Jing R, Gu M, Niu H, Ding L, Xing A, Zhang S, Hua W. A novel risk model for mortality and hospitalization following cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy: the alpha-score. BMC Cardiovasc Disord 2020; 20:205. [PMID: 32345229 PMCID: PMC7189497 DOI: 10.1186/s12872-020-01460-x] [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: 06/13/2019] [Accepted: 04/01/2020] [Indexed: 02/07/2023] Open
Abstract
Background Non-ischemic cardiomyopathy (NICM) has been associated with a better left ventricle reverse remodeling response and improved clinical outcomes after cardiac resynchronization therapy (CRT). The aims of our study were to identify the predictors of mortality and heart failure hospitalization in patients treated with CRT and design a risk score for prognosis. Methods A cohort of 422 consecutive NICM patients with CRT was retrospectively enrolled between January 2010 and December 2017. The primary endpoint was all-cause mortality and heart transplantation. Results In a multivariate analysis, the predictors of all-cause death were left atrial diameter [Hazard ratio (HR): 1.056, 95% confidence interval (CI): 1.020–1.093, P = 0.002]; non-left bundle branch block [HR: 1.793, 95% CI: 1.131–2.844, P = 0.013]; high sensitivity C-reactive protein [HR: 1.081, 95% CI: 1.029–1.134 P = 0.002]; and N-terminal pro-B-type natriuretic peptide [HR: 1.018, 95% CI: 1.007–1.030, P = 0.002]; and New York Heart Association class IV [HR: 1.018, 95% CI: 1.007–1.030, P = 0.002]. The Alpha-score (Atrial diameter, non-LBBB, Pro-BNP, Hs-CRP, NYHA class IV) was derived from each independent risk factor. The novel score had good calibration (Hosmer-Lemeshow test, P > 0.05) and discrimination for both primary endpoints [c-statistics: 0.749 (95% CI: 0.694–0.804), P < 0.001] or heart failure hospitalization [c-statistics: 0.692 (95% CI: 0.639–0.745), P < 0.001]. Conclusion The Alpha-score may enable improved discrimination and accurate prediction of long-term outcomes among NICM patients with CRT.
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Affiliation(s)
- Shengwen Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhimin Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Yiran Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ran Jing
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Min Gu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongxia Niu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ligang Ding
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | | | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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27
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Rusnak J, Behnes M, Weiß C, Nienaber C, Reiser L, Schupp T, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Weidner K, Akin M, Mashayekhi K, Borggrefe M, Akin I. Non-ischemic compared to ischemic cardiomyopathy is associated with increasing recurrent ventricular tachyarrhythmias and ICD-related therapies. J Electrocardiol 2020; 59:174-180. [PMID: 32179288 DOI: 10.1016/j.jelectrocard.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/16/2018] [Revised: 02/13/2019] [Accepted: 02/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The study sought to assess the impact of ischemic (ICMP) compared to non-ischemic cardiomyopathy (NICMP) on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients. BACKGROUND Data comparing recurrences of ventricular tachyarrhythmias in ICD recipients with ischemic or non-ischemic cardiomyopathy is limited. METHODS A large retrospective registry was used including all consecutive ICD recipients with first episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016. Patients with ICMP were compared to patients with NICMP. The primary prognostic endpoint was first recurrences of ventricular tachyarrhythmias at one year. Secondary endpoints comprised ICD-related therapies, rehospitalization and all-cause mortality at one year. Statistics Kaplan-Meier survival and multivariable Cox regression analyses. RESULTS A total of 387 consecutive ICD recipients were included retrospectively (ICMP: 82%, NICMP: 18%). At one year of follow-up, freedom from first recurrences of ventricular tachyarrhythmias was lower in NICMP (81% vs. 71%, log-rank p = 0.063; HR = 1.760; 95% CI 0.985-3.002; p = 0.080), mainly attributed to higher rates of sustained VT (20% versus 12%, p = 0.054). Accordingly, freedom from first appropriate device therapies was lower in NICMP (74% vs. 85%, log rank p = 0.004; HR = 1.951; 95% CI 1.121-3.397; p = 0.028), especially in patients with sustained VT or VF at index. Both groups revealed comparable rates of rehospitalization and all-cause mortality at one year. CONCLUSION NICMP was associated with higher rates of recurrent ventricular tachyarrhythmias and appropriate ICD therapies compared to ICMP at one year of follow-up, whereas rates of rehospitalization and all-cause mortality were comparable. CONDENSED ABSTRACT This study retrospectively compared the impact of cardiomyopathy types (ICMP versus NICMP) on recurrences of ventricular tachyarrhythmias in 387 ICD recipients. Freedom from first episodes of ventricular tachyarrhythmias and first appropriate device therapies were lower in patients with NICMP compared to ICMP.
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Affiliation(s)
- Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany.
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Clinic for Cardiology and Angiology II, Universitaetszentrum Freiburg Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
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Makimoto H, Zielke S, Clasen L, Lin T, Gerguri S, Müller P, Schmidt J, Bejinariu A, Kurt M, Brinkmeyer C, Stern M, Kelm M, Fürnkranz A. Clinical significance of precedent asymptomatic non-sustained ventricular tachycardias on subsequent ICD interventions and heart failure hospitalization in primary prevention ICD patients. Eur J Med Res 2020; 25:5. [PMID: 32183891 PMCID: PMC7076933 DOI: 10.1186/s40001-020-0401-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/18/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The prognostic implications of non-sustained ventricular tachycardia (NSVT) and their significance as therapeutic targets in patients without prior sustained ventricular arrhythmias remain undetermined. The aim of this study was to investigate the prognostic significance of asymptomatic NSVT in patients who had primary prevention implantable cardioverter-defibrillator (ICD) implantation due to ischemic or non-ischemic cardiomyopathy (ICM, NICM). Methods We enrolled 157 consecutive primary prevention ICD patients without previous appropriate ICD therapy (AIT). Patients were allocated to two groups depending on the presence or absence of NSVT in a 6-month period prior to enrollment. The incidence of AIT and unplanned hospitalization due to decompensated heart failure (HF) were assessed during follow-up. Results In 51 patients (32%), precedent NSVT was documented. During a median follow-up of 1011 days, AIT occurred in 36 patients (23%) and unplanned HF hospitalization was observed in 32 patients (20%). In precedent NSVT patients, the incidence of AIT and unplanned HF hospitalization was significantly higher as compared to patients without precedent NSVT (AIT: 29/51 [57%] vs. 7/106 [7%], P < 0.001, log-rank; HF hospitalization: 16/51 [31%] vs. 16/106 [15%], P = 0.043, log-rank). Cox-regression demonstrated that precedent NSVT independently predicted AIT (P < 0.0001). In subgroup analyses, precedent NSVT predicted AIT in both ICM and NICM (P < 0.0001, P = 0.020), but predicted HF hospitalization only in patients with ICM (P = 0.0030). Conclusions Precedent non-sustained VT in patients with primary prevention ICDs is associated with subsequent appropriate ICD therapies, and is an independent predictor of unplanned heart failure hospitalizations in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany. .,CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany.
| | - Sophie Zielke
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany
| | - Tina Lin
- GenesisCare, East Melbourne, VIC, Australia
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Patrick Müller
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Alexandru Bejinariu
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Muhammed Kurt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Brinkmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Manuel Stern
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany
| | - Alexander Fürnkranz
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Zuo H, Zhang Y, Ma F, Li R, Wang Y, Li C, Wang H, Wang DW. Myocardial Deformation Pattern Differs between Ischemic and Non-ischemic Dilated Cardiomyopathy: The Diagnostic Value of Longitudinal Strains. Ultrasound Med Biol 2020; 46:233-243. [PMID: 31718811 DOI: 10.1016/j.ultrasmedbio.2019.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Both ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) are characterized by left ventricular (LV) dysfunction and dilation. Differentiation between ICM and NICM using non-invasive image modalities is a clinical challenge. This study compared the myocardial deformation patterns of ICM and NICM using 2-D speckle tracking echocardiography (2-D STE) and sought to find parameters valuable in the diagnosis and management of dilated cardiomyopathy. The study population comprised 84 consecutive patients with LV end-diastolic dimension >55 mm and ejection fraction (EF) <45 %. Of these patients, 41 were diagnosed with ICM and 43 with NICM by coronary angiography. 2-D STE was performed in all patients. The LV dimension did not differ between ICM and NICM. Compared with patients with ICM, patients with NICM had lower EF (29.0% vs. 33.0%, p = 0.024), lower global longitudinal strain (-5.4 ± 2.6% vs. -7.0 ± 2.5%, p = 0.006) and lower global radial strain (7.5 ± 4.5% vs. 10.7 ± 4.7%, p = 0.019). In contrast, global longitudinal strains did not differ significantly. However, NICM patients had higher apical and lower basal longitudinal strains compared with those with ICM. The ratio of basal to sum of mid- and apical longitudinal strains could predict NICM with a sensitivity of 63.4% and specificity of 88.4% by receiver operating characteristic curve analysis (cutoff value: 0.47, area under the curve: 0.792). Moreover, the concomitant presence of non-significant coronary artery stenosis (>50% and <70%) had no significant influence on global longitudinal strain in NICM. In conclusion, LV dilation and systolic dysfunction, relative apical sparing and a basal worsening pattern of LV longitudinal strain by 2-D STE were observed in patients with NICM but not ICM. The ratio of basal to sum of mid- and apical longitudinal strains could help differentiate NICM from ICM.
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Affiliation(s)
- Houjuan Zuo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenze Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Toya T, Ito K, Kagami K, Osaki A, Sato A, Kimura T, Horii S, Yasuda R, Namba T, Ido Y, Nagatomo Y, Hayashi K, Masaki N, Yada H, Adachi T. Impact of oxidative posttranslational modifications of SERCA2 on heart failure exacerbation in young patients with non-ischemic cardiomyopathy: A pilot study. Int J Cardiol Heart Vasc 2019; 26:100437. [PMID: 31763443 PMCID: PMC6864308 DOI: 10.1016/j.ijcha.2019.100437] [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: 08/20/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 01/14/2023]
Abstract
Background Oxidative posttranslational modifications (OPTM) impair the function of Sarcoplasmic/endoplasmic reticulum (SR) calcium (Ca2+) ATPase (SERCA) 2 and trigger cytosolic Ca2+ dysregulation. We investigated the extent of OPTM of SERCA2 in patients with non-ischemic cardiomyopathy (NICM). Methods and results Endomyocardial biopsy (EMB) was obtained in 40 consecutive patients with NICM. Total expression and OPTM of SERCA2, including sulfonylation at cysteine-674 (S-SERCA2) and nitration at tyrosine-294/295 (N-SERCA2), were examined by immunohistochemical analysis. S-SERCA2 increased in the presence of late gadolinium enhancement on cardiac magnetic resonance imaging. S-SERCA2/SERCA2 and N-SERCA2/SERCA2 correlated with cardiac fibrosis evaluated by Masson’s trichrome staining of EMB. SERCA2 expression modestly increased in parallel with an upward trend in OPTM of SERCA2 with aging. This tendency became prominent only in patients aged >65 years. OPTM of SERCA2 positively correlated with brain natriuretic peptide (BNP) values only in patients aged ≤65 years. Composite major adverse cardiac events (MACE) increased more in the high OPTM group of younger patients; however, MACE-free survival was similar irrespective of the extent of OPTM in older patients. Conclusions OPTM of SERCA2 correlate with myocardial fibrosis in NICM. In younger patients, OPTM of SERCA2 correlate with elevated BNP and increased composite MACE.
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Affiliation(s)
- Takumi Toya
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kei Ito
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kazuki Kagami
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ayumu Osaki
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Atsushi Sato
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toyokazu Kimura
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Shunpei Horii
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Risako Yasuda
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takayuki Namba
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasuo Ido
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Katsumi Hayashi
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hirotaka Yada
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa, Saitama, Japan
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Frommeyer G, Andresen D, Ince H, Maier S, Stellbrink C, Kleemann T, Seidl K, Hoffmann E, Zrenner B, Hochadel M, Senges J, Eckardt L. Can we rely on Danish? Real-world data on patients with nonischemic cardiomyopathy from the German Device Registry. Heart Vessels 2019; 34:1196-1202. [PMID: 30607538 DOI: 10.1007/s00380-018-01337-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/26/2018] [Accepted: 12/28/2018] [Indexed: 11/30/2022]
Abstract
According to current guidelines prophylactic implantable cardioverter-defibrillator (ICD) therapy is recommended in patients with significantly impaired left ventricular systolic function. However, the recently published DANISH trial did not find a significantly lower long-term rate of death from any cause compared with usual clinical care in patients with non-ischemic cardiomyopathy. We investigated whether registry data from a multi-center 'real-life' registry on patients with non-ischemic cardiomyopathy are similar to this trial. The German Device Registry (DEVICE) is a nationwide, prospective registry with one-year follow-up investigating 5451 patients receiving device implantations in 50 German centers. The present analysis of DEVICE focused on patients with non-ischemic cardiomyopathy and a left ventricular ejection fraction ≤35% who received a prophylactic ICD. Out of 779 patients with symptomatic heart failure and nonischemic cardiomyopathy, 33.1% received a single chamber ICD (VVI), while 11.0% were implanted with a dual-chamber ICD (DDD), and 55.8% received a defibrillator system for cardiac resynchronization therapy. Median follow-up was 16.1 months. 90.7% were alive at follow-up, 9.3% had died during this period. Overall mortality after one year was 5.4%. Overall mortality one year after implantation was significantly increased in patients 68 years and older(7.9%) as compared to younger patients (59-68 years: 2.5%; < 59 years: 3.8%; p < 0.015). Data from the present registry support the recently published results of the DANISH trial. In particular the influence of an increased age as proven in the DANISH trial might also play a role in the present collective. This limits the potential beneficial effect of ICD therapy in particular in the elderly population.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
| | - Dietrich Andresen
- Department of Cardiology, Kardiologie Am Hubertus-Krankenhaus, Berlin, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum Am Urban Und Im Friedrichshain, Berlin, Germany.,Universitätsmedizin Rostock, Rostock, Germany
| | - Sebastian Maier
- Department of Cardiology, Klinikum Straubing, Straubing, Germany
| | | | - Thomas Kleemann
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Karlheinz Seidl
- Department of Cardiology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Ellen Hoffmann
- Department of Cardiology, Heart Center Munich-Bogenhausen, Munich, Germany
| | - Bernhard Zrenner
- Department of Cardiology, Krankenhaus Landshut-Achdorf, Landshut, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Briongos-Figuero S, Estévez A, Luisa Pérez M, Martínez-Ferrer JB, García E, Viñolas X, Arenal Á, Alzueta J, Basterra N, Rodríguez A, Lozano I, Muñoz-Aguilera R. Survival and arrhythmic risk among ischemic and non-ischemic heart failure patients with prophylactic implantable cardioverter defibrillator only therapy: A propensity score-matched analysis. Int J Cardiol 2019; 274:163-169. [PMID: 30206014 DOI: 10.1016/j.ijcard.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/29/2018] [Revised: 08/18/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Concerns about the efficacy of prophylactic ICD in non-ischemic cardiomyopathy (NICM) heart failure (HF) patients are still present. We aimed to assess whether survival and arrhythmic risk were different among ischemic cardiomyopathy (ICM) and NICM ICD-only patients, along with specific predictors for mortality. METHODS HF patients undergoing ICD-only implant were extracted from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts. RESULTS 782 patients (556 ICM; 226 NICM) were recruited: mean ejection fraction of 26.6%; 83.4% in NYHA class II-III; mean QRS duration of 108.9 ms (only 14.9% with QRS > 130 ms). After 4.35 years of mean follow-up, all-cause mortality rate was 4.2%/year. In propensity-score (PS) analysis no survival differences between ICM and NICM subgroups appeared (mortality rates: 19.4% vs. 20%, p = 0.375). Age (hazard ratio [HR] = 1.02, p = 0.009), diabetes (HR = 2.61, p ≤ 0.001), chronic obstructive pulmonary disease (HR = 2.13, p = 0.002), and previous HF (HR = 2.28, p = 0.027) correlated with increased mortality for the entire population, however atrial fibrillation (AF) (HR = 2.68, p = 0.002) and chronic kidney disease (HR = 3.74, p ≤ 0.001) emerged as specific predictors in NICM patients. At follow-up, 134 patients (17.1%) were delivered a first appropriate ICD therapy (5.1%/year) without significant differences between ICM and NICM patients in the PS analysis (17.6% vs. 15.8%, p = 0.968). ICD shocks were associated with a higher mortality (HR = 2.88, p < 0.001) but longer detection windows (HR = 0.57, p = 0.042) correlated with fewer appropriate therapies. CONCLUSIONS Mortality and arrhythmia free survival is similar among ICM and NICM HF patients undergoing ICD-only implant for primary prevention strategy.
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Affiliation(s)
| | | | - M Luisa Pérez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Enrique García
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Ángel Arenal
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Aníbal Rodríguez
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Wang Y, Sharbaugh MS, Althouse AD, Mulukutla S, Saba S. Cardiac resynchronization therapy pacemakers versus defibrillators in older non-ischemic cardiomyopathy patients. Indian Pacing Electrophysiol J 2018; 19:4-6. [PMID: 30118798 PMCID: PMC6354212 DOI: 10.1016/j.ipej.2018.08.002] [Citation(s) in RCA: 7] [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: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction With the recent publication of the negative DANISH trial, the mortality benefit of the implantable cardioverter-defibrillator (ICD) has been put in question in patients with non-ischemic cardiomyopathy (NICM). Because a majority of patients in DANISH receive cardiac resynchronization therapy (CRT) devices, we investigated in the present study the survival of recipients of CRT pacemakers (CRT-P) versus CRT ICDs (CRT-D) in a cohort of older (≥75 years) NICM patients at our institution. Methods A total of 135 NICM patients with CRT device were identified (42 with CRT-P and 93 with CRT-D) and were followed to the endpoint of all-cause mortality. Overall survival was compared between the CRT-P and CRT-D groups with adjustment for differences in baseline characteristics. Results Over a median follow-up of 46 months from the time of CRT device implantation, there were 54 total deaths (40%): 14 in the CRT-P (33%) and 40 in the CRT-D (43%) groups. Overall, CRT-P recipients had similar unadjusted mortality compared to CRT-D recipients (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.56–1.93), and this remained unchanged after adjusting for unbalanced covariates (HR 0.95, 95% CI 0.47–1.89) including left ventricular ejection fraction, used of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and the Charlson comorbidity index. Conclusion Our data support that in older NICM patients with CRT devices, the addition of ICD therapy does not improve survival.
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Affiliation(s)
- Yanting Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael S Sharbaugh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew D Althouse
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Suresh Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Adelstein EC, Schwartzman D, Jain S, Bazaz R, Wang NC, Saba S. Left ventricular dimensions predict risk of appropriate shocks but not mortality in cardiac resynchronization therapy-defibrillator recipients with left bundle-branch block and non-ischemic cardiomyopathy. Europace 2018; 19:1689-1694. [PMID: 27856539 DOI: 10.1093/europace/euw323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/24/2016] [Accepted: 09/19/2016] [Indexed: 12/24/2022] Open
Abstract
Aims Patients with non-ischaemic cardiomyopathy (NICM) and left bundle-branch block (LBBB) often benefit markedly from cardiac resynchronization therapy (CRT). Cardiac resynchronization therapy responders have a lower risk of appropriate device shocks from CRT-defibrillators (CRT-D) than do non-responders. Larger baseline left ventricular (LV) dimensions may be associated with less CRT response and thus greater risk of appropriate shocks. Methods and results We analysed all (n = 249; 55% female) primary prevention CRT-D recipients at our institution with LBBB, NICM, and measured LV dimensions prior to device implant for the outcomes of (i) appropriate shocks, (ii) any appropriate tachyarrhythmia therapies, and (iii) risk of death, transplant, or left ventricular assist device (LVAD). During 59 months (interquartile range 21.5-91.5) follow-up, 19 (8%) patients received ≥1 appropriate shock, and 67 (27%) patients died, received a transplant, or required LVAD. Receiver-operating characteristic analysis of LV end-diastolic diameter (LVEDD) per meter height vs. appropriate shock(s) revealed an area under the curve of 0.75 (95% CI 0.65-0.85; P < 0.001). No patient with indexed LVEDD <3.36 cm/m (n = 76) received a shock. There was no statistically significant difference in risk of death, transplant, or LVAD (corrected HR 1.67, 95% CI 0.90-3.03; P = 0.103) in patients with indexed LVEDD above this cut-off compared to those with smaller dimension. Among 102 patients with paired quantitative echocardiograms, there was no difference in LVEF change between patients with indexed LVEDD <3.36 cm/m (n = 27; median 11%) and larger (n = 75; median 14%). Conclusion Patients with LVEDD <3.36 cm/m height prior to CRT-D implant in the setting of NICM and LBBB have minimal risk of appropriate shocks but similar risk of death, transplant- and LVAD and similar extent of LV functional improvement as patients with larger LVEDD. CRT-pacemakers may be appropriate in such patients.
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Affiliation(s)
- Evan C Adelstein
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Str. PUH B535 Pittsburgh, PA, USA
| | - David Schwartzman
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Str. PUH B535 Pittsburgh, PA, USA
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Str. PUH B535 Pittsburgh, PA, USA
| | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Str. PUH B535 Pittsburgh, PA, USA
| | - Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Str. PUH B535 Pittsburgh, PA, USA
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh, 200 Lothrop Str. PUH B535 Pittsburgh, PA, USA
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Abstract
Coronary microvascular dysfunction (CMD) can result from structural and functional abnormalities at the intramural and small coronary vessel level affecting coronary blood flow autoregulation and consequently leading to impaired coronary flow reserve. CMD often co-exists with epicardial coronary artery disease but is also commonly seen in patients with various forms of heart disease, including dilated, hypertrophic, and infiltrative cardiomyopathies. CMD can go unnoticed without any symptoms, or manifest as angina, and/or dyspnea, and contribute to the development of heart failure, and even sudden death especially when co-existing with myocardial fibrosis. However, whether CMD in non-ischemic cardiomyopathy is a cause or an effect of the underlying cardiomyopathic process, or whether it can be potentially modifiable with specific therapies, remains incompletely understood.
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Affiliation(s)
- Paco E Bravo
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- The Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
- Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Heart & Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- The Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
- Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Heart & Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Brigham and Women's Hospital, 70 Francis Street, Shapiro 5th Floor, Room 128, Boston, MA, 02115, USA.
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- The Noninvasive Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA.
- Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Heart & Vascular Center, Brigham and Women's Hospital, Boston, MA, USA.
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Ganga HV, Maan A, Kevin Heist E. Should Primary Prevention ICDs Still Be Placed in Patients with Non-ischemic Cardiomyopathy? A Review of the Evidence. Curr Cardiol Rep 2018; 20:31. [PMID: 29574588 DOI: 10.1007/s11886-018-0974-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Recent evidence has suggested that implantable defibrillator (ICD) in non-ischemic cardiomyopathy (NICM) may not offer mortality benefit in the presence of guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT). RECENT FINDINGS Despite significant benefits of GDMT and CRT, current evidence is derived from ICD trials that rely predominantly on reduced left ventricular ejection fraction alone (LVEF). The majority of patients with sudden cardiac death (SCD) have LVEF > 30% indicating that LVEF by itself is an inadequate predictor of SCD. The Danish study to assess the efficacy of ICD in patients with non-ischemic systolic heart failure on mortality (DANISH) highlights the importance of better risk stratifying NICM patients for ICD implantation. Assessment of life expectancy, comorbidities, presence of advanced heart failure, etiology of NICM, and the presence of myocardial fibrosis can help risk stratify ICD beyond LVEF. Genetics and biomarkers can be of further assistance in risk stratification.
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Röger S, Rosenkaimer SL, Hohneck A, Lang S, El-Battrawy I, Rudic B, Tülümen E, Stach K, Kuschyk J, Akin I, Borggrefe M. Therapy optimization in patients with heart failure: the role of the wearable cardioverter-defibrillator in a real-world setting. BMC Cardiovasc Disord 2018; 18:52. [PMID: 29544442 PMCID: PMC5856002 DOI: 10.1186/s12872-018-0790-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/08/2018] [Indexed: 12/15/2022] Open
Abstract
Background The wearable cardioverter-defibrillator (WCD) has emerged as a valuable tool to temporarily protect patients at risk for sudden cardiac death (SCD). The aim of this study was to determine the value of the WCD for therapy optimization of heart failure patients. Methods One hundred five consecutive patients that received WCD between 4/2012 and 9/2016 were included in the study. All patients were followed for clinical outcome and echocardiographic parameters during WCD therapy and had continued follow-up after WCD therapy, irrespective of subsequent implantable cardioverter-defibrillator (ICD) implantation. Results The most common indication for WCD were newly diagnosed ischemic (ICM) or non-ischemic cardiomyopathy (NICM) with left ventricular ejection fraction (LVEF) ≤35%. Mean WCD wear time was 68.8 ± 50.4 days with a mean daily use of 21.5 ± 3.5 h. Five patients (4.8%) received a total of five appropriate WCD shocks. During WCD wear, patients with ICM and NICM showed significant improvement in LVEF, reducing the proportion of patients with a need for primary preventive ICD implantation to 54.8% (ICM) and 48.8% (NICM). An ICD was finally implanted in 51.4% of the study patients (24 trans-venous ICDs, 30 subcutaneous ICDs). After discontinuation of WCD therapy, all patients were followed for a mean of 18.6 ± 12.3 months. 5.6% of patients with implanted ICDs received appropriate therapies. No patient with subcutaneous ICD needed change to a trans-venous device. None of the patients without an implanted ICD suffered from ventricular tachyarrhythmias and no patient died suddenly. In patients with NICM a significant LVEF improvement was observed during long-term follow-up (from 34.8 ± 11.1% to 41.0 ± 10.2%). Conclusions WCD therapy successfully bridged all patients to either LVEF recovery or ICD implantation. Following WCD, ICD implantation could be avoided in almost half of the patients. In selected patients, prolongation of WCD therapy beyond 3 months might further prevent unnecessary ICD implantation. The WCD as an external monitoring system contributed important information to optimize device selection in patients that needed ICD implantation.
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Affiliation(s)
- Susanne Röger
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| | - Stefanie L Rosenkaimer
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Anna Hohneck
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Boris Rudic
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Krumm P, Mangold S, Gatidis S, Nikolaou K, Nensa F, Bamberg F, la Fougère C. Clinical use of cardiac PET/MRI: current state-of-the-art and potential future applications. Jpn J Radiol 2018. [PMID: 29524169 DOI: 10.1007/s11604-018-0727-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Indexed: 12/19/2022]
Abstract
Combined PET/MRI is a novel imaging method integrating the advances of functional and morphological MR imaging with PET applications that include assessment of myocardial viability, perfusion, metabolism of inflammatory tissue and tumors, as well as amyloid deposition imaging. As such, PET/MRI is a promising tool to detect and characterize ischemic and non-ischemic cardiomyopathies. To date, the greatest benefit may be expected for diagnostic evaluation of systemic diseases and cardiac masses that remain unclear in cardiac MRI, as well as for clinical and scientific studies in the setting of ischemic cardiomyopathies. Diagnosis and therapeutic monitoring of cardiac sarcoidosis has the potential of a possible 'killer-application' for combined cardiac PET/MRI. In this article, we review the current evidence and discuss current and potential future applications of cardiac PET/MRI.
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Affiliation(s)
- Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Stefanie Mangold
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabian Bamberg
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University of Tübingen, Tübingen, Germany
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Abstract
Sustained ventricular tachycardias are common in the setting of structural heart disease, either due to prior myocardial infarction or a variety of non-ischemic etiologies, including idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Over the past two decades, percutaneous catheter ablation has evolved dramatically and has become an effective tool for the control of ventricular arrhythmias. Single and multicenter observational studies as well as several prospective randomized trials have begun to investigate long-term outcomes after catheter ablation procedures. These studies encompass a wide range of mapping and ablation techniques, including conventional activation mapping/entrainment criteria, substrate modification guided by pacemapping, late potential and abnormal electrogram ablation, scar de-channeling, and core isolation. While large-scale, multicenter prospective randomized clinical trials are somewhat limited, the published data demonstrate favorable outcomes with respect to a reduction in overall ventricular tachycardia (VT) burden, reduction of implantable cardioverter defibrillator (ICD) shocks, and discontinuation of anti-arrhythmic medications across varying disease subtypes and convincingly support the use of catheter ablation as the standard of care for many patients with VT in the setting of structural heart disease.
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Romero J, Chaudhary R, Garg J, Lupercio F, Shah N, Gupta R, Nazir T, Bozorgnia B, Natale A, Di Biase L. Role of implantable cardioverter defibrillator in non-ischemic cardiomyopathy: a systematic review and meta-analysis of prospective randomized clinical trials. J Interv Card Electrophysiol 2017; 49:263-70. [PMID: 28674918 DOI: 10.1007/s10840-017-0260-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION A mortality benefit in patients with implantable cardioverter defibrillator (ICD) in ischemic cardiomyopathy is well established. However, the benefit of ICD implantation in non-ischemic cardiomyopathy (NICM) on total mortality remains uncertain. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) evaluating the role of primary prevention ICD in NICM patients. METHODS We performed a systematic review on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from the inception through February 2017 to identify RCT evaluating the role of ICD in NICM patients. Mantel-Haenszel risk ratio (RR) fixed effects model was used to summarize data across treatment arms. If heterogeneity (I 2) ≥25, random effects model was used instead. RESULTS We analyzed a total of 2573 patients from five RCTs comparing ICD with medical therapy in patients with NICM. The mean follow up for the trials was 48 ± 22 months. There was a significant reduction in (a) all-cause mortality (RR 0.84, 95% CI 0.71-0.99, p = 0.03) and (b) sudden cardiac death (RR 0.47, 95% CI 0.30-0.73, p < 0.001) in ICD group versus medical therapy. CONCLUSION Our analysis demonstrates that the use of ICD for primary prevention is associated with a reduction in all-cause mortality and SCD in patients with NICM.
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Beiert T, Malotki R, Kraemer N, Stöckigt F, Linhart M, Nickenig G, Schrickel JW, Andrié RP. A real world wearable cardioverter defibrillator experience - Very high appropriate shock rate in ischemic cardiomyopathy patients at a European single-center. J Electrocardiol 2017; 50:603-609. [PMID: 28499628 DOI: 10.1016/j.jelectrocard.2017.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) has emerged as a valuable tool to protect patients with increased risk of sudden cardiac death (SCD). We sought to characterize WCD patients and to analyze predictors of ventricular arrhythmia (VA) occurrence and WCD shock delivery. METHODS AND RESULTS One hundred fourteen patients with WCD use were included in the study. Indications were mainly ischemic cardiomyopathy (ICM; 31.6%), non-ICM (45.6%) and explantation of implantable cardioverter defibrillator due to device infection (11.4%). We observed sustained VA in 9.6% of the study population and 6.1% received an appropriate shock. VA occurred in 16.7% of ICM, 3.8% of non-ICM and 15.4% of patients with device infection. CONCLUSIONS Our data demonstrate a very high rate of sustained VA in patients at risk for SCD during WCD use. ICM patients, including those with recent MI, bore the highest risk.
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Affiliation(s)
- Thomas Beiert
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany.
| | - Robert Malotki
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Natalie Kraemer
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Florian Stöckigt
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Markus Linhart
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Jan W Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - René P Andrié
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
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Yokoshiki H, Mitsuyama H, Watanabe M, Mitsuhashi T, Shimizu A. Cardiac resynchronization therapy in ischemic and non-ischemic cardiomyopathy. J Arrhythm 2017; 33:410-6. [PMID: 29021842 DOI: 10.1016/j.joa.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 01/09/2017] [Revised: 03/05/2017] [Accepted: 03/14/2017] [Indexed: 01/06/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) using a biventricular pacing system has been an effective therapeutic strategy in patients with symptomatic heart failure with a reduced left ventricular ejection fraction (LVEF) of 35% or less and a QRS duration of 130 ms or more. The etiology of heart failure can be classified as either ischemic or non-ischemic cardiomyopathy. Ischemic etiology of patients receiving CRT is prevalent predominantly in North America, moderately in Europe, and less so in Japan. CRT reduces mortality similarly in both ischemic and non-ischemic cardiomyopathy, whereas reverse structural left ventricular remodeling occurs more favorably in non-ischemic cardiomyopathy. Because the substrate for ventricular arrhythmias appears to be more severe in cases of ischemic as compared with non-ischemic cardiomyopathy, the use of an implantable cardioverter-defibrillator (ICD) backup method could prolong the long-term survival, especially of patients with ischemic cardiomyopathy, even in the presence of CRT. The aim of this review article is to summarize the effects of CRT on outcomes and the role of ICD backup in ischemic and non-ischemic cardiomyopathy.
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Gulsin GS, Shetye A, Khoo J, Swarbrick DJ, Levelt E, Lai FY, Squire IB, Arnold JR, McCann GP. Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? BMC Cardiovasc Disord 2017; 17:98. [PMID: 28390413 PMCID: PMC5385076 DOI: 10.1186/s12872-017-0529-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 12/28/2022] Open
Abstract
Background Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) has excellent specificity, sensitivity and diagnostic accuracy for differentiating between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NICM). CMR first-pass myocardial perfusion imaging (perfusion-CMR) may also play role in distinguishing heart failure of ischemic and non-ischemic origins, although the utility of additional of stress perfusion imaging in such patients is unclear. The aim of this retrospective study was to assess whether the addition of adenosine stress perfusion imaging to LGE-CMR is of incremental value for differentiating ICM and NICM in patients with severe left ventricular systolic dysfunction (LVSD) of uncertain etiology. Methods We retrospectively identified 100 consecutive adult patients (median age 69 years (IQR 59–73)) with severe LVSD (mean LV EF 26.6 ± 7.0%) referred for perfusion-CMR to establish the underlying etiology of heart failure. The cause of heart failure was first determined on examination of CMR cine and LGE images in isolation. Subsequent examination of complete adenosine stress perfusion-CMR studies (cine, LGE and perfusion images) was performed to identify whether this altered the initial diagnosis. Results On LGE-CMR, 38 patients were diagnosed with ICM, 46 with NICM and 16 with dual pathology. With perfusion-CMR, there were 39 ICM, 44 NICM and 17 dual pathology diagnoses. There was excellent agreement in diagnoses between LGE-CMR and perfusion-CMR (κ 0.968, p<0.001). The addition of adenosine stress perfusion images to LGE-CMR altered the diagnosis in only two of the 100 patients. Conclusion The addition of adenosine stress perfusion-CMR to cine and LGE-CMR provides minimal incremental diagnostic yield for determining the etiology of heart failure in patients with severe LVSD.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK. .,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
| | - Abishek Shetye
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Jeffrey Khoo
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Daniel J Swarbrick
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.,The NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
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Hu DJ, Xu J, Du W, Zhang JX, Zhong M, Zhou YN. Cardiac magnetic resonance and galectin-3 level as predictors of prognostic outcomes for non-ischemic cardiomyopathy patients. Int J Cardiovasc Imaging 2016; 32:1725-33. [PMID: 27566192 DOI: 10.1007/s10554-016-0958-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022]
Abstract
This study was aimed at determining whether late gadolinium enhancement (LGE) in conjunction with Galectin-3 (Gal-3) level offered more precise prognosis of non-ischemic cardiomyopathy (NICM) in comparison to LGE alone. Results of LGE and Gal-3 expression in 192 patients with NICM, including 85 subjects with dilated cardiomyopathy (DCM) and 107 with hypertrophic cardiomyopathy (HCM), were examined. As suggested by the characteristics of LGE and Gal-3 levels, patients were divided into four groups: LGE positive + low Gal-3 (n = 10 for DCM, n = 15 for HCM), LGE positive + high Gal-3 (n = 25 for DCM, n = 51 for HCM), LGE negative + low Gal-3 (n = 32 for DCM, n = 29 for HCM), LGE negative + high Gal-3 (n = 18 for DCM, n = 12 for HCM). Primary endpoints over the follow-up period included major adverse cardiac events (MACEs). Kaplan-Meier survival analysis and univariate Cox proportional hazard models were used to analyze the survival status of patients with NICM. The optimal cut-off value of Gal-3 level for two types of NICM was determined by receiver operating characteristic analysis (13.38 U/L for DCM and 14.40 U/L for HCM). The combination of LGE and Gal-3 levels offered a more significant prognostic value than using LGE alone for both DCM and HCM (DCM P = 0.001 < 0.012; HCM P = 0.037 < 0.040). Moreover, the Cox proportional hazard model suggested that both LGE status [Hazard ratio (HR) = 2.62, P = 0.017] and Gal-3 level (HR = 1.16, P = 0.013) were significant predictors of MACEs in DCM, while they did not appear to have significant prognostic values for HCM (P = 0.06 and 0.64). Furthermore, the multivariate analysis only confirmed LGE as an independent element in predicting prognosis of DCM (HR = 12.19, P = 0.026). In conclusion, LGE status was an independent indicator of DCM prognosis, yet the insignificant role of LGE in HCM prognosis could be limited by sample size.
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Gajanana D, Shah M, Junpapart P, Romero-Corral A, Figueredo VM, Bozorgnia B. Mortality in systolic heart failure revisited: Ischemic versus non-ischemic cardiomyopathy. Int J Cardiol 2016; 224:15-7. [PMID: 27599385 DOI: 10.1016/j.ijcard.2016.08.316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 01/11/2023]
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Inui K, Tachi M, Saito T, Kubota Y, Murai K, Kato K, Takano H, Amano Y, Asai K, Shimizu W. Superiority of the extracellular volume fraction over the myocardial T1 value for the assessment of myocardial fibrosis in patients with non-ischemic cardiomyopathy. Magn Reson Imaging 2016; 34:1141-5. [PMID: 27215951 DOI: 10.1016/j.mri.2016.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/16/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to assess the efficacies of the myocardial T1 value and the extracellular volume fraction (ECV) for determining the severity of myocardial fibrosis in patients with non-ischemic cardiomyopathy. MATERIALS AND METHODS Myocardial fibrosis is considered the most important indicator of cardiac damage associated with non-ischemic cardiomyopathy. Recently, modified Look-Locker inversion recovery imaging (MOLLI) has been used for T1 mapping and measurement of the ECV for the assessment of myocardial fibrosis. The present study included 22 patients (mean age, 61.5±12.7; 21 male) with non-ischemic heart failure. Motion corrected myocardial T1 mapping was automatically performed using a MOLLI sequence, and the ECV was estimated from the pre- and post-contrast blood and myocardial T1 values corrected for the hematocrit level. All endomyocardial biopsy specimens were obtained from the inferoposterior left ventricular wall. The percentage of myocardial fibrosis (%F) was determined after Elastica Masson-Goldner staining as follows: (fibrosis area/[fibrosis area+myocardial area])×100. RESULTS No correlation was noted between the %F and the pre- (r=0.290, p=0.191) or post-contrast T1 values (r=-0.190, p=0.398); however, a significant correlation was noted between the %F and ECV (r=0.750, p<0.001). CONCLUSIONS In this study, the ECV reflected the extent of myocardial fibrosis, but the pre- and post-contrast T1 values did not. The ECV may be used to estimate the severity of myocardial fibrosis in patients with non-ischemic cardiomyopathy.
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Chitiboi T, Schnell S, Collins J, Carr J, Chowdhary V, Honarmand AR, Hennemuth A, Linsen L, Hahn HK, Markl M. Analyzing myocardial torsion based on tissue phase mapping cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:15. [PMID: 27062364 PMCID: PMC4826723 DOI: 10.1186/s12968-016-0234-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this work is to analyze differences in left ventricular torsion between volunteers and patients with non-ischemic cardiomyopathy based on tissue phase mapping (TPM) cardiovascular magnetic resonance (CMR). METHODS TPM was performed on 27 patients with non-ischemic cardiomyopathy and 14 normal volunteers. Patients underwent a standard CMR including late gadolinium enhancement (LGE) for the assessment of myocardial scar and ECG-gated cine CMR for global cardiac function. TPM was acquired in short-axis orientation at base, mid, and apex for all subjects. After evaluation by experienced observers, the patients were divided in subgroups according to the presence or absence of LGE (LGE+/LGE-), local wall motion abnormalities (WM+/WM-), and having a preserved (≥50%) or reduced (<50%) ejection fraction (EF+/EF-). TPM data was semi-automatically segmented and global LV torsion was computed for each cardiac time frame for endocardial and epicardial layers, and for the entire myocardium. RESULTS Maximum myocardial torsion was significantly lower for patients with reduced EF compared to controls (0.21 ± 0.15°/mm vs. 0.36 ± 0.11°/mm, p = 0.018), but also for patients with wall motion abnormalities (0.21 ± 0.13°/mm vs. 0.36 ± 0.11°/mm, p = 0.004). Global myocardial torsion showed a positive correlation (r = 0.54, p < 0.001) with EF. Moreover, endocardial torsion was significantly higher than epicardial torsion for EF+ subjects (0.56 ± 0.33°/mm vs. 0.34 ± 0.18°/mm, p = 0.039) and for volunteers (0.46 ± 0.16°/mm vs. 0.30 ± 0.09°/mm, p = 0.004). The difference in maximum torsion between endo- and epicardial layers was positively correlated with EF (r = 0.47, p = 0.002) and age (r = 0.37, p = 0.016) for all subjects. CONCLUSIONS TPM can be used to detect significant differences in LV torsion in patients with reduced EF and in the presence of local wall motion abnormalities. We were able to quantify torsion differences between the endocardium and epicardium, which vary between patient subgroups and are correlated to age and EF.
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Affiliation(s)
- Teodora Chitiboi
- />Jacobs University Bremen, Bremen, Germany
- />Fraunhofer MEVIS, Bremen, Germany
| | - Susanne Schnell
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | - Jeremy Collins
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | - James Carr
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | - Varun Chowdhary
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | | | | | | | - Horst K. Hahn
- />Jacobs University Bremen, Bremen, Germany
- />Fraunhofer MEVIS, Bremen, Germany
| | - Michael Markl
- />Department of Radiology, Northwestern University, Chicago, IL USA
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Lee ASY, Lee DZQ, Vasanwala FF. Amyloid light-chain amyloidosis presenting as abdominal bloating: a case report. J Med Case Rep 2016; 10:68. [PMID: 27026530 PMCID: PMC4812605 DOI: 10.1186/s13256-016-0857-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/23/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We present a case of amyloid light-chain amyloidosis with occult plasma cell dyscrasia, with the rare initial presentation of gastroparesis. While amyloidosis is known to affect the gastrointestinal system, rarely do patients present with gastrointestinal symptoms as their first symptom. To the best of our knowledge, this is the first such case reported with a definitive diagnosis made on gastroscopy. CASE PRESENTATION A 52-year-old Malay man with abdominal bloating, early satiety, and weight loss was found to have significant gastroparesis. He had a past medical history of stable non-ischemic cardiomyopathy. Results from initial screening were negative for common causes of gastroparesis, such as diabetes or offending medications. Gastroscopy did not show any mechanical gastric outlet obstruction. Our patient subsequently developed symptoms of postural giddiness, which then prompted further investigations for possible autonomic dysfunction. These finally revealed evidence of systemic involvement, including postural hypotension, speckled myocardium with infiltrative cardiomyopathy on a transthoracic echocardiogram, and multifocal motor neuropathy on nerve conduction studies, from which he had been relatively asymptomatic. These findings were collectively suggestive of infiltrative disease. Retrospective Congo red staining of a gastric biopsy specimen confirmed the diagnosis of gastric amyloidosis. The final diagnosis was amyloid light-chain amyloidosis secondary to plasma cell dyscrasia, which was confirmed by bone marrow examination. Our patients was started on chemotherapy and prokinetic agents, with some improvement in gastrointestinal symptoms on follow-up. CONCLUSION We present this case to highlight that, although rare, gastroparesis can be the initial sole presentation of amyloidosis. It is important for the internist, gastroenterologist, and hematologist to consider amyloidosis as a differential diagnosis in the investigation of gastroparesis and to be vigilant in monitoring for other systemic involvement.
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Affiliation(s)
- Audry S Y Lee
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Damian Z Q Lee
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Farhad F Vasanwala
- Department of General Medicine, Sengkang General Hospital at Alexandra Hospital, 378 Alexandra Road, Singapore, 159964, Singapore
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Mueller KAL, Schwille J, Vollmer S, Ehinger E, Kandolf R, Klingel K, Kramer U, Gawaz M, Geisler T, Mueller II. Prognostic impact of macrophage migration inhibitory factor in patients with non-ischemic heart failure undergoing endomyocardial biopsy. Int J Cardiol 2015; 203:656-9. [PMID: 26590886 DOI: 10.1016/j.ijcard.2015.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/16/2015] [Accepted: 11/04/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Karin A L Mueller
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany; La Jolla Institute of Allergy and Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Johannes Schwille
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany
| | - Saskia Vollmer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany
| | - Erik Ehinger
- La Jolla Institute of Allergy and Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA
| | - Reinhard Kandolf
- Abteilung für Molekulare Pathologie, Universitätsklinikum Tübingen, Germany
| | - Karin Klingel
- Abteilung für Molekulare Pathologie, Universitätsklinikum Tübingen, Germany
| | - Ulrich Kramer
- Abteilung für Radiologie, Universitätsklinikum Tübingen, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany
| | - Tobias Geisler
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany.
| | - Iris I Mueller
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum Tübingen, Germany
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Kim EK, Chattranukulchai P, Klem I. Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy. Korean J Radiol 2015; 16:683-95. [PMID: 26175568 PMCID: PMC4499533 DOI: 10.3348/kjr.2015.16.4.683] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/13/2015] [Indexed: 01/06/2023] Open
Abstract
In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.
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Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Pairoj Chattranukulchai
- Division of Cardiology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand. ; Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC 27710, USA
| | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC 27710, USA. ; Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
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