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Jahnke C, Sinn M, Hot A, Cavus E, Erley J, Schneider J, Chevalier C, Bohnen S, Radunski U, Meyer M, Lund G, Adam G, Kirchhof P, Blankenberg S, Muellerleile K, Tahir E. Differentiation of acute non-ST elevation myocardial infarction and acute infarct-like myocarditis by visual pattern analysis: a head-to-head comparison of different cardiac MR techniques. Eur Radiol 2023; 33:6258-6266. [PMID: 37438640 PMCID: PMC10415415 DOI: 10.1007/s00330-023-09905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/19/2023] [Accepted: 05/28/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Parametric cardiac magnetic resonance (CMR) techniques have improved the diagnosis of pathologies. However, the primary tool for differentiating non-ST elevation myocardial infarction (NSTEMI) from myocarditis is still a visual assessment of conventional signal-intensity-based images. This study aimed at analyzing the ability of parametric compared to conventional techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns. METHODS Twenty NSTEMI patients, twenty infarct-like myocarditis patients, and twenty controls were examined using cine, T2-weighted CMR (T2w) and late gadolinium enhancement (LGE) imaging and T1/T2 mapping on a 1.5 T scanner. CMR images were presented in random order to two experienced fully blinded observers, who had to assign them to three categories by a visual analysis: NSTEMI, myocarditis, or healthy. RESULTS The conventional approach (cine, T2w and LGE combined) had the best diagnostic accuracy with 92% (95%CI: 81-97) for NSTEMI and 86% (95%CI: 71-94) for myocarditis. The diagnostic accuracies using T1 maps were 88% (95%CI: 74-95) and 80% (95%CI: 62-91), 84% (95%CI: 67-93) and 74% (95%CI: 54-87) for LGE, and 83% (95%CI: 66-92) and 73% (95%CI: 53-87) for T2w. The accuracies for cine (72% (95%CI: 52-86) and 60% (95%CI: 38-78)) and T2 maps (62% (95%CI: 40-79) and 47% (95%CI: 28-68)) were significantly lower compared to the conventional approach (p < 0.001 and p < 0.0001). CONCLUSIONS The conventional approach provided a reliable visual discrimination between NSTEMI, myocarditis, and controls. The diagnostic accuracy of a visual pattern analysis of T1 maps was not significantly inferior, whereas the diagnostic accuracy of T2 maps was not sufficient in this context. CLINICAL RELEVANCE STATEMENT The ability of parametric compared to conventional CMR techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns can avoid potentially unnecessary invasive coronary angiography and help to shorten CMR protocols and to reduce the need of gadolinium contrast agents. KEY POINTS • A visual differentiation of ischemic from non-ischemic patterns of myocardial injury is reliably achieved by a combination of conventional CMR techniques (cine, T2-weighted and LGE imaging). • There is no significant difference in accuracies between visual pattern analysis on native T1 maps without providing quantitative values and a conventional combined approach for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls. • T2 maps do not provide a sufficient diagnostic accuracy for visual pattern analysis for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls.
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Affiliation(s)
- Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amra Hot
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Ulf Radunski
- Department of Cardiology, Regio Clinics, Pinneberg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Stáreková J, Tahir E, Avanesov M, Patten-Hamel M, Münch J, Weinrich J, Bohnen S, Radunski U, Müllerleile K, Stritzky A, Adam G, Lund G. Inzidenz, Lokalisation und Ausprägung von Myokardvernarbungen bei ambitionierten Triathleten im Kardio-MRT. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Stáreková
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - E Tahir
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - M Avanesov
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - M Patten-Hamel
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - J Münch
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - J Weinrich
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - S Bohnen
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - U Radunski
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - K Müllerleile
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - A Stritzky
- UHZ, Allgemeine und interventionelle Kardiologie, Hamburg
| | - G Adam
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - G Lund
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
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Tahir E, Sinn M, Avanesov M, Wien J, Säring D, Stehning C, Radunski U, Müllerleille K, Adam G, Lund G. Reproduzierbarkeit der Größenbestimmung von Läsionen nach akutem Myokardinfarkt mittels nativen und kontrastmittelgestützten Kardio-MRT. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Avanesov M, Säring D, Radunski U, Müllerleile K, Stehning C, Adam G, Lund G. Quantifizierung der Myokardfibrose bei Patienten mit hypertropher Kardiomyopathie mit LGE, prä-/post-KM T1- und ECV-Mapping bezogen auf normal erscheinendes Myokard und Normalwerte gesunder Probanden. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sinn M, Tahir E, Radunski U, Säring D, Müllerleile K, Stehning C, Adam G, Lund G. Serielle Beurteilung der Infarktgröße durch LGE und ECV-Mapping innerhalb von 6 Monaten nach akutem Herzinfarkt. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tahir E, Sinn M, Radunski U, Säring D, Stehning C, Müllerleile K, Adam G, Lund G. Quantitatives Monitoring der Ödemresorption nach akutem Myokardinfarkt mittels seriellem nativem T1- und T2-Mapping. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tahir E, Regier M, Schmidt-Holz J, Säring D, Radunski U, Avanesov M, Adam G, Lund GK. „Das Herz des Fußballspielers“: Beurteilung der linksventrikulären Adaptation bei professionellen Fußballspielern mittels kardialer Magnetresonanztomografie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Radunski U, Franzen O, Barmeyer A, Lange M, Lund G, Rudolph V, Schlüter M, Adam G, Reichenspurner H, Blankenberg S, Baldus S, Muellerleile K. Cardiac Remodeling Following Percutaneous Mitral Valve Repair – Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging. ROFO-FORTSCHR RONTG 2014; 186:951-8. [DOI: 10.1055/s-0034-1366216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- U. Radunski
- Cardiology, University Heart Center, Hamburg
| | | | | | - M. Lange
- Cardiology, University Heart Center, Hamburg
| | - G. Lund
- Radiology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - V. Rudolph
- Cardiology, University Heart Center, Hamburg
| | - M. Schlüter
- Cardiology, University Heart Center, Hamburg
| | - G. Adam
- Radiology, University Medical Center Hamburg-Eppendorf, Hamburg
| | | | | | - S. Baldus
- Cardiology, University Heart Center, Hamburg
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Lund G, Müllerleile K, Bannas P, Barz D, Cürlis J, Radunski U, Sydow K, Stehning C, Schnackenburg B, Adam G. Serielles T2-mapping zur quantitativen Beurteilung der myokardialen Ödemresorption nach akutem Myokardinfarkt. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Radunski U, Schlüter M, Ohdah S, von Stritzky A, Deuse T, Reichenspurner H, Costard-Jäckle A. 657 Effects of Heart Rate Reduction with Ivabradine on Cardio-Pulmonary Capacity in Heart Transplant Recipients. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Radunski U, Ohdah S, Stritzky AV, Deuse T, Reichenspurner H, Costard-Jäckle A. Effects of heart rate reduction with ivabradine on cardio-pulmonary capacity in heart transplant recipients. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chapuy B, Panse M, Radunski U, Koch R, Wenzel D, Inagaki N, Haase D, Truemper L, Wulf GG. ABC transporter A3 facilitates lysosomal sequestration of imatinib and modulates susceptibility of chronic myeloid leukemia cell lines to this drug. Haematologica 2010; 94:1528-36. [PMID: 19880777 DOI: 10.3324/haematol.2009.008631] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Inhibition of BCR-ABL tyrosine kinase activity has evolved as a mainstay of therapy for patients with chronic myeloid leukemia. However, a fraction of leukemic cells persists under targeted therapy and can lead to disease progression on cessation of treatment. DESIGN AND METHODS We analyzed bone marrow progenitor cells with the side population phenotype, and characterized the role of the intracellular ABC transporter A3 in imatinib detoxification. RESULTS BCR-ABL-positive leukemic cells contribute to the side population cell compartment in untreated patients. Such leukemic side population cells, as well as CD34-positive progenitors from chronic myeloid leukemia samples, strongly express the intracellular ABCA3. Functionally, ABCA3 levels are critical for the susceptibility of chronic myeloid leukemia blast cell lines to specific BCR-ABL inhibition by imatinib. The transporter is localized in the limiting membrane of lysosomes and multivesicular bodies, and intracellular [(14)C]-labeled imatinib accumulates in such organelles. The lysosomal storage capacity increases with ABCA3 expression, thus regulating imatinib sequestration. CONCLUSIONS The intracellular ABC transporter A3 is expressed in chronic myeloid leukemia progenitor cells and may contribute to intrinsic imatinib resistance by facilitating lysosomal sequestration in chronic myeloid leukemia cells.
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Affiliation(s)
- Bjoern Chapuy
- Department Hematology and Oncology, Georg-August-University, Goettingen Robert-Koch-Str.40, 37075 Goettingen, Germany
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Chapuy B, Koch R, Radunski U, Corsham S, Cheong N, Inagaki N, Ban N, Wenzel D, Reinhardt D, Zapf A, Schweyer S, Kosari F, Klapper W, Truemper L, Wulf GG. Intracellular ABC transporter A3 confers multidrug resistance in leukemia cells by lysosomal drug sequestration. Leukemia 2008; 22:1576-86. [PMID: 18463677 DOI: 10.1038/leu.2008.103] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multidrug resistance (MDR) seriously limits the efficacy of chemotherapy in patients with cancer and leukemia. Active transport across membranes is essential for such cellular drug resistance, largely provided by ATP-binding cassette (ABC) transport proteins. Intracellular drug sequestration contributes to MDR; however, a genuine intracellular ABC transport protein with MDR function has not yet been identified. Analyzing the intrinsic drug efflux capacity of leukemic stem cells, we found the ABC transporter A3 (ABCA3) to be expressed consistently in acute myeloid leukemia (AML) samples. Greater expression of ABCA3 is associated with unfavorable treatment outcome, and in vitro, elevated expression induces resistance toward a broad spectrum of cytostatic agents. ABCA3 remains localized within the limiting membranes of lysosomes and multivesicular bodies, in which cytostatics are efficiently sequestered. In addition to AML, we also detected ABCA3 in a panel of lymphohematopoietic tissues and transformed cell lines. In conclusion, we identified subcellular drug sequestration mediated by the genuinely intracellular ABCA3 as being a clinically relevant mechanism of intrinsic MDR.
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Affiliation(s)
- B Chapuy
- Department of Hematology and Oncology, Georg-August-University Goettingen, Goettingen, Germany
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