1
|
Elbaum C, Iacuzio L, Bohbot Y, Civaia F, Dommerc C, Tribouilloy C, Guerin P, Levy F. Non-contrast myocardial T1 global and regional reference values at 3 Tesla cardiac magnetic resonance in aortic stenosis. Arch Cardiovasc Dis 2021; 114:293-304. [PMID: 33716045 DOI: 10.1016/j.acvd.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/08/2020] [Accepted: 11/30/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND T1 mapping using cardiac magnetic resonance (CMR) was recently proposed as a promising non-contrast imaging technique for the assessment of diffuse myocardial fibrosis (MF) in aortic stenosis (AS). AIMS To provide reference values for native T1 mapping at 3 Tesla magnetic field strength in subjects with moderate or severe AS and in control subjects; to identify factors associated with the presence of diffuse MF in severe AS; to assess the regional distribution of diffuse MF; and to compare the level of diffuse MF in the different types of AS, stratified by flow and gradient patterns. METHODS Retrospective study based on 160 consecutive patients with moderate (n=11) to severe (n=149) AS and 47 control subjects referred for CMR. RESULTS Mean native T1 increased progressively across controls (1221±23ms), moderate AS (1249±26ms) and severe AS (1273±43ms). T1 times correlated significantly with left ventricular (LV) remodelling (indexed LV mass and LV diastolic volume) and functional LV alterations (global longitudinal strain and LV ejection fraction). Native T1 appears to be elevated in the basal segments of the septum in moderate AS, and to extend to midventricular and apical segments in severe AS. Mean T1 time was higher in classical low-flow/low-gradient AS (1295±62ms) than in the other types of AS (P=0.006). The level of diffuse MF in paradoxical low-flow/low-gradient AS (1280±42ms) was higher than in moderate AS, but similar to that in high-gradient AS (1271±42ms) (P=0.07). CONCLUSIONS Assessment of diffuse MF in AS using T1 mapping is feasible and reproducible in clinical practice. T1 value increases with AS severity, along with morphological and functional LV alterations, particularly in the basal segments of the septum.
Collapse
Affiliation(s)
- Clara Elbaum
- Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco
| | - Laura Iacuzio
- Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco
| | - Yohann Bohbot
- Department of cardiology, University Hospital Amiens, 80054 Amiens, France
| | - Filippo Civaia
- Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco
| | - Carine Dommerc
- Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco
| | | | - Patrice Guerin
- Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco
| | - Franck Levy
- Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco.
| |
Collapse
|
2
|
Seunes C, Paquet P, Janvier F, Mroueh A, Troux J, Ouadah A, Verhaeghe M, Broucqsault D, Grebet J, Hannebicque G. [Mitral prolapse and sudden death. A case report]. Ann Cardiol Angeiol (Paris) 2020; 69:323-326. [PMID: 33039113 DOI: 10.1016/j.ancard.2020.09.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
The association between the mitral valve prolapse and the sudden Cardiac Death remains controversial, the high prevalence of this valvulopathy contrasting with the low incidence of sudden death in this population. We report the case of a 54-year-old woman admitted for a sudden cardiac death, revealing a bi-prolapse with low-grade leakage, leading to the implantation of a subcutaneous automatic defibrillator. Combined echocardiography and cardiac MRI can identify the mitral annular disjunction, the rolling motion of the posterior face of the mitral annulus towards the myocardium, and the myocardial fibrosis of the inferolateral wall induced by streching forces of the sub valvular apparatus, that may lead to ventricular arrhythmias. More than the conventional clinical parameters (young woman, ventricular premature beats with a right bundle branch block morphology, mitral bi-prolapse), mitral annular disjunction and myocardial fibrosis are to be considered as powerful markers of the rhythmic risk of mitral prolapse and must be systematically sought and integrated into the prognostic evaluation of these patients. In the absence of randomised trials, therapeutic management is difficult especially in primary prevention, and needs Heart Team advice.
Collapse
Affiliation(s)
- C Seunes
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - P Paquet
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - F Janvier
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - A Mroueh
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - J Troux
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - A Ouadah
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - M Verhaeghe
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - D Broucqsault
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - J Grebet
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France
| | - G Hannebicque
- Service de cardiologie, centre hospitalier d'Arras, groupe hospitalier Artois-Ternois, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France.
| |
Collapse
|