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Khine S, Edupuganti S, Bachuwa G. A Case of Severe Cardiomyopathy Due to Covid-Induced Myocarditis, Completely Resolved after Colchicine and Immunoglobulin Therapy. Eur J Case Rep Intern Med 2023; 10:003877. [PMID: 37680779 PMCID: PMC10482136 DOI: 10.12890/2023_003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 09/09/2023] Open
Abstract
Coronavirus 19 (COVID-19) is well known for causing acute respiratory distress syndrome. Among other systemic complications, myocarditis is a frequently reported presentation as well as complication. One systematic review reported a 14% mortality rate in patients with COVID-19 myocarditis. Endomyocardial biopsy is a definitive diagnostic test but has been a challenge to perform in most cases of COVID myocarditis due to the contagious nature of the disease. Patients presenting with new cardiomyopathy with troponin leak and arrhythmias, supported by recent COVID-19 diagnosis should be suspected for COVID-induced myocarditis. Supportive treatment has been the mainstay of treatment with limited data on immunotherapy and colchicine. Our case is about a male in his 50s who had a cardiac arrest due to ventricular fibrillations, with a positive COVID-19 test. Further workup showed severe non-ischaemic cardiomyopathy with an EF of 15-20%. He was treated with intravenous immunotherapy and colchicine. A repeat echocardiogram 3 days later showed resolution of cardiomyopathy. Our case report highlights the possible beneficial effects of immunotherapy and colchicine in viral myocarditis. LEARNING POINTS Myocarditis should be suspected in patients with acute onset cardiomyopathy with troponin leak and no evidence of ischaemia. COVID-19 myocarditis can present with arrhythmia, which could be fatal in some cases.Even though supportive management is the mainstay of treatment for COVID-19 myocarditis, there have been reports of benefits of intravenous immunotherapy (IVIG) and colchicine.More studies are warranted to explore the beneficial effects of IVIG and colchicine not just in COVID-19 myocarditis, but also in other viral causes of myocarditis he aim of this study is also to raise awareness among healthcare professionals about the Bentall procedure in patients with type A aortic dissection involving the aortic valve.
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Affiliation(s)
- Su Khine
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Srujan Edupuganti
- Department of Internal Medicine-Pediatrics, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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Laymouna R, El-Sharkawy E, El-Taha S, Elfiky M. Prognostic value of myocardial scar in ischaemic and non-ischaemic cardiomyopathy using cardiac magnetic resonance imaging. Cardiovasc J Afr 2023; 34:132-139. [PMID: 36162438 PMCID: PMC10658723 DOI: 10.5830/cvja-2022-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/02/2022] [Indexed: 06/16/2023] Open
Abstract
AIM The aim of this research was to evaluate the prognostic value of myocardial scar using cardiac magnetic resonance (CMR) imaging in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM). METHODS One hundred and fifty-four patients with either ICM or NICM underwent CMR with late gadolinium enhancement sequences for assessment of left ventricular ejection fraction (LVEF), and detection and quantification of any myocardial scar using three methods: manual, number of segments involved, and percentage of scarred myocardium. Patients were followed up for at least six months for clinical cardiac events. RESULTS Patients were divided into two groups: group I, patients with ICM (58%) and group II, those with NICM (42%). Clinical presentation ranged from eventless lpar;10%) to chest pain (18%), heart failure (15%), hospitalisation (35%), syncope (1%), ventricular tachycardia (< 1%) and cardiac arrest (< 1%). The scar mass was larger in size in group I (17 ± 15%) than in group II (8 ± 13%). A direct relationship was observed between scar size and event severity (p < 0.001). An inverse relationship between LVEF and event severity was found in group I (p < 0.001) but not in group II (p = 0.128). CONCLUSIONS Myocardial scar size was a strong predictor of clinical outcome in both the ICM and NICM patients. LVEF was less reliable in predicting morbidity in cardiomyopathy patients.
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Affiliation(s)
- Reem Laymouna
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt.
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Eman El-Sharkawy
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Salah El-Taha
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
- International Cardiac Centre Scan, Alexandria, Egypt
| | - Mohamed Elfiky
- Cardiology and Angiology Department, Alexandria University, Alexandria, Egypt
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Di Marco A, Brown PF, Bradley J, Nucifora G, Anguera I, Miller CA, Schmitt M. Extracellular volume fraction improves risk-stratification for ventricular arrhythmias and sudden death in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:512-521. [PMID: 35877070 DOI: 10.1093/ehjci/jeac142] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate whether cardiac magnetic resonance (CMR)-based parametric mapping and strain analysis can improve the risk-stratification for ventricular arrhythmias (VA) and sudden death (SD) in non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Secondary analysis of a prospective single-centre-registry (NCT02326324), including 703 consecutive NICM patients, 618 with extracellular volume (ECV) available. The combined primary endpoint included appropriate implantable cardioverter defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. During a median follow-up of 21 months, 14 patients (2%) experienced the primary endpoint. Native T1 was not associated with the primary endpoint. Left ventricular global longitudinal strain lost its significant association after adjustment for left ventricular ejection fraction (LVEF). Among patients with ECV available, 11 (2%) reached the primary endpoint. Mean ECV was significantly associated with the primary endpoint and the best cut-off was 30%. ECV ≥ 30% was the strongest independent predictor of the primary endpoint (hazard ratio 14.1, P = 0.01) after adjustment for late gadolinium enhancement (LGE) and LVEF. ECV ≥ 30% discriminated the arrhythmic risk among LGE+ cases and among those with LVEF ≤ 35%. A simple clinical risk-stratification model, based on LGE, LVEF ≤ 35% and ECV ≥ 30%, achieved an excellent predictive ability (Harrell's C 0.82) and reclassified the risk of 32% of the study population as compared to LVEF ≤ 35% alone. CONCLUSIONS Comprehensive CMR evaluation in NICM showed that ECV was the only parameter with an independent and strong predictive value for VA/SD, on top of LGE and LVEF. A risk-stratification model based on LGE, LVEF ≤ 35% and ECV ≥ 30% achieved an excellent predictive ability for VA/SD. CLINICAL TRIAL REGISTRATION UHSM CMR study (NCT02326324) https://clinicaltrials.gov/ct2/show/NCT02326324.
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Pamela F Brown
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Joshua Bradley
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Gaetano Nucifora
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Matthias Schmitt
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
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Bayram Z, Dogan C, Efe SC, Guvendi B, Karagoz A, Acar RD, Uysal S, Akbas RB, Yilmaz F, Akbal OY, Tokgoz HC, Kirali MK, Kaymaz C, Ozdemir N. Ischaemic versus non-ischaemic: how does heart failure aetiology affect pulmonary arterial capacitance and pulmonary artery pulsatility index in end-stage heart failure? Acta Cardiol 2022; 77:204-210. [PMID: 34923932 DOI: 10.1080/00015385.2021.1951999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aetiology of heart failure may have different effects on right ventricular (RV) function, pulmonary pressures and RV afterload. Pulmonary arterial capacitance (PAC) and pulmonary artery pulsatility index (PAPi) are novel haemodynamic indices used in determining RV afterload and RV function, respectively. We aimed to investigate whether there was a difference in PAC and PAPi between ischaemic cardiomyopathy (ICMP) and non-ischaemic cardiomyopathy (NICMP) in patients with end-stage heart failure. METHODS AND RESULTS A total of 215 subjects undergoing evaluation for heart transplantation or left ventricular (LV) assist device were classified into two groups: ICMP (n = 101) and NICMP (n = 114). The patients with LV ejection fraction ≤ 25% were included in the study. ICMP group had lower PAC and higher PAPi values compared to NICMP group [1.25 (0.82-1.86) vs. 1.58 (1.02-2.21), p = 0.002 and 3.4 (2.2-5.0) vs. 2.5 (1.7-4.0); p = 0.007]. Pulmonary vascular resistance, pulmonary artery systolic and mean pressure were higher in ICMP group compared to NICMP group [3.5 ± 1.8 vs. 2.9 ± 2.3, p = 0.004; 59.0 (42.0-73.0) vs. 46.0 (37.0-59.0), p < 0.001, 35.0 (27.0-46.0) vs. 31.0 (23.0-39.0), p = 0.002]. The patients with ICMP had higher tricuspid annular plane systolic excursion and less RV dilatation. ICMP was an independent risk factor for pulmonary hypertension (OR: 4.02, 95% CI: 1.13-14.24, p = 0.031). CONCLUSION ICMP was associated with lower PAC and higher PAPi. These results indicated that an ischaemic aetiology is associated with higher RV afterload and better RV function in the end-stage heart failure.
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Affiliation(s)
- Zubeyde Bayram
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cem Dogan
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Suleyman C. Efe
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of Cardiology, Istanbul Maltepe State Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ravza Betul Akbas
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yilmaz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Y. Akbal
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaan Kirali
- Cardiovascular Surgery Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Cardiology Department, Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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5
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Hooks M, Okasha O, Velangi PS, Nijjar PS, Farzaneh-Far A, Shenoy C. Left ventricular thrombus on cardiovascular magnetic resonance imaging in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 22:1425-1433. [PMID: 33026088 PMCID: PMC11004928 DOI: 10.1093/ehjci/jeaa244] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Case reports have described left ventricular (LV) thrombus in patients with non-ischaemic cardiomyopathy (NICM). We aimed to systematically study the characteristics, predictors, and outcomes of LV thrombus in NICM. METHODS AND RESULTS Forty-eight patients with LV thrombus detected on late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE CMR) in NICM were compared with 124 patients with LV thrombus in ischaemic cardiomyopathy (ICM), and 144 matched patients with no LV thrombus in NICM. The performance of echocardiography for the detection of LV thrombus was compared between NICM and ICM. The 12-month incidence of embolism was compared between the three study groups. Independent predictors of LV thrombus in NICM were LV ejection fraction (LVEF) [hazard ratio (HR) 1.36 per 5% decrease; P = 0.002], LGE presence (HR 6.30; P < 0.001), and LGE extent (HR 1.33 per 5% increase; P = 0.001). Compared with patients with LV thrombus in ICM, those with LV thrombus in NICM had a 10-fold higher prevalence of thrombi in other cardiac chambers. The performance of echocardiography for the detection of LV thrombus was not different between NICM and ICM. The 12-month incidence of embolism associated with LV thrombus was not different between NICM and ICM (8.7% vs. 6.8%; P = 0.69) but both were higher compared with no LV thrombus in NICM (1.5%). CONCLUSION Independent predictors of LV thrombus in NICM were lower LVEF, LGE presence, and greater LGE extent. The 12-month incidence of embolism associated with LV thrombus in NICM was not different compared with LV thrombus in ICM.
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Affiliation(s)
- Matthew Hooks
- Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
- Department of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Pratik S Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
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Spath NB, Singh T, Papanastasiou G, Kershaw L, Baker AH, Janiczek RL, Gulsin GS, Dweck MR, McCann G, Newby DE, Semple SI. Manganese-enhanced magnetic resonance imaging in dilated cardiomyopathy and hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020:jeaa273. [PMID: 33200175 DOI: 10.1093/ehjci/jeaa273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/17/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS The aim of this study is to quantify altered myocardial calcium handling in non-ischaemic cardiomyopathy using magnetic resonance imaging. METHODS AND RESULTS Patients with dilated cardiomyopathy (n = 10) or hypertrophic cardiomyopathy (n = 17) underwent both gadolinium and manganese contrast-enhanced magnetic resonance imaging and were compared with healthy volunteers (n = 20). Differential manganese uptake (Ki) was assessed using a two-compartment Patlak model. Compared with healthy volunteers, reduction in T1 with manganese-enhanced magnetic resonance imaging was lower in patients with dilated cardiomyopathy [mean reduction 257 ± 45 (21%) vs. 288 ± 34 (26%) ms, P < 0.001], with higher T1 at 40 min (948 ± 57 vs. 834 ± 28 ms, P < 0.0001). In patients with hypertrophic cardiomyopathy, reductions in T1 were less than healthy volunteers [mean reduction 251 ± 86 (18%) and 277 ± 34 (23%) vs. 288 ± 34 (26%) ms, with and without fibrosis respectively, P < 0.001]. Myocardial manganese uptake was modelled, rate of uptake was reduced in both dilated and hypertrophic cardiomyopathy in comparison with healthy volunteers (mean Ki 19 ± 4, 19 ± 3, and 23 ± 4 mL/100 g/min, respectively; P = 0.0068). In patients with dilated cardiomyopathy, manganese uptake rate correlated with left ventricular ejection fraction (r2 = 0.61, P = 0.009). Rate of myocardial manganese uptake demonstrated stepwise reductions across healthy myocardium, hypertrophic cardiomyopathy without fibrosis and hypertrophic cardiomyopathy with fibrosis providing absolute discrimination between the healthy myocardium and fibrosed myocardium (mean Ki 23 ± 4, 19 ± 3, and 13 ± 4 mL/100 g/min, respectively; P < 0.0001). CONCLUSION The rate of manganese uptake in both dilated and hypertrophic cardiomyopathy provides a measure of altered myocardial calcium handling. This holds major promise for the detection and monitoring of dysfunctional myocardium, with the potential for early intervention and prognostication.
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Affiliation(s)
- N B Spath
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - T Singh
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - G Papanastasiou
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - L Kershaw
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - A H Baker
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
| | - R L Janiczek
- Department of Clinical Imaging, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - G S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - M R Dweck
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - G McCann
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - D E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - S I Semple
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
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Kuo L, Liang JJ, Nazarian S, Marchlinski FE. Multimodality Imaging to Guide Ventricular Tachycardia Ablation in Patients with Non-ischaemic Cardiomyopathy. Arrhythm Electrophysiol Rev 2020; 8:255-264. [PMID: 32685156 PMCID: PMC7358957 DOI: 10.15420/aer.2019.37.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Catheter ablation is an effective treatment option for ventricular tachycardia (VT) in patients with non-ischaemic cardiomyopathy (NICM). The heterogeneous nature of NICM aetiologies and VT substrate in patients with NICM play a role in long-term ablation outcomes in this population. Over the past decades, more precise identification of NICM aetiologies and better characterisation of various substrates have been made. Application of multimodal imaging has greatly contributed to the accurate diagnosis of NICM subtypes and improved VT ablation strategies. This article summarises the current knowledge of multimodal imaging used in the characterisation of non-ischaemic NICM substrates, procedural planning and image integration for the optimisation of VT ablation.
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Affiliation(s)
- Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Saman Nazarian
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
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8
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Walsh JL, AlJaroudi WA, Lamaa N, Abou Hassan OK, Jalkh K, Elhajj IH, Sakr G, Isma'eel H. A speckle-tracking strain-based artificial neural network model to differentiate cardiomyopathy type. SCAND CARDIOVASC J 2019; 54:92-99. [PMID: 31623474 DOI: 10.1080/14017431.2019.1678764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/25/2022]
Abstract
Objectives. In heart failure, invasive angiography is often employed to differentiate ischaemic from non-ischaemic cardiomyopathy. We aim to examine the predictive value of echocardiographic strain features alone and in combination with other features to differentiate ischaemic from non-ischaemic cardiomyopathy, using artificial neural network (ANN) and logistic regression modelling. Design. We retrospectively identified 204 consecutive patients with an ejection fraction <50% and a diagnostic angiogram. Patients were categorized as either ischaemic (n = 146) or non-ischaemic cardiomyopathy (n = 58). For each patient, left ventricular strain parameters were obtained. Additionally, regional wall motion abnormality, 13 electrocardiographic (ECG) features and six demographic features were retrieved for analysis. The entire cohort was randomly divided into a derivation and a validation cohort. Using the parameters retrieved, logistic regression and ANN models were developed in the derivation cohort to differentiate ischaemic from non-ischaemic cardiomyopathy, the models were then tested in the validation cohort. Results. A final strain-based ANN model, full feature ANN model and full feature logistic regression model were developed and validated, F1 scores were 0.82, 0.79 and 0.63, respectively. Conclusions. Both ANN models were more accurate at predicting cardiomyopathy type than the logistic regression model. The strain-based ANN model should be validated in other cohorts. This model or similar models could be used to aid the diagnosis of underlying heart failure aetiology in the form of the online calculator (https://cimti.usj.edu.lb/strain/index.html) or built into echocardiogram software.
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Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Nader Lamaa
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama K Abou Hassan
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalil Jalkh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad H Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - George Sakr
- Computer Engineering Department, St Joseph University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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9
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Shanbhag SM, Greve AM, Aspelund T, Schelbert EB, Cao JJ, Danielsen R, þorgeirsson G, Sigurðsson S, Eiríksdóttir G, Harris TB, Launer LJ, Guðnason V, Arai AE. Prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in older adults. Eur Heart J 2019; 40:529-538. [PMID: 30445559 PMCID: PMC6657269 DOI: 10.1093/eurheartj/ehy713] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 07/06/2016] [Revised: 10/25/2017] [Accepted: 10/11/2018] [Indexed: 12/23/2022] Open
Abstract
Aims Non-ischaemic cardiomyopathies (NICM) can cause heart failure and death. Cardiac magnetic resonance (CMR) detects myocardial scar/fibrosis associated with myocardial infarction (MI) and NICM with late gadolinium enhancement (LGE). The aim of this study was to determine the prevalence and prognosis of ischaemic and non-ischaemic myocardial fibrosis in a community-based sample of older adults. Methods and results The ICELAND-MI cohort, a substudy of the Age, Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) study, provided a well-characterized population of 900 subjects after excluding subjects with pre-existing heart failure. Late gadolinium enhancement CMR divided subjects into four groups: MI (n = 211), major (n = 54) non-ischaemic fibrosis (well-established, classic patterns, associated with myocarditis, infiltrative cardiomyopathies, or pathological hypertrophy), minor (n = 238) non-ischaemic fibrosis (remaining localized patterns not meeting major criteria), and a no LGE (n = 397) reference group. The primary outcome was time to death or first heart failure hospitalization. During a median follow-up of 5.8 years, 192 composite events occurred (115 deaths and 77 hospitalizations for incident heart failure). After inverse probability weighting, major non-ischaemic fibrosis [hazard ratio (HR) 3.2, P < 0.001] remained independently associated with the primary endpoint, while MI (HR 1.4, P = 0.10) and minor non-ischaemic LGE (HR 1.2, P = 0.39) did not. Major non-ischaemic fibrosis was associated with a poorer outcome than MI (HR = 2.3, P = 0.001) in the adjusted analysis. Conclusion Major non-ischaemic patterns of myocardial fibrosis portended worse prognosis than no fibrosis/scar in an older community-based cohort. Traditional risk factors largely accounted for the effect of MI and minor non-ischaemic LGE.
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Affiliation(s)
- Sujata M Shanbhag
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
| | - Anders M Greve
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
- Department of Clinical Biochemistry, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark
| | - Thor Aspelund
- Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
- University of Iceland, Sæmundargata 2, Reykjavik, Iceland
| | - Erik B Schelbert
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
- University of Pittsburgh Medical Center, Heart and Vascular Institute, 200 Lothrop St., Ste. A349, Pittsburgh, PA, USA
| | - J Jane Cao
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
- St. Francis Hospital, The heart Center, State University of New York at Stony Brook, 100 Port Washington Blvd, Roslyn, NY, USA
| | | | | | | | - Guðný Eiríksdóttir
- Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
| | - Tamara B Harris
- Laboratory of Epidemiology & Population Science, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, GWY Bldg Rm 2N300, 7201 Wisconsin Ave, Bethesda, MD, USA
| | - Lenore J Launer
- Laboratory of Epidemiology & Population Science, National Institute on Aging, National Institutes of Health, Department of Health and Human Services, GWY Bldg Rm 2N300, 7201 Wisconsin Ave, Bethesda, MD, USA
| | - Vilmundur Guðnason
- Hjartavernd (Icelandic Heart Association), Holtasmari 1, Kopavogur, Iceland
- University of Iceland, Sæmundargata 2, Reykjavik, Iceland
| | - Andrew E Arai
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, MSC 1061, 10 Center Dr., Bethesda, MD, USA
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Abstract
Arrhythmogenic inflammatory cardiomyopathy is a recent clinical description of a subgroup of patients with non-ischaemic cardiomyopathy who are referred to electrophysiologists for evaluation and management of ventricular arrhythmias and are found to have evidence of active cardiac inflammation. The identification of these patients is key, since the aetiology of their arrhythmic burden is likely both related to scar-mediated and direct inflammatory mechanisms, which may have different treatment approaches. Evaluation of these patients starts with a full clinical history and physical examination along with echocardiography, as with most patients with cardiomyopathy, however, additional imaging with fluorodeoxyglucose PET-CT and cardiac MRI is crucial. Medical treatment is aimed at targeting traditional neurohumeral mediators to achieve recovery of ejection fraction, in addition to immunosuppressant medication to directly treat inflammation. While medical treatment alone is successful in many patients, some will require further invasive management with electrophysiologic study and radiofrequency catheter ablation.
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Affiliation(s)
- Brenton S Bauer
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA Los Angeles, USA
| | - Anthony Li
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA Los Angeles, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA Los Angeles, USA
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11
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Katritsis DG, Auricchio A. Do We Need an Implantable Cardioverter-defibrillator for Primary Prevention in Cardiac Resynchronisation Therapy Patients? Arrhythm Electrophysiol Rev 2018; 7:157-158. [PMID: 30416727 DOI: 10.15420/aer.2018.7.3.eo1] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
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